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NSG552 / NSG 552 LATEST EXAM 2
PSYCHOPHARMACOLOGY GRADE A
QUESTIONS AND DETAILED
SOLUTIONS
Question-buprenorphine - answer-Taking this medication too soon after last opioid use increases the chances of intense withdrawal that comes on very quickly (precipitated withdrawal). Question-opioid intoxication - answer-Symptoms include nausea and vomiting, respiratory depression, constipation, itching, mioisis (small pupil). Patient will experience euphoria and sedation. Question-opioid withdrawal - answer-Symptoms include N/V/D and dehydration, irritability, restlessness, yawning, and twitching, increased HR/BP, chills, increased temperature, rhinorrhea, lacrimation, dilated pupils. Question-naloxone - answer-Treatment for opioid intoxication during which cardiac or respiratory depression is a concern. Question-cocaine intoxication - answer-Symptoms include dilated pupils, HA, tremor, hyper- reflexia, twitching, seizures, or coma, increased HR/BP, arrhythmias, and MI, N/V, incontinence/ARF, or rhabdomyolysis Question-cocaine intoxication - answer-Treatment includes BZD, antipsychotics, and management of medical problems including HTN, stroke, cardiac arrhythmias, hyperthermia, and seizures. Question-cocaine - answer-The use of beta blockers for treatment of chest pain and MI during this intoxication is to be avoided due to unopposed a adrenergic stimulation. Naloxone - answer-MOA: Pure opioid antagonist that competes and displaces opioids at opioid receptor sites.
Question-methadone, buprenorphine, buprenorphine+naloxone - answer-Treatments for opioid use disorder. Question-buprenorphine+naloxone - answer-Treatment for opioid use disorder with comorbid pain. Question-opioids - answer-Inappropriate use of what substance may be due to uncontrolled pain? Question-tablet, injectable, implant - answer-Naltrexone delivery methods. Question-implant - answer-Form of naltrexone limited to inpatient use. Question-buprenorphine - answer-Mu receptor partial agonist for opioid withdrawal. Question-alcohol intoxication - answer-Signs vary with blood levels, from decreased reaction time, muscle incoordination, ataxia, dysarthria, to respiratory failure and coma. Question-severe alcohol intoxication - answer-Treatment includes cardiopulmonary function maintenance, thiamine, and haloperidol PRN agitation. Question-thiamine - answer-Given IM/IV for 3 days to prevent Wernicke's encephalopathy, along with IV fluids and a banana bag. Question-benzodiazepines - answer-Class of drugs to avoid for acute alcohol intoxication. Question-uncomplicated alcohol withdrawal - answer-Treatment includes BZD in either symptom triggered or fixed dose; diazepam and chlordiazepoxide have a longer half life, and oxazepam and lorazepam are suitable for patients with hepatic dysfunction. Question-diazepam and chlordiazepoxide - answer-bzds with a long half-life used to treat AUD.
Question-atypical antipsychotics - answer-Treatment for agitation in patients with dementia. Question-BZD - answer-Used only for short term and acute episodes of aggression, agitation, and psychosis in patients with dementia. Question-delirium - answer-tcas, Anticholinergics, Benzos, Non-benzos, Corticosteroids, H blockers, opioids cause what medical emergency in elderly patients? Question-hypersexuality, hyperorality - answer-Klüver-Bucy syndrome, a type of frontotemporal degeneration (FTD), results from bilateral lesions of the medial temporal lobe and manifests with what 2 common symptoms? Question-Donepezil, rivastigmine, galantamine - answer-Cholinesterase inhibitors appropriate for mild to moderate dementia, remember Damn, Grandma's Regressing Question-memantine - answer-NMDA receptor antagonist that promotes synaptic plasticity and is used for moderate to severe dementia. Question-nortiptyline - answer-TCA with fewest anticholinergic effects, making it the most appropriate TCA in the elderly ssris ARE PREFERRED Question-mirtazapine - answer-Most appropriate medication for elderly patient with MDD, insomnia, and decreased appetite. Question-methylphenidate - answer-In cases of severe depression or psychomotor retardation, this may be used in low doses as an adjunct to antidepressants. Question-trazodone - answer-Best alternative to sedative-hypnotic use for insomnia in the elderly as it's less likely to cause memory impairment, paradoxical excitement, or rebound insomnia.
Question-delirium - answer-A reversible condition that may be caused by drugs, electrolyte imbalance, low O2 sat, infection, reduced sensory input, intracranial events, urinary retention, or myocardial issues. Question-methylphenidate, amphetamine salts, dexmethylphenidate, dextroamphetamine - answer-The 4 stimulants for treating ADHD. Man, Adhd Does Damage know long vs short acting Question-tcas, clonidine, guanfacine, bupropion, atomoxetine - answer-The 5 non-stimulants for treating ADHD. Calm Teens Give Better Answers Question-height, weight, BP, HR, EKG - answer-What baseline measurements are needed prior to starting treatment for ADHD? Question-atomoxetine - answer-Second line treatment, non-stimulant, used in patients with history of SUD or when family prefers non-stimulant. Question-intermediate or long acting - answer-Types of stimulants used when patient needs duration of action longer than 4 hours; also improves adherence and is less likely to be abused. Question-dizziness, poor growth, decreased appetite, insomnia, mood lability - answer-Common adverse effects of stimulants Dizzy Patients Demand Immediate Monitoring Question-dizziness - answer-Children exhibiting this symptom require BP and HR monitoring. If it occurs at peak, patient should be switched to a longer acting formula. Question-insomnia - answer-Patients exhibiting this stimulant associated symptom should be switched to a shorter acting formula. Question-cardiovascular - answer-Prior to starting a stimulant, patient history, family history, and exam should be conducted with what focus?
Question-dose reduction - answer-May be used to reduce sexual side effects caused by psychotropic medications when cost is an issue. Question-hypogonadism - answer-A cause of hypoactive desire in males that indicates a life-long rather than acquired condition. Question-antisocial - answer-Cluster B personality disorder that begins as a conduct disorder in childhood. Question-DBT - answer-Gold-standard treatment for borderline. Question-BZD - answer-Class of medications strongly discouraged in treating BPD, due to risks of worsening impulsivity and suicidality. Question-pharmacological - answer-Treatment modality recommended against when treating the primary traits of antisocial personality disorder. Question-hormone replacement therapy - answer-Treatment for male hypoactive sexual desire disorder and female sexual interest/arousal disorder. Question-guanfacine - answer-Alpha 2 agonist, first line for tic disorder. Question-desmopressin, imipramine - answer-First line treatment options for enuresis. Question-behavioral therapy - answer-Modality for the management of IDD deficits. Question-methylphenidate - answer-Stimulant medication FDA approved for children 6+ that should not be used in patients with PRE-EXISTING CARDIAC CONDITIONS. Question-dextromethylphenidate - answer-FDA stimulant approved for children 3+.
Question-guanfacine - answer-Non-stimulant approved for children 6-17. Low potency antipsychotic medications - answer-Low potency means low affinity to dopamine receptors, meaning increased doses are required. Question-High potency antipsychotic medications - answer-High potency is a greater affinity of dopamine receptors, meaning decreased doses are required. Question-First generation antipsychotics examples - answer-Chlorpromazine (thorazine), Thioridazine (mellaril), Loxapine (loxitane), Thiothixene (Navane), Perphenazine (Trilaforn), Haldol, Fluphenazine, Trifluoperazine. Question-Prolonged QTC - answer-Obtain baseline EKG. Question-Orthostasis - answer-Due to the blockade of α1 receptors. Question-Elevated liver enzymes - answer-A side effect of first generation antipsychotics. Question-EPS - answer-Extrapyramidal Symptoms (akathisia, dystonia, parkinsonism). Question-Gynecomastia - answer-Enlargement of breasts in males, a side effect in men. Question-Tardive Dyskinesia - answer-A mostly irreversible involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors. Question-Risk factors for Tardive Dyskinesia - answer-High doses, long duration, old age, women, hx of EPS, substance abuse (heavy smoking), diabetes.
Question-Absence of menses in women - answer-A side effect of first generation antipsychotics. Question-Erectile dysfunction in men - answer-A side effect of first generation antipsychotics. Question-Dystonia - answer-A type of EPS associated with antipsychotic medications. Question-Tardive Dyskinesia (TD) - answer-TD symptoms may initially worsen transiently as medication dosages are lowered. Question-Clozapine (Clozaril) - answer-Considered for switching as it has the lowest risk of tardive dyskinesia. Question-Akathisia - answer-A movement disorder characterized by an intense feeling of inner restlessness and the inability to stay still. Question-Treatment for Akathisia - answer-Beta-blocker (propranolol). Question-Pseudo-Parkinsonism - answer-Refers to a group of symptoms resembling those seen in Parkinson's disease but induced by medications, particularly antipsychotic drugs. Question-Symptoms of Pseudo-Parkinsonism - answer-May include tremors, muscle stiffness or rigidity, bradykinesia (slowness of movement), and postural instability. Question-Treatment for Pseudo-Parkinsonism - answer-Benztropine (Cogentin). Question-Neuroleptic Malignant Syndrome (NMS) - answer-A life-threatening idiopathic reaction to antipsychotic medications, more common with fgas, with a 20% mortality rate if untreated. Question-Symptoms of NMS - answer-Fever, autonomic instability (BP, HR), leukocytosis, tremor, elevated CK, rigidity, excessive sweating.
Question-Management of NMS - answer-Includes D/C medication, supportive care (hydration, IV benzos for relaxation, cooling blankets), and administering sodium dantrolene, bromocriptine, amantadine. Question-Co-prescribing drugs to prevent EPS - answer-Do NOT co-prescribe drugs in efforts to prevent EPS due to high anticholinergic side effects. Question-Starting dose for elderly patients - answer-Start at lower doses to help prevent EPS. Question-Sensitivity of elderly patients - answer-Elderly patients are often more sensitive to the side effects of antipsychotic medications, including EPS and anticholinergic effects. Question-Second-Generation Antipsychotics (sgas) - answer-Examples include clozapine, olanzapine, quetiapine. Question-Indication for sgas - answer-First line of treatment for psychiatric disorders such as acute mania, bipolar disorder, and as adjunctive in unipolar depression. Question-Management of symptoms by sgas - answer-They manage positive and negative symptoms of schizophrenia. Question-Percentage of total antipsychotics prescribed - answer-Accounts for 80% of total antipsychotics prescribed. Question-MOA - answer-Blocks both dopamine and serotonin receptors Question-Metabolic syndrome in SGAS - answer-A cluster of conditions that increases the risk of heart disease, stroke and diabetes. Question-Conditions included in metabolic syndrome - answer-Obesity, elevated triglycerides, low HDL levels, BP greater than 135/
Question-Lurasidone metabolic syndrome risk - answer-Low risk for metabolic syndrome Question-Caution with Lurasidone - answer-Use with caution in patients with hepatic impairment Question-Clozapine (Clozaril) use - answer-Used to treat refractory schizophrenia Question-Clozapine and SI risk - answer-Only antipsychotic shown to decrease SI risk Question-Common side effect of Clozapine - answer-Hypersalivation (sialorrhea); occurs in 30- 80%. Question-Clozapine lab monitoring - answer-Monitor WBC and absolute neutrophil count (ANC) Question-Agranulocytosis monitoring for Clozapine - answer-Monitor for agranulocytosis (highest first 3 months of treatment) Question-Clozapine WBC/ANC monitoring frequency - answer-Perform WBC/ANC weekly for first 6 months of treatment and can decrease frequency thereafter Question-Pimavanserin (Nuplazid) use - answer-Used in Parkinson's related psychosis (it's a newer med) Question-Haldol and Prolixin allergic reactions - answer-Allergies in patients sensitive to sesame. Question-Increased risk in elderly with dementia - answer-Antipsychotics can cause an increased risk of death. Question-Allergies in patients sensitive to sesame - answer-Watch for allergic reactions.
Question-Increased risk of death in elderly with dementia related psychosis - answer- Antipsychotics can cause an increased risk of death. Question-Increased risk of falls and nonvertebral fractures - answer-Observed in patients over 65+ years. Question-Major depression disorder s/s (SIG - E - CAPS) - answer-Sleep changes, Interest (loss of), Guilt, Energy, Cognition/concentration, Appetite, Psychomotor, Suicide/death thoughts. Question-Factors that impact antidepressant selection - answer-Previous patient/family member response, impact on comorbidities, clinician familiarity, patient preference, safety in overdose, availability, cost, drug interactions. Question-Top distressing side effects of antidepressants - answer-Sexual dysfunctions, sleep disturbances, and weight gain. Question-Monoamine hypothesis - answer-Depression is associated with low levels of serotonin, dopamine, and norepinephrine in the brain. Question-Delayed onset of therapeutic response to antidepressants - answer-Can take up to 2- 6 weeks. Question-Neurogenic Theory of Depression - answer-Depression causes physical changes/damage to brain tissue, a neurodegenerative process. Question-Genetic vulnerability + stress - answer-Can lead to disorder. Question-Brain derived neurotrophic factor (BDNF) - answer-Can be increased via medication, therapy, or exercise to help repair neurons.
Question-Response rate of antidepressants - answer- 60 - 70% of patients with MDD will respond to antidepressant medications. Question-Trial duration for antidepressants - answer-Most antidepressants require a trial of at least 3-4 weeks for effect and in some cases 6-8 weeks for noticeable effects. Question-Maintenance therapy duration - answer- 6 - 13 months. Question-Withdrawal phenomenon of antidepressants - answer-Most antidepressants have a withdrawal phenomenon; educate patients not to stop abruptly, as this can cause dizziness, headaches, nausea, insomnia, anxiety, electric shocks like 'zaps', malaise, depending on dose and half-life. Question-Mechanism of action for ssris - answer-ssris inhibit presynaptic serotonin reuptake pumps, which increases the availability of 5HT in synaptic clefts. Question-Downstream effects of ssris - answer-Increases brain plasticity; it is the first line of antidepressants. Question-Initial effects of ssris - answer-It may initially worsen anxiety or panic attacks. Question-SSRI drugs - answer-Fluoxetine, fluvoxamine, paroxetine, escitalopram, citalopram, sertraline. Question-ssris black box warning - answer-Increased suicidality in children, adolescents, and young adults. Question-Fluoxetine/Prozac fun facts - answer-Longest half-life (2-3 days, no need to taper), safe in pregnancy, approved for use in children/adolescents, approved for bulimia, can be dosed once a week, can elevate levels of antipsychotics, can cause an activating effect in combination with olanzapine.
Question-Citalopram (Celexa) 20-40mg - answer-Associated with dose-dependent QTC prolongation in doses 40mg+; max dose in geriatrics = 20mg; fewer drug interactions; most lethal in overdose. Question-Sertraline (Zoloft) 50-200mg - answer-Has the most gastrointestinal side effects; give with food; very few drug interactions; activating (agitation, anxiety); favored during pregnancy and nursing. Question-Activating Antidepressants - answer-Good for patients who want to avoid medications that cause tiredness, such as Fluoxetine. Question-ssris advantage over other classes - answer-When choosing an SSRI, consider the inhibition of CYP-450 isoenzymes (induction vs. Inhibition). Question-Most lethal SSRI in overdose - answer-Consider cardiac effects. Question-snris - answer-Serotonin Norepinephrine Reuptake Inhibitors; inhibits dual reuptake of NE and 5HT, leading to increased extracellular concentrations of NE and 5HT. Question-Side Effects of snris - answer-Sustained elevated blood pressure. Question-snris - answer-Venlafaxine (Effexor) 75 - 375mg BID Question-snris - answer-MDD, GAD, neuropathic pain Question-snris - answer-Useful in treating anxiety and panic attacks in depressed patients Question-snris - answer-XR available Question-snris - answer-Highest med with SEXUAL DYSFUNCTION
Question-SRAA - answer-Sedating and promotes appetite (Used with patients who have weight loss and insomnia as primary symptoms of their depression) Question-Tricyclic Antidepressants (tcas) - answer-2nd line of treatment for depression Question-Tricyclic Antidepressants (tcas) - answer-Increases extracellular concentrations of 5HT and NE by inhibiting pre-synaptic reuptake Question-Tricyclic Antidepressants (tcas) - answer-Side effects: anticholinergic effects (dry mouth, blurred vision, constipation, memory problems, urinary retention, narrow angle glaucoma) Question-Tricyclic Antidepressants (tcas) - answer-Lethal in overdose (give 1-week prescription especially in high-risk patients); desipramine is the most lethal Question-Tricyclic Antidepressants (tcas) - answer-Note the 3 c's: Cardiotoxic (arrhythmia), convulsions, coma (caution with cardiac patients) Question-Tertiary Amines tcas - answer-Imipramine (Tofranil) Question-Tertiary Amines tcas - answer-Used for enuresis (incontinence) and panic disorder Question-Tertiary Amines tcas - answer-Clomipramine (Anafranil) Question-Tertiary Amines tcas - answer-Approved for the treatment of OCD Question-Important information for tertiary amine tcas - answer-These are highly anticholinergic/antihistaminergic, antiadrenergic and with greater lethality in overdose Question-Secondary Amines - answer-Nortriptyline, desipramine, amoxapine
Question-Secondary Amines - answer-Less anticholinergic/antihistaminic/antiadrenergic Question-Nortriptyline (Pamelor) - answer-Useful to obtain therapeutic level. Can be safely used in geriatric population Question-Secondary Amines TCAS - answer-Useful in treating chronic pain, useful to obtain therapeutic level, can be safely used in geriatric population. Question-Important information for Secondary Amines TCAS - answer-Less anticholinergic / antihistaminic / antiadrenergic. Question-maois - answer-Monoamine oxidase inhibitors. Question-MAO-A inhibitors - answer-Helpful in treating major depression. Question-MAO-B inhibitors - answer-Used to treat Parkinson's and Alzheimer's. Question-Dietary restrictions for selegiline - answer-NO! Question-MAOI hypertensive crisis - answer-This can occur when an MAOI is taken with tyramine rich foods (red wine, aged cheese, chicken liver, fava beans, cured meats). Question-Symptoms of MAOI hypertensive crisis - answer-Sudden explosive headaches, high BP, facial flushing, palpitation, diaphoresis, fever, n/v, photophobia, autonomic instability, chest pain, arrhythmia and death. Question-Avoid with maois - answer-tcas, atypical antipsychotics, St John's wort, asthma meds, ssris, decongestants, opiates (fentanyl, tramadol, meperidine).
