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PMHNP Exam > ANA / ANCC practice > Flashcards

ANA / ANCC practice Flashcards

1
Q

The following criteria must be met before commiting someone

A
  1. have a diagnosed psychiatric disorder
  2. they are unaware or unwilling to accept the nature and severity of the disorder
  3. as a result of the mental disorder, they are harmful to themselves or others
  4. As a result of the disorder they cannot take care of their basic needs (food, clothing, shelter)
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2
Q

what 2 depression scales are in the public domain that are sensitive and specific for depression

A
  1. PHQ-2
  2. PHQ-9
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3
Q

what is the first step in beginning a systems change project

A

conduct a system needs assessment

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4
Q

two models that can be used to conduct a quality improvement project

A
  1. PDSA
  2. donabedian model (structure, process, outcome)
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5
Q

Describe donabedian model

A
  1. structure - setting where care takes place (includes the availability of equipment, human and material resources)
  2. Process - the components of care delivered (patient-related processes and organizational aspects)
  3. outcomes - the effect of healthcare on health status of patients and populations
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6
Q

receptors and basic function of norepineprine

A
  • a1 & a2
  • alertness
  • focused attention
  • orientation
  • primes fight or flight
  • learning and memory
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7
Q

symptoms of deficiency of norepinephrine

A

dullness, low energy, depressive effect

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8
Q

symptoms of excess norepinephrine

A
  • anxiety
  • hyperalertness
  • increased startle
  • paranoia
  • decreased appetite
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9
Q

Dystonia clinical presentation

A
  • oculogyric crisis -fixed deviation of the eyes in one direction
  • protrusion of tongue (thick tongue)
  • forced jaw opening
  • torticollis
  • difficulty speaking
  • trismus - restricted opening of mouth
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10
Q

acetylcholine receptors and general function

A
  • nicotinic & muscanaric
  • attention
  • MEMORY
  • thirst
  • mood regulation
  • REM sleep
  • MUSCLE TONE
  • sexual behavior
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11
Q

symptoms of acetylcholine deficit

A
  • unihibited
  • DECREASED MEMORY
  • euphoria
  • antisocial actions
  • speech decrease
  • dry mouth, blurred vision consitpation
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12
Q

symptoms of acetylcholine excess

A
  • overly inhibited
  • anxiety
  • depression
  • somatic complaints, self conciousness
  • drooling
  • EXTRAPYRAMIDAL MOVEMENTS
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13
Q

Examples of primary prevention

A

Aimed at decreasing the incidences (new cases) of mental health disorders
* stress management classes graduate students, smoking prevention classes, DARE and Keeping it real curriculum

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14
Q

Secondary prevention

A

aimed at decreasing the prevalence (# of existing cases) of mental health disorders
* early case finding, screening, prompt and effective treatment - telephone hotlines, crisis intervention, disaster responses

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15
Q

Tertiary prevention

A

aimed at decreasing the disability and severity of mental illness
* rehabillative services
* avoidance or postponement of complications (day treatment programs, case management for physical, housing or vocational needs, social skills training)

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16
Q

dopamine receptors and general function

A
  • d1 and d2
  • thinking
  • decision making
  • reward-seeking
  • fine muscle action
  • integrated cognition
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17
Q

symptoms of dopamine excess

A

mild
* improved creativity, improved ability for abstract thinking, improved executive functioning, improved spaciality

moderate
* disorganized thinking, loose associations, tics, stereotypic behavior

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18
Q

symptoms of dopamine deficit

A

mild
* poor impulse control, poor spaciality, lack of abstractive thought

Severe
* parkinson’s disease, endocrine alterations, movement disorders

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19
Q

primitive idealization

A

a defense mechanism that involves viewing people as having superhuman abilities and the capacity to achieve anything

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20
Q

projective identification

A

the projector splits off aspects of themselves and projects them onto another person. The other person then internalizes the projected qualities and believes they are characterized by them.

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21
Q

clear ego boundaries

A

sense of individuality

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22
Q

example for a nurse practitioner to promote interprofessional environment

A
  • assign roles for ALL staff members in improving patient outcomes
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23
Q

Patient on stimulants for ADHD develops tic and is worsening, but med is effective. What do you do?

A
  • discontinue and start on a non-stimulant (guanafacine ER) and monitor’s the patient
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24
Q

What process could an NP implement if she is tasked with continually improving the quality of care on an inpatient unit.

A

PDSA process

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25
Q

name a way that a NP who is concerned about access to care issues in the local community and wants to DEVELOP HEALTHCARE POLICY to help patients acess care more effectively.

A

work with local chapter of nurse’s professional organization

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26
Q

Bulimia treatment

A
  • meds + therapy
  • CBT, fluoxetine (FDA approved for bulimia)
  • SSRI or TCA have been shown to decrease bingeing and purging episodes
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27
Q

trend in legal rulings over the past 25 years involving mental illness

A

protect the person’s freedoms or rights when he or she is commited to a mental hospital

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28
Q

what is an ACO (accountable care organization)

A

group of heatlhcare providers, hospitals, or doctors who come together voluntarily to provide high quality care to medicare patients.

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29
Q

all TCA’s are inhibitors, inducers or substrates and which CYP enzyme

A

2D6 substrates

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30
Q

When may TCAs not be suitable for

A

history of heart or liver disease, or who recently had a heart attack

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31
Q

How might someone with OSA describe their sleep

A

frequent awakenings and a sense that they are not sleeping deeply “tossing and turning”

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32
Q

transactional analysis

A
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33
Q

Dexamethasone suppression test

A

measures body’s response to dexamethasone, a synthetic glucocoticoid, to assess adrenal gland function and diagnose cushings sydrome

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34
Q

transactional analysis

A
  • communication is in the form of 3 egos, child, adult, parent
  • childhood experiences, specifically how we were parented affect the development and formation of 3 egs
  • dysfunctional behavior is the result of self-limiting decisions made from our childhood in the interest of survival - informs our “life script” pre-concious life plan that governs the way life is lived out.
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35
Q

countertransference

A

therapists emotional reaction to a client influenced by the therapistts own personal history.

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36
Q

People with antisocial personality disorder were often raised in what type of environment

A

AUD

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37
Q

OCD type of isolating defense mechanisim

A

type of isolation affect instead of actual isolation

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38
Q

which antidepressant, other than wellbutrin, has less sexual side effects

A

mirtazapine

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39
Q

What type of medication is esketamine (spravato)

A
  • NMDA receptor antagonist
  • used in severely treatment resistant depression, SI
  • Only available under REMS
  • must be administered in presence of healthcare provider
  • requires monitoring for at least 2 hours after administration
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40
Q

what does an inverse agonist do

A
  • Do the opposite of the agonist
  • cause the receptor to close the ion channel
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41
Q

The effect of alcohol on GABA and glutamate in the VTA

A

Increases GABA and decreases Glutamate

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42
Q

what is the most active ingredient in cannabis

A
  • delta-9-tetrahydrocannabinol (THC)
  • is the chemical responsible for the psychoactive effects of cannabis
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43
Q

dopamine, epinephrine, and norepinephrine are inhibitory or excitatory neurotransmitters

A

excitatory

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44
Q

which sertotonin receptor makes an atypical antipsychotic atypical

A

5HT2A antagonism and D2 antagonism

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45
Q

considering a patient is going to surgery and is on slegeline, which medication would be strictly prohibited

A

Meperidine (demerol)
if taken with an MAOI can cause hypertensive crisis

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46
Q

two areas of brain where norepinephrine is produced

A

locus coeruleus and the medullary reticular formation

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47
Q

what area of the brain is transcranial magnetic stimulation targeted

A
  • dorsolateral prefrontal cortex (DLPFC)
  • area of the brain responsible for mood regulation
  • Can also be bilateral
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48
Q

MRI brain findings consistent with schizophrenia

A

enlarged cerebral ventricles, decreased electrical activity in the frontal lobes, decreased glutamate and GABA release, and decreased total brain volume.

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49
Q

TCAs block what leading to hypotension

A

alpha 1 adrenergic receptors

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50
Q

TCAs block what leading sedation

A

histamine 1 receptors, alpha 2 adrenergic receptors

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51
Q

What do TCA medications block leading to anticholinergic effects

A

muscarinic

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52
Q

what is the greatest risk factor for antisocial personality disorder

A

it is five times more common among 1st degree relatives of men with the disorder thant in the general population, making genetic predisposition the greatest risk factor.

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53
Q

an example of a acetylcholine inhibitor and a butrylcholinesterace (BuChE) inhibitor

A

rivastigmine (exelon),

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54
Q

which medications are acetylcholine inhibitors only

A

donzepil (aricept); galantamine (Razadyne)

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55
Q

which alzheimers med is a N-methyl D-aspartate (NMDA) receptor anatagonist

A

memantine (Namenda)

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56
Q

unilateral tinnitus or ringing in the ear, can be the first symptom of

A

an acoustic neuroma

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57
Q

which anticonvulsant is associated with SIADH

A
  • carbamazepine
  • impaired water secretion, leading to hypnatremia, with hypervolemia or euvolemia
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58
Q

what is vraylar (cariprazine used for)

A
  • atypical antipsychotic (3rd generation)
  • for patients who do not tolerate Abilify for schizophrenia
  • for patients who do not tolerate lurasidone, olanzapine for bipolar depression
  • possibly negative mood states in schizophrenia
  • possibly mixed mood states such as depression and mania with mixed features
  • very expensive
  • could be helpful in those with substance use disorder
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59
Q

kdiney stones are a potential side effect of this mood stabilizer

A

topiramate

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60
Q

when does the prefrontal cortex mature fully in males

A

in the mid 20s or early 30s

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61
Q

vilazodone (viibryd)

A
  • serotonin reuptake inhibition and serotonin 1A- partial agonism
  • the parital agonism at the sertotonin 1A receptor might be able to diminish any sexual dysfunction caused by serotonin reuptake inhibition
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62
Q

this area is responsible for regulating and perceiving pain, and chronic pain has been linked to the reduction of gray matter in this area

A
  • prefrontal cortex
  • the reduction in gray matter may be due to predisposition or the toxic effects of long-term medication use.
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63
Q

side effects of trileptal (oxcarbazepine)

A
  • excessive thirst and urination
  • labs may have elevated glucose with a normal A1C <5.7, (prediabetes 5.7-6.4, DM > 6.5)
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64
Q

mechanism of action remeron

A

alpha 2 receptor antagonist, 5-HT2A and 5-HTC receptor antagonist

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65
Q

What kind of medication is atomoxetine

A

Strattera - NRI
(also inhibits the reuptake of dopamine in specific areas of the brain, such as the prefrontal cortex)

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66
Q

how does disulfiram (antabuse) work

A

causes build up of acetaldehyde when taken with alcohol

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67
Q

which mood stabilizer when taken when pregnant can increase the risk for cleft lip and palate

A

topiramate

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68
Q

Primary clinical features of aspergers

A
  • qualitative social impairment
  • use of abnormal nonverbal communicative gestures
  • failure to develop peer relationships
  • lack of social or emotional reciprocity
  • impaired ability to express pleasure in the happiness of others
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69
Q

which CYP enzynme does smoking primarily influence

A

Inducer of CYP 1A2

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70
Q

Cannabis use can induce this disorder in individuals who have a family history of the disorder.

A

schizophrenia

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71
Q

what is a pro drug that after converted to its active component increases norepineprhine and dopamine

A
  • lisdexamfetamine (vyvanse)
  • it is a prodrug for dextroamphetamine and thus is not active until it has been absorbed by the intestinal tract and converted to dextroamphetamine
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72
Q

which side of the brain is affected if the person fails the clock drawing test

A

right hemisphere

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73
Q

what type of drug is benzotropine (cogentin)

A

anticholinergic drug and muscanaric 1 antagonist thart partially inhibits cholnerfic activity in the basal ganglia and enhances dopamine availability by blocking the reuptake and storage.

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74
Q

When administering fluvoxamine with this drug can increase risk for bleeding.
what other drugs use caution with fluvoxamine

A

NSAID, st john’s wart, tryptophan and warfarin

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75
Q

fragile x features

A

more common in males than females, large head, hyperextensible joints, comorbid ADHD or autism

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76
Q

what disorder presents with care au lait spots and neurofibromas

A

recklinghausen’s disease

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77
Q

prader-willis physical features

A

obesity, small statute, hypogonadism

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78
Q

In MMSE what does drawing intersecting pentagons test for

A

construction praxis the ability to copy, draw and color patterns

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79
Q

The 5 As for behavioral change counseling

A

assess, advise, agree, assist, arrange

80
Q

Short form 36

A

Self administered tool that patients use referring to the last 4 weeks, functional scale. The 8 subscales are
* physical functioning
* role limitations due to physical functioning
* general health perception
* vitality
* social functioning
* role limitations due to emotional problems
* general mental health
* health transition

81
Q

Study by Felitti et al showed that ACEs have a + relationship with the following disorders

A
  • anxiety
  • depression
  • sleep disorders
  • diabetes
  • heart disease
  • fractures
  • dissasociative orders
  • eating disorders
  • STDs
  • obesity
  • unintended pregnancy
  • alcoholism
82
Q

cut off points for PHQ9 for

A

mild, moderate, moderately severe, severe
5, 10, 15, 20

83
Q

immediate memory

A

also known as short-term memory tasks such as solving simple calculations and cognitive tasks

84
Q

episodic memory

A

specific life events

85
Q

declarative memory

A

Type of long-term memory that involves consciously recalling facts and events from the past
Examples - remembering your pet birds name from childhood, remembering where you were when 911 happened, date of your mom’s birthday.

86
Q

anterograde memory

A

the learning and remembering of new events following a brain injury.

87
Q

Demographics binge drinking

A
  • more common in men, white, ages 18-34
88
Q

depersonalization

A

detached from self, like watching self in a movie or from a distance

89
Q

alexithymia

A

inability to describe, differentiate, express different emotions

90
Q

does tangetiality ever reach the point

A

no

91
Q

what are the risks of anabolic steroid use

A

irritability, liver damage, depression, stroke, blood clots, cholesterol changes, HTN, hepatic cancer, mood swings, distractablity, increased sexual behavior, euphoria, aggression, increased energy

92
Q

the belief someone has been replaced by and imposter

A

capgras

93
Q

which medication in combinational with prozac has FDA approval to treat bipolar depression

A

zyprexa
The combination medication is called Symbyax

94
Q

What QTc interval puts the patient at greates risk for torsades de points

A

500-700

95
Q

Basic symptoms of schizoaffective disorder

A

psychotic symptoms persist even when mood is stable

96
Q

NMS prominet labs

A

leukocytosis and elevated CPK

97
Q

age kids prozac and wellbutrin

A

age 8 and older

98
Q

how to differentiate between mixed receptive and expressive disorders from autism

A

autism typically has echolalia, stereotypical phrases out of context

99
Q

mutism is present in NMS or SS

A

NMS

100
Q

common symptoms of hyponatremia

A

nausea, fatigue, weakness, headache, decreased appetite

101
Q

what interventions has supported evidence for reducing substance abuse in schizophrenia

A

manualized group intervention with motivational enhancement

102
Q

basic principe of crisis intervention

A

focus on one primary concern at a time

103
Q

first line treatment evidence supported in Bipolar 1 disorder maintenance

A
  1. lithium, lamictal, seroquel
  2. Lithium + seroquel
  3. depakote, abilify, olanzapine
104
Q

delusional personality disorder

A

DOES NOT EXIST

105
Q

schizotypal

A

ideas of reference and magical thinking (thinking they wished for an accident and it happened because they wised for it; Ideas of reference - show on TV or radio is about them.

106
Q

schizoid

A

fantasy, isolation, introversion
fantasy examples - being buried alive, being skinned alive, skinless, lost object within self

107
Q

what form does zyprexa come in

A
  • tablet
  • disintegrating tablet
  • long acting injection (relprevv) every 2-4 weeks
  • Zyprexa IM (10 mg) for acute situations (agitation) - not for long term
108
Q

what form does geodon come in

A

capsule and short acting injections (agitation)

109
Q

what form does paliperidone come in

A

oral tablets and long acting injection
Invega sustenna monthly and Invega Trinza 3 month injection

110
Q

2 evidence based treatments for PTSD nightmares

A
  1. prazosin
  2. image rehearsal therapy (IRT) - CBT technique that can help reduce the frequency and intensity of nightmares
111
Q

Adrenergic

A

activate sympathetic nervous system, release norepinephrine, increases HR and contractile forces

112
Q

cholinergic

A

activate parasympathetic nervous system; cholinergic fibers release acetylcholine, cholinergic signaling decreases HR and contractile forces

113
Q

20 year old patient newly diagnosed with schizophrenia. Most important 1st step for patient and family

A

patient and family education, disease course, treatment regimens, support systems, life management skills

114
Q

facts regarding pospartum psychosis after having first child

A
  • as many as 2/3 of postpartum psychosis patients have a 2nd episode of an underlying affective disorder in the year after the baby’s birth
  • an incidence rate of pospartum psychosis is about 1-2 per 1000 childbirths. About 50-60% of affected women have just had their first child
  • Subsequent pregnancies are associated with increased risk of another episode as high as 50%
  • an episode of postpartum psychosis is essentially an episode of a mood disorder, an is usually an indicator of bipolar disorder
115
Q

what is important to note about latuda absorption (specifcially if taken at bedtime)

A

to ensure proper absorption of Latuda, must take at least 360 calories. The 360 calories from a carbohydrate may help induce sleepiness.

116
Q

In bipolar I disorder, men or women have more manic episodes

A

men
(women have more rapid cycling, mixed episodes, depressive episodes)

117
Q

WBC and differential cut off points for Clozaril

A

Discontinue if
* WBC 2000-3000
* granulocytes of 1000 to 1500 for agranulocytosis and severely compromised immune system
* neutrophils < 1000

118
Q

symptoms of serotonin (SSRI) discontinuation syndrome

A

agitation, anxiety, GI distress, disequilibrium, sensory disturbances, and flu like symptoms.

119
Q

can Zolpidem be stopped abruptly

A

yes, only issues may rebound insomnia

120
Q

Lisdexamfetamine in regards to use in binge eating disorder

A

shows modest short-term effects, primarily in obese patients with unclear benefits for others

121
Q

complementary therapy and perimenopausal sx

A

hypnotherapy and mindfulness may have some benefits, but evidence for natural products is mixed. St johns wart should not be mixed with SSRIs. Acupuncture has shown inconsistent results.

122
Q

REMS programs

A

risk ealuation and mitigation strategy REMS are FDA required for certain drugs which is implemented by the drug companies

123
Q

immediate treatment for dystonia

A

discontinue offending agent, give benzotropine 1 mg IM or IV and prescribe benzotropine for 1 mg BID for 5 days.

124
Q

how much folic acid is recommended for someone planning or at risk for becoming pregnant to prevent neural tube defects

A

0.4-0.8 mg

125
Q

what lab should be checked for someone on a PPI

A

B12

126
Q

Statistics for developing antisocial personality disorder

A
  • males are 3 times more common than females
  • higher incidence in lower socioeconomic status and urban settings
  • it is more common among 1st degree relatives (both male and female)
  • adoption studies indicate that both genetic and environmental factors contribute to the risk of APD. Both adopted and genetic children of parents with APD are at increased risk of developing APD.
127
Q

topiriamate and OC

A

topiramate can lower OC effectiveness

128
Q

phentermine and wellbutrin

A

both lower the seizure threshold

129
Q

most important factor in therapeutic communication

A

non-verbal communication - gestures, facial expressions, and body language communicate more than do verbal messages.

130
Q

minimum standard of therapy for a child with a history of trauma

A

trauma focused CBT

131
Q

Recommended practices in psychotherapy with a person with BPD

A
  • establish clear roles of patient and therapist
  • mutually agreed upon limited setting
  • use of concominant individual and group approaches
  • therapists shoue be active and directive listeners rather than passive participants.
132
Q

multigenerational transmission of violence theory

A

Example - men who witness violence in their family of origin often perpetuate violence in their families as adults

133
Q

negative group outcomes are associated with what personality trait of the leader

A

leaders who are overconfrontaional

134
Q

bowlbys attachment theory

A

chidren who come from parents with high expressed emotion and unresolved losses tend to develop disorganized attachment characterized by inability to feel safe with their caregiver and inability for feel soothing comfort.

135
Q

why is the attachment relationship between infant and caregiver critical primarily because

A

attachments to significant relationships facilitates self-regulation of emotions

136
Q

what age can a child balance on one foot, vocabulary up to 1000 words, use 3-4 word sentences, can follow 2-step commands, communicate in a way that is understood by the family, plays make believe, briefly shares toys

A

age 3

137
Q

adjectives that could be used to describe a therapeutic frame that is flexible for changes, consistent enough for stability and safety

A

Mindful, reflective, intentional

138
Q

brief intervention includes

A
  1. feedback
  2. responsibility
  3. advise
  4. menu of treatment optons
  5. empathetic counseling
  6. optism about self-efficacy
139
Q

working with a trauma patient who is avoidant, what type of communication is recommended

A

for avoidant patients, arousal may increase expressive communication. Techniques such as
* interpretation
* immediacy
* focusing
* observation

140
Q

what are some supportive de-arousing methods

A

restating, suggesting, recognition, and information given

141
Q

what might the ego state

A

I think or I evaluate

142
Q

The Id might state

A

I want

143
Q

The superego might state

A

I should or I ought

144
Q

what type of therapy can be very beneficial to a 10 year old child who has recently lost a parent

A

group therapy with peers who have experienced similar losses normalizes grief and emphasizes support, hope, and universality

145
Q

what type of therapy uses differentiation of self, triangles, and genograms and focuses on the role of context.

A

systemic family

146
Q

which family therapy focuses on structural and behavioral aspects of the family.

A

strategic

147
Q

which family therapy focuses on relationships, hierarchies, and boundaries

A

strucural

148
Q

which type of therapy attempts to establish more secure family patterns

A

emotionally focused family therapy

149
Q

this theoretical framework emphasizes the roles of choice and responsibility for consequences

A

existentialism

150
Q

Theoretical framework of the normal life cycle

A
  • normal tasks include renegotiating the marital system
  • developing adult relationships with between grown children and parents
  • realigning other relationships
  • addressing disabilities and death of parents and grandparents
  • Example “empty nest” stage involves finding or redifining life’s meaning.
151
Q

explain advocacy for PMHNP role

A

means more than doing something altruistic. Advocacy means getting out and showing and explaining to people the value of what an NP can do

152
Q

In states that require a collaborating physician, what happens if patient family files a lawsuit, such as wrongful death of a patient that the NP was treating. Who has legal responsibility.

A

PMHNP is SOLEY LEGALLY RESPONSIBLE

153
Q

Under HIPPA, a covered entity is

A

having the ability to transmit protected health information

154
Q

Most organizational change models include what 3 processes

A
  1. focusing on stakeholders
  2. identifying and surmounting organizational barriers
  3. evaluating impact
155
Q

Muslim cultural considerations

A
  • many prefer to be treated by a member of the same sex
  • very modest
  • follow a halal diet
  • gelatine is sometimes produced from pig bones.
  • Halal diets avoidance of pig products.
156
Q

what can social justice involve

A

providing resources to those with the least access and the greatest needs.

157
Q

what does outcome measurement entail

A
  • evaluating the outcome of care to
  • analyze the effectiveness of an intervention,
  • to inform treatment changes,
  • to profile practice patterns of providers
158
Q

how is primary prevention through **community education **best illustrated

A

through an example that involves reaching the broadest general audience through television, radio, or newspaper.

159
Q

Wider confidence intervals suggest

A
  • ususally based on smaller sample sizes
  • fewer outcome events
  • indicate reduced precision in estimate of effect

(confidence intervals reflect a range of values within one can be confident the the true valuse is situated. )

160
Q

core values in culturally competent care

A
  1. respect
  2. collaboration
  3. advocacy
161
Q

duty to warn professional responsibility

A

Duty to warn varies by state. It is professional responsibility to what is required by the state you practice in.

162
Q

symptoms of compassion fatigue

A
  • denial about problems
  • isolating from others
  • complaining about administrative functions
  • addiction
  • poor self-care and hygeine
163
Q

Health Insurance Portability and Accountability Act of 1996

A

Made changes to the COBRA act of 1985
* * protects employed americans by decreasing the chance that an individual will lose health coverage, facilitating change from one health plan to another and facilitating the purchase of individual or family health insurance coverage if coverage is lost from an employer’s pan or no other health insurance coverage is available.

164
Q

Type II errors

A
  • occurs when the investigators do not reject a null hypothesis that is false, and conclude that there is no relationship between the variables, when in fact a relationship does exist
  • occurs when there is insufficient power to detect the difference between the variable and is linked to the adequacy of the sample sze. If a sample is too small, the study will have insufficient power to detect differences between groups
165
Q

Chodoff 1976

A

involuntary hospitalization may be justified when ther are severe intrapsychic (e.g., dpression) and interpersonal disturbances (e.g. withdrawal due to depression) disturbances.

166
Q

What does PICOT stand for

A

P -patient population
I - intervention
C- comparison (alternative to the intervention)
O - outcome - the specific outcome or results you want to measure
T - timeframe - the specific time period over which the study intervention will occur

167
Q

how does alcohol effect lithium levels

A

can increase levels due to deceased renal clearance.

168
Q

how does lithium reduce suicidal behaviors

A

modulation of glutamate receptors, which is associated with a decrease in impulsivity and aggressive behavior making it a valuable choice for those with suicidal behaviors.

169
Q

what happens to lithium levels in the presence of hypokalemia

A

Decrease by enhancing renal excretion
(hypokalemia symptoms = muscle weakness and palpitations)

170
Q

symptoms of hyperamonemia

A

N&V, abdominal pain, irritability, headaches, ataxia, issues with speech, behavioral changes

171
Q

temporal lobe primary functions

A

primarily responsible for auditory processing, language comprehension, face recognition. Dysfunction can result in symptoms such as complex partial seizures, languagnf e deficits and memory impairment.

172
Q

parietal lobe function

A

primarily responsible for sensory processing, spatial awareness, and integration of sensory input. Dysfunction in the parietal lobe can lead to difficulties in spatial perception, coordination, mathematical abilities and spatial drawing.

173
Q

Thalamus function

A

relay stating for sensory information, transmitting sensory signals to various parts of the brain for processing. Deficits can lead to deficits in sensory discrimination and processing.

174
Q

Describe SGA effect on negative symptoms of schizophrenia

A

they have balanced action on both serotonin and dopamine receptors. With their unique receptor profile, can help alleviate negative symptoms by modulating dopamine activity without significantly reducing it further in the mesocortical pathway and may offer serotogenic benefits.

175
Q

First line treatment for akathisia

A

beta blocker

176
Q

akinesia

A

paucity of movement, general slownesss, lack of spontaneous activity

177
Q

Hallmark presentation of Lewy body disease including lewy body demetia

A

hallucinations, parkinsonism, braydkinesia and rigidity.

178
Q

most accurate and effective way of testing for Huntington’s disease

A

it is a highly accurate DNA test that directly detects the presence of the HD gene mutation.

179
Q

what pathophysiologic mechanism contributes to treatment resistent depression

A

hypothalmic pituitary adrenal axis hyperactivity. Chronic stress and depression can lead to dysregulation of the HPA axis, resulting in hyperactivity. This can contribute to treatment resistent depression by causing persistent activation of the stress response system and altered neuroendocrine function.

180
Q

what brain structure abnormalities might you see on an MRI of someone with Alzheimers

A
  1. enlargement of cerebral ventricles. as neurons and synapses degenerate, the ventricles expand to fill the space left behind resulring in the characteristic structural change.
  2. hippocampal atrophy - the hippocampus is a critical structure for memory and learning and is particulary vulnerable. Atrophy in this region is the hallmark of Alzheimers.
181
Q

in bipolar disorder what neurotransmitters are involved in the depressive phase.

A

dysregulation of serotonin and norepineprhine - low levels contribute to low energy, hopelessness, and diminished interest in activities.

182
Q

neurotransmitters in GAD

A
  • Decreased serotonin - low levels are associated with anxiety, and SSRIs are often used to treat GAD
  • Increased norepinephrine contribute to heightened arousal and the flight or fight response.
183
Q

neurtransmitters in depression

A
  • decreased serotonin - persistent sadness and change in appetite and sleep
  • norepineprhine - dysregulation of norepineprhine transmission is linked to depressive symptoms
184
Q

neurotransmitters in Tourette’s disorder

A
  • dopamine dysregulation in basal ganglia, increased dopamine activity is thought to contribute to tics
  • serotonin - can modulate dopamine levels and affect tic severity
185
Q

which antidepressant should be avoided in those with a history of substance abuse.

A

wellbutrin - dopaminergic activity make it less suitable

186
Q

Which class of medications is contraindicated in patients with a history of AUD

A

MAOIs can have dangerous interactions with alcohol and can lead to hypertensive crisis and other severe reactions

187
Q

which medications should be avoided in those wtih parkinsons

A

1st generation antipsychotics due to their severe dopamine blocking activity.

188
Q

Which neurotransmitters does lithium effect and what is the effect

A

serotonin and norepinephrine - polydipsia, polyuria

189
Q

Which CYP enzyme is responsible for the metabolism of clozapine

A

1A2

190
Q

one way that SGA lessen the risk of extrapyramidal side effects

A

increase dopamine in the nigostriatal pathway

191
Q

chronic alcohol use can lead to damage in this structure in the brain causing memory issues and cognitive impairments.

A

hippocampus is particularly vulnerable to the toxic effects of alcohol leading to shrinkage.

192
Q

Treatment Catatonia

A

Benzo 1st line, ECT refractory, AVOID antipsychotics

193
Q

Which part of brain affective symptoms

A

ventromedial prefrontal cortex

194
Q

Which part of brain aggressive symptoms

A

amygdala, orbitofrontal

195
Q

Which part of brain cognitive symptoms

A

dorsolateral prefrontal cortex

196
Q

Which part of brain negative symptoms

A

mesocortial prefrontal cortex and nucleus accumbens reward circuit

197
Q

SNRIs

A
  • duloxetine (cymbalta)
  • effexor
  • pristiq
  • fatizma

PMHNP Exam (7 decks)

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