chap 15: Drugs affecting the the Central Nervous System

Question 1

Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

1. Understanding that obesity is a contraindication to prescribing phentermine
2. Anorexiants may cause tolerance and should only be prescribed for 6 months
3. Patients should be monitored for postural hypotension
4. Renal function should be monitored closely while on anorexiants

Answer 1

2. Anorexiants may cause tolerance and should only be prescribed for 6 months

Question 2

Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to:

1. Additive respiratory depression risk
2. Additive effects affecting liver function
3. The risk of serotonin syndrome
4. The risk of altered cognitive functioning

Answer 2

3. The risk of serotonin syndrome

Question 3

Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus.

1. IV phenobarbital
2. Rectal diazepam (Diastat)
3. IV phenytoin (Dilantin)
4. Oral carbamazepine (Tegretol)

Answer 3

2. Rectal diazepam (Diastat)

Question 4

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2. For pedal edema throughout therapy
3. Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
4. For vision changes, such as red-green blindness, at least annually

Answer 4

1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment

Question 5

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

1. Dwayne hasn’t been taking his carbamazepine because it causes insomnia.
2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
3. Dwayne was not originally prescribed the correct amount of carbamazepine.
4. Carbamazepine is probably not the right antiseizure medication for Dwayne.

Answer 5

2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.

Question 6

Carbamazepine has a Black Box Warning due to life-threatening:

1. Renal toxicity, leading to renal failure
2. Hepatotoxicity, leading to liver failure
3. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
4. Cardiac effects, including supraventricular tachycardia

Answer 6

3. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis

Question 7

Long-term monitoring of patients who are taking carbamazepine includes:

1. Routine troponin levels to assess for cardiac damage
2. Annual eye examinations to assess for cataract development
3. Monthly pregnancy tests for all women of childbearing age
4. Complete blood count every 3 to 4 months

Answer 7

4. Complete blood count every 3 to 4 months

Question 8

Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:

1. Increased seizure activity, as this drug may auto-induce seizures
2. Altered renal function, including renal failure
3. Blood dyscrasias, which are uncommon but possible
4. Central nervous system excitement, leading to insomnia

Answer 8

3. Blood dyscrasias, which are uncommon but possible

Question 9

Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:

1. Increase her dose
2. Assess for suicidal ideation
3. Discontinue the medication immediately
4. Decrease her dose to half then slowly titrate up the dose

Answer 9

2. Assess for suicidal ideation

Question 10

Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:

1. Tell her to increase her caloric intake to counter the effects of the topiramate.
2. Consult with a neurologist, as this is not a common adverse effect of topiramate.
3. Decrease her dose of topiramate.
4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.

Answer 10

4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.

Question 11

Monitoring of a patient on gabapentin to treat seizures includes:

1. Routine therapeutic drug levels every 3 to 4 months
2. Assessing for dermatologic reactions, including Steven’s Johnson
3. Routine serum electrolytes, especially in hot weather
4. Recording seizure frequency, duration, and severity

Answer 11

4. Recording seizure frequency, duration, and severity

Question 12

Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

1. He should not play sports due to the risk of increased seizures
2. He should monitor his temperature and ability to sweat in the heat while playing
3. Reminding him that he may need higher dosages of topiramate when exercising
4. Encouraging him to use sunscreen due to photosensitivity from topiramate

Answer 12

2. He should monitor his temperature and ability to sweat in the heat while playing

Question 13

Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:

1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
2. To wear sunscreen due to photosensitivity from levetiracetam
3. To get an annual eye exam while on levetiracetam
4. To report weight loss if it occurs

Answer 13

1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures

Question 14

Levetiracetam has known drug interactions with:

1. Combined oral contraceptives
2. Carbamazepine
3. Warfarin
4. Few, if any, drugs

Answer 14

4. Few, if any, drugs

Question 15

Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

1. Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days
2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3. Rapid strep test and symptomatic care if strep test is negative
4. Observation only, with further assessment if she worsens

Answer 15

2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure

Question 16

Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:

1. Contraceptive failure
2. Excessive weight gain
3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed

Answer 16

3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine

Question 17

The tricyclic antidepressants should be prescribed cautiously in patients with:

1. Eczema
2. Asthma
3. Diabetes
4. Heart disease

Answer 17

4. Heart disease

Question 18

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex)
2. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce
3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment
4. All of the above

Answer 18

4. All of the above

Question 19

Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:

1. Fluoxetine
2. Fluvoxamine
3. Sertraline
4. Escitalopram

Answer 19

1. Fluoxetine

Question 20

Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:

1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
2. Red-green color blindness may occur and should be reported.
3. If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately.
4. She should eat lots of food high in fiber to prevent constipation.

Answer 20

1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects.

Question 21

Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:

1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Amitriptyline (Elavil)
4. Duloxetine (Cymbalta)

Answer 21

4. Duloxetine (Cymbalta)

Question 22

Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:

1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients

Answer 22

2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)

Question 23

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

1. Reduce the chance of tardive dyskinesia
2. Potentiate the effects of the drug
3. Reduce the tolerance that tends to occur
4. Increase central nervous system (CNS) depression

Answer 23

2. Potentiate the effects of the drug

Question 24

Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

1. Insomnia
2. Weight gain
3. Hypertension
4. Galactorrhea

Answer 24

1. Insomnia

Question 25

A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: 1. Bradykinesia, akathisia, and agitation 2. Excessive weight gain 3. Hypertension 4. Potentially fatal agranulocytosis

Answer 25

1. Bradykinesia, akathisia, and agitation

Question 26

In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: 1. Chlordiazepoxide (Librium) 2. Clonazepam (Klonopin) 3. Alprazolam (Xanax) 4. Oxazepam (Serax)

Answer 26

3. Alprazolam (Xanax)

Question 27

A patient with anxiety and depression may respond to: 1. Duloxetine (Cymbalta) 2. Fluoxetine (Prozac) 3. Oxazepam (Serax) 4. Buspirone (Buspar) and an SSRI combined

Answer 27

4. Buspirone (Buspar) and an SSRI combined

Question 28

When prescribing temazepam (Restoril) for insomnia, patient education includes: 1. Take temazepam nightly approximately 15 minutes before bedtime. 2. Temazepam should not be used more than three times a week for less than 3 months. 3. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better. 4. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam.

Answer 28

2. Temazepam should not be used more than three times a week for less than 3 months.

Question 29

Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: 1. Zolpidem should be taken just before going to bed. 2. Zolpidem may cause dry mouth and constipation. 3. Patients may need to double the dose for effectiveness. 4. They should stop drinking alcohol at least 30 minutes before taking zolpidem.

Answer 29

1. Zolpidem should be taken just before going to bed.

Question 30

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: 1. Orthostatic hypotension 2. Agitation and irritability 3. Drowsiness and nausea 4. Painful urination and abdominal distention

Answer 30

3. Drowsiness and nausea

Question 31

Tom is taking lithium for bipolar disorder. He should be taught to: 1. Take his lithium with food 2. Eat a diet with consistent levels of salt (sodium) 3. Drink at least 2 quarts of water if he is in a hot environment 4. Monitor blood glucose levels

Answer 31

2. Eat a diet with consistent levels of salt (sodium

Question 32

Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? 1. Valproate is safe during all trimesters of pregnancy. 2. She can get pregnant while taking valproate, but she should take adequate folic acid. 3. Valproate is not safe at any time during pregnancy. 4. Valproate is a known teratogen, but may be taken after the first trimester if necessary.

Answer 32

4. Valproate is a known teratogen, but may be taken after the first trimester if necessary.

Question 33

When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: 1. The medication may cause sedation and they should not drive. 2. Constipation is a common side effect and they should increase fluids and fiber. 3. Patients should not take any other acetaminophen-containing medications at the same time. 4. All of the above

Answer 33

4. All of the above

Question 34

Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol)

Answer 34

1. Ibuprofen (Advil)

Question 35

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol)

Answer 35

2. Acetaminophen with hydrocodone (Vicodin)

Question 36

Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: 1. Slurred speech and insomnia 2. Bradycardia and confusion 3. Dizziness and orthostatic hypotension 4. Insomnia and decreased appetite

Answer 36

4. Insomnia and decreased appetite

Question 37

Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: 1. ADHD symptoms 2. Routine height and weight checks 3. Amount of methylphenidate being used 4. All of the above

Answer 37

4. All of the above

Question 38

When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: 1. Blood pressure 2. Blood glucose levels 3. Urine ketone levels 4. Liver function

Answer 38

1. Blood pressure