Nursing question from prior exam
Week 3 Quiz
#1 is C.
- Volume neurotransmission refers to?
The diffusion of neurotransmitter to nearby neurons.
- Retrograde neurotransmissions refers to?
The flow of neurotransmitter from postsynaptic neuron to presynaptic neuron
- Use the following CYP450 table to hypothesize drug interactions and their clinical significance for a patient on clozapine who carbamazepine, a mood stabilizer?
Clozapine levels would decrease, placing the patient at risk for re-emergence of psychotic symptoms.
- In ligand-gated ion channels, an?
Antagonist, in the presence of an agonist, can return a channel to resting state.
- Which of the following statements about drug absorption is trued?
Concurrent use of some medications can slow absorption.
- A neurotransmitter binds to a receptor, causing electrical impulses to travel the neuron’s axon; it eventually releases the neurotransmitter and repeats the process with a postsynaptic neuron. Which type of neurotransmission does this describe?
Classic synaptic neurotransmission
- Which of the following statements is true about drug distribution?
Protein binding of psychotropic drugs can impact their availability at receptor sites.
- Which of the following statements is true about neuronal gene expression?
Environmental factors can alter a neuron’s gene expression.
- First pass effect refers to the?
Metabolism of the drug in the liver, prior to reaching systemic circulation
- Matching the following.
Pharmacodynamics- Action of drugs on the body
Pharmacokinetics- Action of the body on the drugs
Axon- The fiber-like part of the neuron that sends information to receiving neurons
Ionic filter- Regulates the flow of ions in ligand-gated channels
Excitation-secretion coupling- The conversion of an electrical signal to a chemical signal
Dendrite- The point of contact for receiving information from neurons in the classical neurotransmission
- Use the following CYP450 table to hypothesize drug interactions and their clinical significance for a patient on haloperidol, a conventional antipsychotic, who is prescribed paroxetine, an antidepressant?
Haloperidol levels would increase, placing the patient at risk for antipsychotic side effects.
- Elimination of a drug can be impacted by all of the following scenarios except?
A Mediterranean diet.
- Which of the following statements is true about ligand-gated ion channels?
Allosteric modulators can enhance or inhibit ion channels when in the presence of neurotransmitter.
- Pharmacokinetics involves consideration all of the following except the?
Receptor binding site of the drug
- The direct role of transcription factors is to?
Influence gene expression
- Second messengers are?
Intracellular messengers activated by extracellular messengers.
- Which of the following statements about pharmacokinetics is true?
Accumulation of psychotropic drugs occurs faster in the brain then adipose tissue.
- G-linked proteins?
Bind enzymes that synthesize second messengers.
- Carbamazepine has a half-life of approximately 12 hours. The clinical implications of this are?
Therapeutic blood monitoring of carbamazepine should not occur before 2 ½ days of starting the medication.
- When an inverse agonist binds to a G-protein linked receptor, signal transduction is?
- When an antagonist binds to a G-protein-linked receptor, signal transduction is?
- Which of the following statements is true about concentration-time curve of medication absorption?
Steady-state refers to the point at which blood level fluctuations are mild and not clinically significant.
- When an agonist binds to a G-protein-linked receptor, signal transduction is?
- The two main targets of signal transduction cascades are?
Gene expression and phosphoproteins.
- Which of the following methods of drug delivery is slowest to reach the bloodstreams?
- When a partial agonist binds to a G-protein-linked receptor, signal transduction is?
- When comparing phase I and phase II metabolism which of the following statements is true?
Phase I metabolism refers to CYP450 enzyme activity whereas Phase II metabolism refers to conjugation of drug.
- Enzyme inhibition as a target of drug therapies is?
A means of preventing the degradation of neurotransmitters.
Week 4 Quiz
- When prescribing atypical antipsychotic medications, it is important to consider which of the following?
Atypical antipsychotics are not approved for the treatment of geriatric dementia-related psychosis and carry increased risk of mortality in this population.
- Atypical antipsychotics, also known as second-generation antipsychotics, are related to as atypical because?
They have the clinical profile of equal positive symptom antipsychotic actions but low extrapyramidal symptoms and less hyperprolactinemia compared to conventional antipsychotics.
- Which of the following statement is true regarding cognitive symptoms of psychosis?
Cognitive symptoms are the strongest correlate of real-world functioning in schizophrenia.
- Match the following?
Muscarinic anticholinergic receptor blockade- Constipation, blurred vision, dry mouth, and drowsiness.
Histamine H1 receptor blockade- Weight gain and drowsiness
Alpha-1 adrenergic receptor blockade- Orthostatic hypotension and drowsiness.
- Which of the following statement is true about conventional antipsychotics?
Conventional antipsychotics are thought to block dopamine at the D2 receptor equally in dopamine neural circuits.
- Which of the following statement is true about tardive dyskinesia?
Elderly patients may develop tardive dyskinesia sooner in treatment than younger patients.
- When considering metabolic risk associated with atypical antipsychotics which of the following statements is true?
Patients taking atypical antipsychotics are at increased risk for diabetes and cardiovascular disease.
- Which of the following statements best describes the nigrostriatal dopamine pathway?
Chronic blockade of D2 receptors in the nigrostriatal dopamine pathway may result in tardive dyskinesia.
- Which of the following statements is true about dopamine?
Tyrosine is a precursor to dopamine.
- Which of the following statement is true when switching antipsychotics?
For antipsychotics with high anticholinergic, antihistaminergic and anti-alpha 1 adrenergic side effects, it is best to taper slowly to minimize withdrawal effects.
- Which of the following statement is true about the development of schizophrenia is true?
Stress from the environment can cause abnormal expression or abnormal silencing of normal genes which are associated with schizophrenia.
- Failure to give with about a 500 calorie meal can result in lowering oral absorption by half and inconsistent efficacy for which medication?
- Which of the following statement about long-acting injectable (LAI) antipsychotics is true?
Patients with a history of neuroleptic malignant syndrome should not be initiated on LAI antipsychotics.
- Which of the following statements about metabolic syndrome is true?
Diet and lifestyle education should be included as a strategy for reducing risk of metabolic syndrome.
- Which of the following statements best describes the mesolimbic dopamine pathway?
Hyperactivity of the mesolimbic dopamine pathway may account for positive symptoms of schizophrenia.
- Which of the following is true when you consider EPS and Tardive dyskinesia as antipsychotic side effect?
EPS and Tardive dyskinesia are the result of dopamine blockade in the nigrostriatal pathway.
- Which antipsychotic carries a risk of QTc prolongation?
- Which of the following antipsychotics is least likely to cause significant weight gain?
- Which of the following statements best describes the mesocortical dopamine pathway?
Hypoactivity of the mesocortical dopamine pathway is thought to be associated with negative and cognitive symptoms of schizophrenia.
- Which of the following statements best describes the tuberoinfundibular dopamine pathway?
Inhibition of dopaminergic neurons in the nigrostriatal dopamine pathway leads to increased prolactin levels.
- Which atypical antipsychotic carries the highest risk of EPS?
- Which of the following antipsychotics is least likely to cause sedation?
- A 28 year old man has been diagnosed with schizophrenia at age 19. He has a body mass index of 30, fasting triglycerides of 220 mg/dL, and fasting glucose of 114 mg/dL. Which of the following is most likely to worsen his metabolic profile?
- A patient on aripiprazole complains that they cannot sit still. They fidget throughout their appointment and state that they feel like they are crawling out of their skin. Assessment is consistent with akathisia.
These symptoms would best respond to a beta blocker.
- Which of the following statement is true about adverse antipsychotic side effects?
Neuroleptic malignant syndrome could be mistaken for another side effect early in its progression.
FYI: Ingrezza (valbenazine) is now approved or the treatment of tardive dyskinesia (TD),
FYI: Dentrolene is for (NMS) Neuroleptic malignant Syndrome – s/s confusion/agitation/high temp/seizures, for patients who are placed on a 1st or generation aka typical antipsychotic.
FYI: For acute dysyonia use Benadryl / Akathisia use BB propanolol
Week 6 Quiz
- Which of the following statements is true about tyramine and MAO inhibitors?
Tyramine is metabolized by monoamine oxidase.
- Which of the following neurotransmitters is not considered significant in mood disorders?
- Match the following?
Escitalopram- Is considered to have fewest side effects and drug-drug interactions
Fluvoxamine- Is not FDA approved for depression in the US
Sertraline- Has dopamine transported inhibition
Paroxetine- Has the largest side effect profile and most drug-drug interactions of SSRIs
Fluoxetine- Is considered activating
Citalopram- Carries warnings about QTc prolongation in higher doses
- Which antidepressant is least likely to cause sexual side effects?
- Which of the following statements is true about venlafaxine?
Venlafaxine can cause hypertension at higher doses.
- Which of the following is true about repetitive transcranial Magnetic stimulation (rTMS)?
Standard rTMS treatments occur once a weekday for six weeks.
- Which of the following foods would be considered safe when consumed concurrently with a monoamine oxidase inhibitor?
A bowl of ice cream.
- When a patient achieves remission of depression, what is the recommended length of time that treatment should continue?
The recommended length of treatment depends on the number of depressive episodes that a patient has had.
- Which of the following statements is true about trazodone?
Trazodone is an effective hypnotic at low doses.
- The monoamine transporters SERT (serotonin), NET (norepinephrine) and DAT (dopamine) are key targets for most of the known?
- Which of the following is hypothesized to be true abut neural circuits in depression?
Neural circuits are hypothesized to account for variability in depression presentation.
- Match the following?
Monoamine oxidase inhibitors- Can cause hypertensive crisis when combined with other antidepressants or foods containing tyramine, phenylalanine, tryptophan or tyrosine.
Tricyclic antidepressants (TCA’s)- Have overdose toxicity with as little as a 10 day supply.
Selective serotonin reuptake inhibitors- Are considered safe in overdose.
- Which of the following describes treatment resistance?
A patient has two adequate trials of antidepressants and fails to respond to treatment.
- Which of the following statements about bupropion is true?
Bupropion may have a mild benefit in ADHD.
- Which of the following is true about electroconvulsive therapy (ECT)?
ECT has a rapid onset of action for depression.
- Which of the following statements is true about suicide and antidepressant use?
Antidepressant use lowers the incidence of suicide in parents over 65.
- Which of the following statements about the STAR*D study is true?
STAR*D findings suggest the antidepressant non-responders should be switched to a different medication, whereas partial responders should be augmented.
- Which of the following is true about antidepressant treatment?
Patients that achieve remission are less likely to relapse.
- Which of the following is true about hyponatremia and antidepressants?
Symptoms of hyponatremia include lethargy, delirium, an nausea.
- Which of the following is true about tricyclic antidepressants?
They have histaminergic side effects of weight gain and sedation.
- Which of the following statements is trued about duloxetine?
Duloxetine carries risks for liver toxicity and should be avoided in patients with liver disease.
- Which of the following agents is considered to have the best evidence as an augmentation agent in the treatment of depression?
- Of suggested antidotes for sexual side effects which is considered most effective?
- When treating a depressed patient who is treatment resistant, which of the following factors are important to consider?
Misdiagnosis should be considered as a factor in non- or partial responders.
- Dry mouth from antidepressants?
Can lead to increased risk of dental caries.
- Which of the following is true about antidepressants and bleeding?
Concurrent use of antidepressants and NSAID’s can increase risk of bleeding.
- Which of the following side effects may improve with adjustments to dose timing or formulation change?
- Which of the following best describes the mechanism of action of selective serotonin reuptake inhibitors?
SSRIs cause the indirect downregulation of 5HT1A autoreceptors, increasing neuronal impulse flow.
- Which of the following statements is true about antidepressant side effects?
Discussing possible side effects before starting medication is associated with parents staying on medications longer.
- Which of the following is true when comparing desvenlafaxine to venlafaxine.
Desvenlafaxine likely no more efficacious venlafaxine.
- Independent of antidepressant use, depression is thought to cause which symptom of sexual dysfunction?
- Which of the following statements about psychotherapy in the treatment of depression is true?
Psychotherapy can work synergistically with psychotropic medication.
- Which of the following statements about stress and depression is true?
BDNF is dysregulated in stress.
- Which of the following antidepressant side effects may resolve with time?
- Which of the following statements about antidepressant augmentation with atypical antipsychotics is true?
Risks of atypical antipsychotics (metabolic issues, EPS) should be considered before prescribing as an augmentation strategy.
- Which of the following statements most accurately describes the monoamine receptor hypothesis of depression?
The monoamine receptor hypothesis posits that dysregulation of monoamine receptors alters molecular events such as gene expression.
- When comparing serotonin syndrome to hypertensive crisis, which of the follow statements is true?
While both syndromes have muscular symptoms, only serotonin syndrome has hyperreflexia and myoclonus.
- Which of the following statements is true about mirtazapine?
Mirtazapine has side effects of weight gain and sedation.
Week 8 Quiz
- All of the following are important aspects of sleep hygiene except:
- Avoid caffeine, nicotine, and large meals prior to bedtime.
- Limit exposure to blue light 90 minutes prior to bedtime
- Set a regular rising time.
- If unable to fall asleep stay in bed.
- Buspirone is indicated for which anxiety disorder?
Generalized anxiety disorder.
- When considering the use of benzodiazepine in the treatment of bipolar disorder, which of the following statements is true?
- Benzodiazepines are not considered an effective monotherapy for bipolar disorder
- Benzodiazepines are effective monotherapy for the stabilization phase of bipolar disorder
- Benzodiazepines are not appropriate for use in bipolar disorder
- Benzodiazepines are effective adjunctive treatment for bipolar depression
- Match the following mood stabilizer to the recommended lab monitoring.
Carbamazepine- CBC, LFT,
Valproic acid- LFT, CBC with platelet
Quetiapine- Glucose, lipid profile, BMI, blood pressure
Lithium- BUN/Cr, TSH/T4, electrolytes.
- Which of the following statements about insomnia true?
untreated insomnia often precedes depressive episodes
- An important noradrenergic pathway in the brain which may be overactive in anxious subjects originates in the: Correct answer:
- Which of the follow statements is true about Topamax in the treatment of bipolar disorder?
Topamax carries the problematic side effect of cognitive dulling.
- Which of the following statements about z-drugs is true?
Z-drugs can be taken mid-sleep cycle for mid sleep waking and early morning awakening.
- Which of the following statements about benzodiazepines and GABA receptors is true?
Benzodiazepine binding to GABA receptors increases the frequency of opening of inhibitory chloride channels.
- When considering a bipolar agent for an individual with liver disease, which medication would be most favorable?
Correct answer: Lithium carbonate
- Which of the following statements about BuSpar, is a selective serotonin 1A partial agonist, is true?
Correct answer: it has twice daily dosing, therefore may be difficult for patients forgetful with medications.
- Which of the following statements about lamotrigine is true?
Correct answer: Lamotrigine carries a black box warning for potentially life threatening rash.
- Which of the following statements about atypical antipsychotics in the treatment of bipolar is true?
Correct answer: Atypical antipsychotics are hypothesized to tune dysfunctional dopamine and serotonergic circuits in bipolar disorder.
- Which brain structure plays a central role in the anxiety experience and has many reciprocal connections throughout the brain?
- Which of the following statements about benzodiazepines in the treatment of bipolar is true?
Correct answer: Adjunctive use of benzodiazepines with mood stabilizers is useful for agitation and insomnia.
- Which of the following statements about anxiety disorders and depressive bipolar disorders is true?
Correct answer: Overlapping symptoms of depression and anxiety suggest that both disorders can be targeted with the same first-line agents.
- Which of the following statements about lithium carbonate is true?
Kidney impairment after long term lithium treatment is a common adverse side effect.
- When considering length of action of benzodiazepines, Which of the following statements is true?
Both short-acting and long-acting benzodiazepines have been associated with increased risk for the development of dementia.
- Which of the following anti-anxiety medications is used to treat re-experiencing nightmares in PTSD?
- Which of the following medications is considered second line-treatment for bipolar disorder?
- Based on your carlat psychiatry report reading, what is a good recommendation for patients experiencing poor sleep quality?
- Which of the following is a potentially serious side effect of oxcarbazepine?
- Which of the following statements is true about the use of clonidine and propranolol in the statement of anxiety?
Clonidine and propranolol target the physiologic symptoms associated with anxiety.
- Which of the following statements about treating bipolar depression with antidepressants is true?
In some instances antidepressant use may lead to rapid cycling.
- Which of the following statements about benzodiazepines is true?
Seizure risk is high with abrupt cessation from long term benzodiazepine use.
- When choosing a PRN/As needed medication for a patient with alcohol dependence and an anxiety disorder, which of the following medications would be most appropriate choice?
- Which medication is not considered appropriate for the treatment of acute bipolar mania?
- Which of the following statements about memory and fear is true?
New learning can modulate a conditioned fear response.
- Which of the following Is not considered efficacious in bipolar depression?
- Which medication might be a good choice for a shift worker with excessive daytime sleepiness?
- Which of the following medications would be considered first line treatment for generalized anxiety disorder?
- Which neurotransmitter is believed to be responsible for the mechanism of action for ramelteon?
- Which of the following is not considered standard of care when prescribing hypnotics to treat insomnia?
Dose nightly on an ongoing basis.
- When tapering someone from long-term benzodiazepine use, which of the following is true?
It is best begin a benzodiazepine taper with a long-acting benzodiazepine for increased tolerance to the taper.
- Which of the following statements about anticonvulsants in the treatment of bipolar disorder is true?
Most anticonvulsants are believed to work through inhibitory effects on voltage sensitive ion channels.
- Which statement about bipolar treatment options is true?
Antidepressant use may increase cycling, including precipitating mania.
- Which of the following statements about fear and the amygdala is true?
Memory recall can result in fear response via communication between the amygdala and the hippocampus.
Week Quiz 10
- When prescribing guanfacine, the clinician should consider which of the following?
Rebound hypertension can occur when abruptly stopping guanfacine.
- Which of the following medications is a selective norepinephrine inhibitor approved for treating ADHD in children and adults?
- Which neurotransmitters are implicated in the development of ADHD?
Dopamine and norepinephrine.
- Which of the following is NOT a red flag for prescription drug misuse?
A patient requests to decrease the dose of his controlled substance.
- Which of the following statements about methylphenidate and mixed amphetamine salts is true?
Amphetamine salts appear to have a greater abuse potential than methylphenidate.
- Which of the following statements about opioid withdrawal is true?
Buprenorphine should not be administered until a patient is in moderate opioid withdrawal.
- Which of the following is trued about medications for nicotine dependence?
Nicotine replacement is treatment of choice of nicotine withdrawal symptoms.
- Which of the following medications may worsen tics?
- When considering the neuroscience of addiction, which of the following statements is true?
Dopamine pathways are implicated in all substances of abuse.
- Which of the following statements about glutamate and NMDA receptors in alcohol addiction is true?
Chronic alcohol consumption results in an upregulation of NMDA receptors and increased excitability in acute abstinence.
- When treating ADHD symptoms in the presence of comorbid disorders, which of the following statements is true?
Order of treatment should be individualized for the patient.
- Problems with selective attention associated with ADHD are hypothetically regulated by the?
Anterior cingulate cortex.
- Which of the following statements about preventing and recognizing prescription drug misuse is true?
Patients with active substance use should not be prescribed controlled substances.
- Which of the following statements about impulsivity and compulsion is true?
Impulsivity and compulsion are modulate “top down” by the orbitoprefrontal cortex.
- Which of the following statements about stimulant dependence is true?
Agitation and psychosis may be present in early withdrawal states.
- Which of the following statements is true about behaviors in addiction?
Dopaminergic neurons begin responding to environmental reminders of use through conditioned responses.
- Which of the following statements is true about buprenorphine?
Buprenorphine is the preferred treatment for opioid maintenance therapy.
- Which of the following is NOT a potentially serious side effect of psychostimulants?
- Which of the following medications or className of medications facilitates safe detoxification from alcohol?
- Which of the following may be helpful for ADHD?
- Which of the following conditions is considered physiologically safe?
- Which of the following statements best describes the anti-award system in substance abuse?
Over time, substance use shifts from seeking the pleasurable effects of intoxication to avoiding of dysphoria associated with withdrawal states.
- Which of the following statements about substance dependence is true?
Persons with a history of substance dependence are vulnerable to craving or relapse following exposure to any psychoactive substance.
- Which of the following should be monitored in children prescribed psychostimulants?
- When considering tonic and phasic firing of dopamine and norepinephrine neurons and ADHD, which of the following statements is true?
Stress activates excessive phasic norepinephrine and dopamine firing, possible leading to the development of impulsivity and inattention.
- Which ADHD symptom is about commonly present in adults?
- Which of the following statements is true about psychostimulants?
A patient must provide the pharmacy with a hard copy of the prescription.
- Which of the following is not important to monitor for patients taking psychostimulants?
- Which of the following statements is true about ADHD?
ADHD is believed to be a problem of dysfunctional tuning of dopamine and norepinephrine circuits.
- Which of the following statements about the CIWA-Ar and COWS is true?
The CIWA-Ar and COWS can guide treatment decisions for withdrawal states.
- Which of the following statements about atomoxetine is true?
Atomoxetine is best targeted to patients who present with inattention as their primary difficulty.
Quiz Week 13
- Which of the following statements about neurotransmitters and development is true?
Norepinephrine levels increase with age.
- Which of the following statements best describes the amyloid hypothesis of Alzheimer’s?
Abnormal processing of amyloid precursor protein results in formation of amyloid plaques and the subsequent formation of tangles.
- Which of the following statements is about anticonvulsant use in pregnancy is true?
As a className, anticonvulsants carry the highest risk of major congenital malformations.
- Which of the following statements and pharmacokinetics of children and adolescents is true?
Increased body fat in girls impacts distribution and half-life considerations of psychotropics when compared with boys.
- Which of the following medications is FDA approved for the treatment of depression in children?
- Which of the following statements about antipsychotic use in the elderly is true?
Antipsychotic use in dementia is associated with increased risk of CVA and of mortality.
- Which of the following statements is true about teratogenicity in pregnancy?
The greatest risk of teratogenicity often occurs before a patient is aware that they are pregnant.
- Which of the following statements about psychotropic use in pregnancy is true?
All medications cross the placenta and pose a potential risk to the fetus.
- Which of the following statements about antipsychotic use in pregnancy is true?
Atypical antipsychotic use in pregnancy does not appear to be associated with major congenital malformations.
- Which of the following statements about antidepressant use during pregnancy is true?
Pharmacokinetic changes in pregnancy may result in need for higher dosages of medication to reach efficacy.
- When treating acute aggression, which of the following medication combinations is a suggested treatment?
Haldol + lorazepam
- Which of the following statements is true when prescribing for pediatric populations?
It is important to address parent/caregiver’s perception of psychiatric medication.
- Which of the following statements is true about psychotropic use during lactation?
The postpartum period is considered a vulnerable time for onset, relapse and recurrence of mental disorders.
- Which of the following statements about FDA warnings and antidepressants in children and adolescents is true?
For moderate to severe anxiety and depression, antidepressant benefit may outweigh risks.
- Which of the following statements about premenstrual dysphoric disorder (PMDD) is true?
Lifestyle changes such as eliminating caffeine and sugar, getting adequate sleep and regular exercise can mitigate symptoms of PMDD.
- The psychiatric disorder most likely to result in aggression or violence is?
Substance use disorders.
- Which of the following states about cholinesterase inhibitors is true?
GI side effects are common with cholinesterase inhibitors.
- For which patient profile is a beta blocker a good choice the treatment of aggression?
Persistent aggression in the presence of neurocognitive deficits.
- First line treatment for persistent aggression is?
- Which of the following statements about SSRI discontinuation syndrome in neonates is true?
SSRI discontinuation syndrome is time-limited and usually resolves within 2 weeks.
- Which of the following statements about memantine is true?
Memantine is a NMDA receptor antagonist and is hypothesized to reduce abnormal activation of glutamate.
- Which of the following statements about pediatric psychiatry is true?
Behavioral and psychological strategies should be included in all treatment plans.
- Which of the following statements about managing behavioral and psychological symptoms of dementia is true?
Habilitation therapy, the practice of understanding problematic behaviors as communications of a need and then finding ways to meet that need, has been shown to reduce agitation.
- The medication side effect mostly to result in aggression or violence is?
- When prescribing for preschool aged children which of the following statements is true?
Behavioral and psychotherapeutic interventions are first line treatment for all psychiatric disorders in preschool aged children.
- Which statements best describes the mechanism of action of cholinesterase inhibitors for the treatment of dementia?
Cholinesterase inhibitors prevent the inactivation of acetylcholine, slowing the decline in function on Alzheimer’s disease.
- Which of the following statements is FALSE when considering psychotropic medication in children and adolescents?
Escitalopram has been shown to be ineffective in the treatment of depression
Another way of looking at it
Substrate = Original drug (Haldol)
Inhibitor = Increases the substrate drug - More Haldol in blood
Inducer = decreases the substrate drug - Less Haldol in blood