Domain 1 Scientific Foundations Flashcards
What medications cause sexual dysfunction infrequently ?
Mirtazapine(rameron)
Esketamine (Spravato) is classified as an:
NMDA RECEPTOR ANTAGONIST
Which medications is excreted unchanged from the body?
Lithium , unchanged in urine
Which brain structure is activated in patients with severe anxiety as expressed as fear, panic, and extreme anxiety?
Amygdala
Most serotonin in the brain is generated in the:
Raphe nuclei
The neurons of the raphe nuclei are principle source of what release in the brain?
Serotonin
An inverse agonist produces the what effect?
Causing the opposite effect of an agonist and causing the receptor to close the ion channel.
When assessing side effects produced by dopamine antagonism in the tuberoinfundibular pathway, what should you ask?
Are you experiencing breast discharge?
Is gaba or glutamate excitatory ?
Glutamate
Alcohol has what effect on GABA and glutamate in the ventral tegmental area ?
Increase GABA and decrease glutamate.
What are classic symptoms of NMS?
Acute mental status change, muscular rigidity, and autonomic instability.
What neurotransmitter is an inhibitory neurotransmitter ?
GABA
Antagonism of which serotonin receptor makes an antipsychotic “atypical”?
5HT2A
Which medication is contraindicated in combination with Selegiline?
Meperidine
What drug class is selegiline?
Monoamine oxidase inhibitor (MAOI)
Meperidine and MAOI (selegiline) can cause what?
Hypertensive crisis= death
What area of the brain has a majority of norepinephrine neurons?
Locus coeruleus and the medullary reticular formation.
Leukocytosis
High white blood cells.
Lithium causes what hematologist affect?
Leukocytosis
What area of the brain is targeted by TMS?
Transcranial magnetic stimulation
Dorsolateral prefrontal cortex
Which medication should be taken with food to enhance absorption?
Ziprasidone (geodon)
TCAs block what?
Alpha -1 adrenergic receptors
Orthotic hypotension associated with TCAs is caused by blockade of what?
Alpha 1 adrenergic receptors
Blockade alpha 2 adrenergic and histamine-1 receptors cause what?
Sedation
Blocking muscarinic receptors cause what?
Anticholinergic effects
What is a main risk factor for antisocial personality disorder ?
Genetic predisposition of first-degree familymember
What medication is both an acetylcholine inhibitor and a butyrylcholinesterase inhibitor ?
Rivastigmine (exelon)
rivastigmine is not an antidepressant. Rivastigmine is a medication used to treat dementia associated with Alzheimer’s disease and Parkinson’s disease. It works by inhibiting the enzymes acetylcholinesterase and butyrylcholinesterase, which increases the levels of acetylcholine in the brain, thereby helping to improve cognitive function.
Rivastigmine belongs to a class of drugs known as cholinesterase inhibitors. These medications work by inhibiting the breakdown of acetylcholine, a neurotransmitter important for memory and learning, thereby increasing its levels in the brain. This mechanism helps to improve cognitive symptoms in patients with Alzheimer’s disease and Parkinson’s disease dementia.
What medications are acetylcholine inhibitors?
Donepezil and galantamine
What medication is a N-methyl-d-aspirate (NMDA) receptor antagonist?
Memantine
If you are switching a patient from a SSRI to a MAOI, how long do you have to wait to start the MAOI?
5 half life’s after discontinuation of the SSRI
What medication can cause SIADH?
Carbamazepine
What are the symptoms of antidiuretic hormone secretion ?
Impair water excretion leading to hyponatremia, hypervolemia, or euvolemia.
What mood stabilizer to treat bipolar disorder can cause kidney stones?
Topiramate ( topamax)
What are facial characteristics of a child who might have fetal alcohol syndrome ?
Small head, short eyelid opening, flat midface, smooth philtrum, underdeveloped jaw, thin upper lip, and short nose.
Naltrexone is what receptor antagonist?
Mu-opioid receptor antagonist
If a pt is having sexual disfunction problem and depression what is a possible medication?
Vilazodone
What is vilazodones primary mechanisms of action?
Serotonin reuptake inhibition and serotonin 1A partial agonism
Pts of Asian decent have to be genetic screening for what?
HLA-B 15:02
If a pt is Asian and genetic testing should be completed for what allele and for what medication?
HLA-B15:02, carbamazepine (tegretol) because it can cause SJS and epidermal infection
Patient has NMS, what medication do you give to lower dopamine receptor blockade?
Bromocriptine
Dantrolene is used for what?
NMS as a muscle relaxant
Which part of the brain area is believed to play a role in regulating pain and is targeted in transcranial magnetic stimulation for the purpose of reducing pain?
Prefrontal cortex
Chronic pain is associated with part of the brain?
Decreased gray matter in the prefrontal cortex
The most likely mechanism of action of mirtazapine (remeron)?
Noradrenergic and selective serotonergic antidepressant, an antagonist or presynaptic alpha-2 adrenergic receptors and facilitates serotonin release.
Decreasing gamma-aminobutyric acid (gaba) in the mesolimbic cortex increases symptoms of what?
Anxiety
What is the most abundant inhibitory neurotransmitter in the brain?
GABA
Benzodiazepines bind with what receptors to potentiate what effect?
GABA receptors to create anxiolytic or calming effects of GABA.
What is the mechanism of action of atomoxetine in ADHD?
Selective norepinephrine reuptake inhibitor
What does strattera inhibit?
The presynaptic norepinephrine transporter, preventing the reuptake of norepinephrine throughout the brain while also inhibiting the reuptake of dopamine in specific brain regions , like prefrontal cortex
Lithium exposure during pregnancy is most associated with the following conditions in the infant?
Cardiac malformations
Ebsteins anomaly is associated with what medication?
Lithium, cardiac malformation of a heart
Where is clozapine metabolized?
Liver
Clozapine is metabolized by what CYP enzyme?
1A2
Smoking tobacco can induce the activity of this enzyme and lead to what?
Increased metabolism of medication, like clozapine .
After being converted to its active form , this prodrug works by increasing norepinephrine and dopamine . The medication is what?
Lisdexamfetamine (vyvanse)
what is acetylcholine primarily associated with?
cognitive functions
glutamate is excitatory or not neurotransmitter?
excitatory
endorphins are associated with what?
pain modulation
histamine plays a role in what?
role in alertness and the sleep-wake-cycle.
if lithium level is above 1.5 what do you do as a provider as the initial action of the PMHNP?
DISCONTINUE LITHIUM AND START THE PATIENT ON AN ALTERNATIVE MOOD stabilizer
serotonin and dopamine, including bipolar disorder
low serotonin levels are associated with depressive symptoms, while elevated dopamine levels are linked to manic or hypomanic symptoms. the patient’s presentation of both depressive and elevated mood episodes suggests the involvement of these two neurotransmitter systems.
Lithium toxicity symptoms
Tremors, nausea, confusion, and coarse hand tremors.
Lithium goes through what organ?
Kidney
aripiprazole goes through what organ?
Liver, partial D-2 receptor agonist, decreased weight gain.
Olanzapine goes through what organ
kidney
ziprasidone is processed through what organ?
liver-
what do you treat serotonin syndrome?
cyproleptadine /benzo, hydration, electroly,
major s/s = tremers, clonus, hyperflexia
lithium is a protectant medication for pt with SI in what disease? why?
bipolar with hx of suicide attempts or has current suicide ideation.
lithium’s primary mechanism in reducing suicidal ideation involves the modulation of glutamate receptors. this action is associated with a decrease in impulsivity and aggressive behavior, making it a valuable choice for patients at risk of suicide.
what do you treat NMS with
treat with bromocriptine = D2 med
dantrolene= muscle relactant
major s/s= mutism, cognition change, ridigidity, increased CK= rabdo
if a pt is taking lithium and consuming alcohol, what caution should be taken regarding lithium levels?
lithium levels may be higher due to decreased renal clearance.
alcohol use disorder can lead to impaired renal function, and since lithium is primarily excreted by the kidneys, decreased renal clearance can result in higher lithium levels in the blood stream.
are course hand tremors and confusion are symptoms of what? what do you do?
lithium toxicity, stop the medication/discontinue lithium. if not an option then draw lithium levels.
a pt is on olanzapine for a year and has a sedentary lifestyle, gaining weight, and lab results indicate metabolic syndrome. What is the most appropriate initial action for the PMHNP?
educate the patient!!
How does hypokalemia affect Lithium?
Decrease lithium levels by enhancing renal excretion
how does hyponatremia affect Lithium?
increase lithium by reducing renal excretion
dehydration affects Lithium how?
Increase Lithium levels due to decreased renal excretion
How does NSAIDs affect Lithium?
NSAIDS increase lithium levels by reducing renal excretion
Inhibitors
HI= hi drug level=increase drug level and decreases metabolism= toxic levels
InDucers
DECREASE DRUG LEVELS= increase metabolism= subtheraputic levels
How do diuretics affect Lithium?
inhibitor=increase medication, need to decrease lithium
how does zyprexa and nicotine?
inducer= decrease zyprexa= decreasing medication, increase medication dose
pt recently stopped smoking and on zyprexa? what do you do?
decrease zyprexa.
pt on carbamazepine and oral contraceptive?
increase carbamazepine and use other pregnancy precautions
carbamazepine and erythromycin?
decrease carbamazepine
ibuprofen and lithium?
decrease lithium
NASAIDS and ace inhibitors?
decrease lithium
flonase and tegretol?
increase tegretol
birth control pills and lamictal?
increase lamictal
can a mood stabilizer cause an HTN crisis?
yes
can antidepressant cause HTN crisis?
yes
if a pt is experiencing hypertension, headache, and anxiety, bp=200/130. Is the patient eXPERIENCING HTN Crisis?
yes
What is the priority action of the PMHNP with suspected hypertensive crisis and taking antidepressant and mood stabalizer?
d/c BOTH medications immediately
what mood stabilizer is considered safe during pregnancy?
Lamotrigine (Lamictal)
a mood stabilizer that has been studied more extensively in pregnant populations and is often considered safer compared to depakote.
What issues is Valproic acid/depakote/sodium valproate associated with during pregnancys?
neural tube defects and other congenital malformations.
what is the most likely side effect associated with valproic acid/depakote? what is the appropriate action for the PMHNP?
hyperammonemia; monitor ammonia levels and consider dosage adjustment.
what are symptoms of hyperammonemia?
hand tremors, excessive thirst, and increased urination, are indicative of hyperammonemia.
WHAT IS a rare side effect of Depakote?
Pancreatitis
rare side effect of Depakote.
what are s/s of pancreatitis due to Depakote?
severe abdominal pain, nausea, and vomiting are indicative of potential pancreatic involvement.
What is the initial action of the PMHNP if pt has pancreatitis symptoms on depakote?
d/c depakote and order pancreatic enzyme tests.
What are patients at risk for with Tegretol? Is it an inducer or inhibitor? what CYP?
agranulocytosis, Inducer, CYP 3A4, 1A2, &2c19
what are the signs and symptoms of Tegretol (Carbamazepine)? what is the initial action of the PMHNP?
fever, sore throat, and malaise. Promp D/C of the medication is crucial to prevent further complications and ordering CBC.
what is a rare but serious side effect of Carbamazepine (Tegretol)? what is the PMHNP’s immediate action?
Aplastic Anemia, D/C tegretol and order a CBC.
S/S: fatigue, pallor, and petechiae= hematological involvement.
In the Asian population, which mood stabilizer requires genetic testing before initiation to assess the risk of severe dermatologic reactions?
Carbamazepine (Tegretol) is known to be associated with a higher risk of severe dermatologic reactions, especially in individuals of Asian descent. Genetic testing, particularly for the presence of the HLA-B 1502 allele, may be recommended b/f initiating treatment.
What are normal TSH level?
0.5-5.
what are normal BUN: CREATININE?
10:1-20:1
normal sodium levels?
135-145
normal WBC?
4,500-11,000
normal creatinine serum level?
0.6-1.2
Elevated creatinine levels= reduced renal clearance.
what are normal BUN level?
10-20
where are lithium excreted from ?
kidney
what is the risk of taking clozaril?
agranulocytosis= life-threatening drop in white blood cell count.
Pt has parkinson’s disease, symptoms are primarily due to the degeneration of what? and in what specific area of the brain?
dopaminergic neurons and in the substantia nigra area of the brain (midbrain). This leads to deficiency of dopamine in the basal ganglia= motor symptoms such as bradykinesia (slowness of movement), resting tremors, and rigidity.
what ist he hippocampus associated with?
learning and memory processes
what is the amygdala involved with?
emotion processing and regulation
thalamus serves as what?
a relay center for sensory information.
what area of the brain is ADHD associated with and affects?
prefrontal cortex, which plays critical role in executive functions, including attention, impulse control, and decision-making.
which neurotransmitters are most directly involved in the regulation of executive functions in the prefrontal cortex and may be dysregulated in ADHD pts?
dopamine and norepinephrine
clozapine is associated with what liver enzyme?
CYP1A2; INDuction leading to increased clozapine metabolism, reducing its effectiveness and potentially causing treatment failure.
What is the mechanism of action of atypical antipsychotic medications in the treatment of schizophrenia?
these medications block dopamine receptors int he mesolimbic pathway while increasing dopamine activity in the nigrostriatal pathway. Primary mechanism of action is related to dopamine receptor blockade.
Second-generation antipsychotics have a strong affinity for seotonin receptors, leading to increased serotonin transmission.
what is the mechanism of action of typical (first-generation antipsychotic medications?
blockade of dopamine D2 receptors in the mesolimbic pathway.
typical antipsychotic medications primarily work by blocking dopamine D2 receptors in the mesolimbic pathway. this helps alleviate positive symptoms of schizophrenia, such as hallucinations and delusions.
what test will you have the patient do to test cranial nerve VII?
Have the patient smile, frown, and puff out their cheeks.
What are symptoms of cranial nerve VII dysfunction =
facial drooping, difficulty closing one eye, and asymmetric smile.
WHat cranial nerve are you testing with different scents with nostrils?
Olfactory nerve= CN I= sense of smell
Cranial nerve II
Optic nerve= visual acuity
read an eye chart.
