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PMHNP Exam > First > Flashcards

First Flashcards

1
Q

The concepts of defense mechanisms, transference and countertransference are derived from what theory?

A

Psychodynamic theory (Freud, Jung, Adler)

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2
Q

What is the basic premise of psychodynamic Theory?

A

There are conscious and unconscious mental processes that guide and influence a person’s thoughts and behaviors. The focus is the unconscious processes and how they relate to and affect a person’s behavior.

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3
Q

12 cranial nerves (on occasion our trusty truck acts funny, very good vehicle anyhow)

A

I- olfactory
II - optic
III- oculomotor
IV - trochlear
V- trigeminal
VI- abducens
VII - facial
VIII- vestibulocochlear
IX- glosopharyngeal
X- vagus
XI- accessory
XII- hypoglossal

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4
Q

Which class and which antidepressants block voltage sensitive Na+ channels in the — and — leading to —-

A

TCA
Clomipiramine (AnaFranil)
Heart and brain
Increases QT prolongation and Lowers seizure threshold

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5
Q

Mild serotonin syndrome syndrome symptoms

A

Tachycardia, flushing, fever, HTN, ocular oscillations, myoclonic jerks

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6
Q

Severe serotonin syndrome symptoms

A

Hyperthermia, coma, convulsions, autonomic instability, death

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7
Q

10 curative factors that differentiate group work from individual therapy. Who was the first to propose the theory.

A

Instillation of hope
University
Altruism
⬆️ socialization skills
Imitative behaviors
Interpersonal learning
Group cohesiveness
Catharsis
Existential factors
Corrective refocus

Yalom
“In university, all social skills, imitate, interpersonal, groups, catty existential, corrections”

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8
Q

Paired structure of DNA in nucleus cell

A

Chromosomes (structures of DNA)

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9
Q

Which medication is associated with retinal pigmentation, at what dose and what may it lead to even when stopped?

A

Thioridazine (mellaril), > 1000 mg. May lead to blindness.

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10
Q

Most central neurotransmitter in the neurophysiology of psychosis

A

Dopamine

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11
Q

Universal excitatory neurotransmitter and what has it been connected to?

A

Glutamate - bipolar disorder, seizures, mood imbalances and schizophrenia.

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12
Q

Which dopaminergic pathway is involved in addiction?

A

Ventral tegmental (reward pathway)
(Very addictive, heroin and meth work on this pathway).
Mnemonic- Very Tingling Addiction.

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13
Q

Nigo Strialtal Pathway

A

Involuntary movement, Stuttering, Parkinsonism

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14
Q

Meso limbic system

A

Transmits dopamine to prefrontal cortex and midbrain. = (+) symptoms of schizophrenia. {blocking dopamine decreases (+) symptoms of schizophrenia.

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15
Q

Frontal lobe reaches maturity at what age?

A

Mid to late 20’s

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16
Q

Frontal lobe begins to atrophy at age?

A

60’s

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17
Q

What does frontal lobe govern?

A

Controls voluntary movement, ability to project future consequences based on current actions, governs according to social cues, distinguishes similarities and differences.

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18
Q

What does frontal lobe dysfunction result in?

A

Incongruent affect, decreased motivation, impaired judgment and attention. Confabulation.

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19
Q

Internal validity

A

Independent variable causes a change in the dependent variable

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20
Q

External validity

A

when sample is representative of the population and the results can be generalized.

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21
Q

Variance

A

how the values are dispersed around the mean

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22
Q

Antecedants to lapse or relapse

A

accessability to substance, rationalization, and minimizing consequences

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23
Q

Example of an immediate determinant of lapse or relapse

A

coping skills

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24
Q

Symptoms of neurosyphillis

A
  1. wide based gait
  2. (+) romberg sign
  3. loss of vibratory and proprioceptive senses in lower extremities
  4. Decreased deep tendon reflex
  5. Pupil abnormalities
  6. Tremor
  7. Dyscoordination
  8. Spacitity in lower extremities
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25
Q

Risk factors for MDD

A

Genetic predisposition, first degree relative with MDD or dysthmymia

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26
Q

What factors affect distribution of a drug in the body

A

-Malnourished - protein deficit (< 16 mg/dl), toxicity can be achieved at low dose.

-fat to lean muscle ratio (as in elderly)

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27
Q

In terms of half-life, how are drugs typically dosed.

A

Once per half life

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28
Q

In terms of half-life, when is steady state achieved in the body?

A

Five half-lives

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29
Q

Typically, how many half-lives are needed before a drug is completely eliminated from the body.

A

Five Half-lives are needed to eliminate the drug from circulation completely.

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30
Q

What do CYP 450 inducers do to drugs

A

Increase metabolism thereby decreasing serum levels of the drug

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31
Q

What affect do CYP450 inhibitors have on drug

A

Slows metabolic rate thereby increasing the serum blood levels

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32
Q

Which drugs most commonly associated with Steven’s-Johnson syndrome?

A

Sulfa drugs, lamictal, carbamazepine

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33
Q

What elevates ammonia and which medication combination

A

Depakote, severe liver disease. Most common when depakote combined with amitryptyline and fluoxetine (inhibit metabolism of valpofic acid.

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34
Q

Advanced directive

A

Aka durable power of attorney. It’s a written document that’s legally binding in all 50 states appoints a person to make healthcare decisions on your behalf if you’re unable to.

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35
Q

HAM-A rating system

A

Hamilton anxiety score
Mild - 14-17
Moderate - 18-24
Severe - 25-30

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36
Q

Statistics regarding ADHD

A
  • Rare to occur after age 35
  • Mean age of onset is 19.5
  • Males have earlier age of onset (25% before age 10)
  • females are affected slightly more
  • 12 month prevalence in the US is 1.2%
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37
Q

Schizoid personality traits

A

Lifelong pattern of emotional detachment, isolation, lack of interest in forming relationships

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38
Q

Schizophrenia negative cluster symptoms

A

Attention deficit, alogia or poverty of speech, affective flattening, avolition, apathy, anhedonia, difficulties with abstract thinking

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39
Q

Positive symptom cluster schizophrenia

A

Hallucinations, delusions, aggression, disorganized behaviors, grandiosity, mania, paranoia

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40
Q

Associated symptom cluster schizophrenia

A

Inappropriate affect, dysphoric mood, depersonalization, derealization, high anxiety

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41
Q

Immediate determinants of relapse

A
  1. High risk situations -negative emotional states (associated with highest risk of relapse) can be triggered by perceived peer pressure, lack of support
  2. Coping skills - response to high risk situations
  3. outcome expectancies - what the person expects to occur in response to substance use versus abstaining
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42
Q

Antecedents relapse and prevention

A
  1. lifestyle factors, alternative healthy behaviors, life balance, recreational activities, social connections
  2. Urges/cravings: environmental cues, accessability to substances, romanticizing use, mentally minimizing consequences, rationalization
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43
Q

PDQ-4

A

personality diagnostic questionnaire designed to assess personality traits and potentially personality disorder.

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44
Q

What population has highest rate of antisocial personality disorder?

A

Adult men with alcohol use disorder in a forensic setting

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45
Q

Tryptophan increases the risk of serotonin syndrome when taken with?

A

SSRI, MAOI. St john’s wart

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46
Q

What medications does melatonin interact with

A

Aspirin, NSAIDS, beta blockers, and steroids.

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47
Q

Which case determined competence to stand trial?

A

1960 Dusky vs. US

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48
Q

Which case is known for originating the insanity defense

A

Durham vs. US

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49
Q

Which case ruleds that harmlessly mental ill patients who can survive outside cannot be held against their will. Determined that the presence of a mental illness alone does not justify involuntary hospitalization.

A

1976 case of O’connor vs. Donaldson

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50
Q

Which case determined that the patients have the right to refuse any treatment and use an appeals process?

A

Rennie vs. Klein 1979

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51
Q

The reticular formation is part of what structure and regulates what?

A

Brain stem and regulates involuntary movement, muscle tone, BP and respiratory rate

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52
Q

Which neurotransmitter involves memory and sustained autonomic functions

A

acetylcholine and glutamate (primary excitatory neurotransmitter in CNS that regulates sympathetic function - increased HR and BP)

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53
Q

The general function of serotonin

A

regulation of sleep, pain perception, mood states, temperature, aggression and libido

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54
Q

Females with bipolar disorder are more likely to experience which features

A

rapid cycling and mixed states, depressive episodes, higher rates of comorbid alcohol use and eating disorders.

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55
Q

What values can be increased during treatment with lithium, thiazide diuretics, alkaline antacids or vitamin D

A

Calcium

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56
Q

What is the RAPS4

A

Rapid alcohol problem screen - 4 questions (remorse, amnesia, performance, and eye opener).

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57
Q

According to Erikson, which psychological stage if not resolved, develops delinquet behavior, borderline personality, gender-realted identity disorders

A

Identity vesus role confusion: adolescence to adulthood

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58
Q

Which theorist believed that child development is shaped by native endowment, biological and environemental factors

A

Jean Piaget

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59
Q

What are the barriers to interprofessional collaboration?

A
  1. Gender, power, socialization, education, status, cultural differences
  2. lack of a payment system and structure that rewards collaboration
  3. Misunderstanding of the scope and contribution to each profession
  4. Turf protection
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60
Q

Corrective refocusing

A
  • Yalom - group work, one of the curative factors
  • Occurs when participants reexperience family conflicts in the group. These experiences allow them to recognize and change their problematic behaviors.
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61
Q

According to Harry Stack Sullivan’s interpersonal theory, the primary motive of human behavior is?

A
  • The satisfaction of interpersonal needs.
  • The needs arise from early experiences and shape the development of personality.
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62
Q

Who published the 2010 report The Future of Nursing: Leading Change, advancing Health.

A

The Institute of Medicine

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63
Q

The Future of Nursing: Leading Change, Advancing Health report developed what 4 key messages?

A
  1. Nurses should practice to the full extent of their education
  2. Nurses should seek higher levels of education through seamless academic progression.
  3. Nurses should be full and equal partners with physicians.
  4. To improve the quality of health care, nurses need an improved information infrastructure.
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64
Q

What are the nurse practitioner’s standards of practice?

A
  1. Authoritative statements regarding the quality and type of practice that should be provided.
  2. Offer a way to judge the nature of care provided
  3. Reflect the expectation for the care that should be provided
  4. Professional agreement focused on the minimum level of acceptable performance.
  5. Can be used to legally describe the standard of care.
  6. May be either precise or general guidelines.
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65
Q

Nurse practitioners scope of practice

A
  • Defines the NP role and actions
  • Identifies competencies assumed to be held by al NP who function in a particular role.
  • Has broad variations from state to state due to outdated legislation.
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66
Q

What % of US homeless population has coocurring substance and mental health disorders.

A

50%

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67
Q

Which sleep disorder falls asleep and wakes earlier

A

Advanced sleep cycle

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68
Q

Which sleep cycle falls asleep later and wakes later

A

Delayed sleep phase

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69
Q

Falling asleep usually and waking up progressively later

A

Non 24 hr sleep cycle

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70
Q

Decreased levels of what can cause renal failure

A

Calcium

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71
Q

What disorders are related to increased calcium

A
  • Acidosis - (increases amount of calcium flowing out of bones, increased stimulation of parathyroid hormone, increased albumin bound calcium released into circulation)
  • hyperthyroidism - (increase in thyroid hormone, increase bone turnover and lead to hypercalcemia)
  • Addison disease- Adrenals doesnt produce enough hormones, specifically reduced cortisol leading to critically low blood pressure -may increase reabsorption of Ca into circulation and decreased removal from kidneys.
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72
Q

What specifier is used for a mood disorder with depressive and manic episodes

A

With mixed features

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73
Q

Regarding mood disorders, what does atypical features refer to

A

Excessive eating and weight gain, excessive sleeping, feeling sluggish or paralyzed, sensitive to rejection

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74
Q

Regarding mood disorders, what does with melancholic features specifier mean

A

Feeling worse upon wakening than in the afternoon, weight loss, decreased appetite, excessive guilt, agitation and are indecisive

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75
Q

What disorders does Sam-e treat

A

Depression, liver disease, osteoarthritis

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76
Q

Lethality in mental health means

A

The likelihood a person will commit suicide or homicidal violence.

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77
Q

Description of ODD including time frame

A

An enduring pattern of defiance, angry, irritable mood, argumentative and vindictive behavior for at least 6 months.

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78
Q

What is thought to be the etiology of ODD

A

Parents who express emotions in an extreme way, unresolved conflicts, trauma, PTSD, temperament

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79
Q

What is supplemental insurance from private insurance companies elderly can purchase to cover extra expenses Medicare doesn’t cover

A

Medi-gap

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80
Q

5 stages of group dynamics

A
  1. Forming
  2. Storming
  3. Norming
  4. Performing
  5. Adjourning
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81
Q

Hallmark presentation of delirium.

A

Impaired attention and memory. It’s an acute fluctuating disturbances in attention and awareness. Accompanied by changes in perception, cognition, behavior. Patients may also experience disturbances in sleep wake cycle, perceptual disturbances, hallucinations or delusions.

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82
Q

Humanistic therapy focuses on

A

Socratic questioning, CBT techniques focusing on self actualization, finding meaning in one’s life and its circumstances. Self-growth.

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83
Q

Which therapy targets finding meaning in one’s life and accepting reality and making responsible decisions.

A

Existential Therapy

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84
Q

Goals of family systems therapy

A

Murray Bowen- focuses on chronic anxiety in families with the goals of increasing self differentiation, which helps family members learn that their self worth is not dependent on external relationships, circumstances or occurrences.

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85
Q

id

A

Freud- primitive and instinctual part of the psyche driven by the pleasure principle seeking immediate gratification of basic needs and desires.

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86
Q

Ego

A

Rational and logical principle seeking balance the balance of the impulses of the id with the demands of reality.

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87
Q

Grassroots lobbying

A

nonpaid individuals contact legislators to influence policy

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88
Q

Special interest group

A

collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers.

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89
Q

caucus

A

group of members of congress or a political party created to support a defined political ideology.

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90
Q

continuing resolution

A

type of appropriations legislation that financially supports the Government.

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91
Q

Virtue of hope is associated to resolution fo which stage

A

erikson - trust vs mistrust

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92
Q

Virtue of will is associated with which resolution

A

erikson - autonomy versus shame and doubt

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93
Q

Virtue of purpose is associated with resolution of which stage

A

erikson - initiative versus guilt

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94
Q

Virtue of competence is associated with resolution of which stage

A

Erikson - industry versus inferiority

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95
Q

Virtue of fidelity is associated with the resolution of which stage

A

identity versus role confusion (forms a strong sense of self able to commit to values)

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96
Q

Virtue of love related to the resolution of which stage

A

Erikson - intimacy versus isolation

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97
Q

Virtue of **care **is related to resolution of which stage

A

erikson - generativity vs stagnation

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98
Q

Virtue of wisdom is related to resolution of which stage?

A

Erikson - ego integrity versus despair

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99
Q

What does the hippocampus play a role in

A

memory and spatial navigation

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100
Q

what is the basal ganglia involved in

A

motor control

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101
Q

what is the cerebellum involved in

A

coordination and balance

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102
Q

In patient interviewing clarification is what type of techinique

A

expanded psychiatric interview technique

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103
Q

Superego

A

Represents the moral and ethical standards of the individual striving for perfection and demanding adherence to social norms and values.

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104
Q

What is the Wisconsin card sorting test (WCST)

A

A test for executive function specifically looking at cognitive shifting, mental flexibility and problem solving. Abstract thinking.

Sort cards, rules change without notice, need to figure out rule and make correct choice.

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105
Q

What is the TRail making test (TMT)

A

Test for visual attention, cognitive flexibility, and processing speed.

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106
Q

What is the Stroop Color and Word Test (SCWT)

A

Assess cognitive control and response inhibition.

Giving two conflicting pieces of information - given the word blue with red font asking what color the word is in.

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107
Q

What is the WHODAS

A

World Health Organization disability assessment schedule. Assess 6 domains.
1 -cognition
2- mobility
3- self care
4 -getting along with people
5 -life activities
6 -participation in society

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108
Q

According to Piaget, children between the age of 6-11 are in what cognitive development stage

A

Cognitive-spatial concepts
-hierarchy classification
-reversibility
-conservation
-decentration
-spatial operations
-horizontal decelage
-transitive inference

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109
Q

What year was first nurse practitioner program developed

A

1965

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110
Q

What is the cerebral cortex responsible for

A

Receiving sensory incoming sensory information from the thalamus

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111
Q

What structure converts short term memory into long-term memory

A

Hippocampus (of the limbic system)

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112
Q

3 examples of how different cultures describe panic attacks

A

Hit by the wind - Vietnamese
Soul lost- Cambodia
Attack of the nerves -Latin America

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113
Q

What is ARRA

A

American recovery and reinvestment act. 2009 Obama aimed at saving and creating jobs and establishing infrastructure, education and healthcare. It included the HITECH act which attempts to update American infrastructure including electronic health records.

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114
Q

Which type of dementia manifests as a progressive cognitive decline in a step wise fashion.

A

Vascular dementia

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115
Q

What are extrapyramidal side effects associated with

A

Drug effects that affect motor activity and muscle movement. They occur in the nigostriatal tract where there is deficiency in dopamine and excess acetylcholine.

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116
Q

What does muscaranic 1 antagonist medications do

A

**anticholinergics **- Reduce effects of excessive acetylcholine relieving extrapyramidal symptoms.

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117
Q

Ethical duty doing what’s fair

A

Justice

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118
Q

Ethical duty veracity

A

Telling the truth, honest and to provide accurate information. Requires nurses to be truthful in all aspects of a patient’s care, including diagnosis and treatment goals. Helps patients make informed decisions and builds trust.

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119
Q

Which ethical duty means treating everyone with dignity

A

Respect

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120
Q

Lethality

A

The liklihood that a person will commit suicidal or homicidal focused violence

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121
Q

Biological preventative factors for developing a psychiatric disorder

A
  • without a history of mental illness
  • Healthy nutritional status
  • good general health
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122
Q

Psychological preventative factors

A
  • Good self esteem
  • Good self concept
  • Internal locus of control
  • Healthy ego defenses
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123
Q

Social preventative factors for developing a psychiatric disorder

A
  • Low stress occupation
  • higher socioeconomic status
  • Higher level of education
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124
Q

What is the drug of choice for managing an agitated or confused patient with delirium

A

Haldol

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125
Q

Name some things that can cause an increase in calcium

A

vitamin D, lithium, alkaline antacids

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126
Q

Clozapine induced agranulocytosis symptoms

A

High fever, pharyngitis, oral and peri-anal ulcerations

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127
Q

Ataque de nervios

A

Latinos from carribean - sense of being out of control, uncontrollable shouting, breaking things, trembling, crying, fainting. Usually occurs after a stressful event relating to family.

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128
Q

Which medications can cause depression

A

Beta blockers, progesterone, interferon, retroviral drugs, neoplastic drugs, isotretinoin

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129
Q

Which medications induce mania

A

Steroids, disulifuram (Antabuse), antidepressants, isoniazid

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130
Q

Prevalence of bipolar disorder including which folks have higher rates of

A

Higher in high income countries 1.4% compared to 0.7 % low income. Those who are separated, divorced, or widowed have higher rates. 12 month prevalence of bipolar disorder in US is 1.8%. Lifetime male to female ratio is 1:1.

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131
Q

What is the reticular formation part of and what dies it regulate.

A

Brain stem- regulates involuntary movement, muscle tone, blood pressure, and respiratory rate.

132
Q

Ziprasidone (key points to remember)

A

Geodon - taking with food increases absorption two fold, monitor QTc, caution in CHF, hypothermia, hypomagnesia, recent MI.

133
Q

Beneficence

A

The duty to help a patient by doing what’s best for them.

134
Q

Barriers to meaningful use include

A

Staff training, workflow, usability, altered patient provider interaction, clinician resistance to change.

135
Q

What medical conditions is panic disorder associated with

A

IBS, dizziness, cardiac arrhythmia, hyperthyroidism, asthma, COPD

136
Q

Phallic stage

A

Age 3-5/6, identify with same sex parent, penis object of interest to both genders during this stage

137
Q

Internal validity

A

When an independent variable causes a change in the dependent variable.

138
Q

Serotonin dopamine antagonist

A

2nd generation antipsychotic

139
Q

Examples of healthcare informatics tools

A

Clinical guidelines, EHR, patient care technology devices, database of healthcare guidelines

140
Q

Black box warnings carbamazepine

A

Agranulocytosis, aplastic anemia

141
Q

When there is a disruption in this pathway, ADHD, addiction, and schizophrenia can result.

A

Mesocorticolimbic

142
Q

Timeline Criteria for GAD

A

More days than not for at least 6 months

143
Q

What % of incarcerated population has severe mental illness

A

15-24%

144
Q

Examples of nursing sensitive adverse events

A

Failure to rescue
Nosocomial infection
Pressure ulcers
Falls
Medication errors
Transfusion errors

(Events that can be directly related to quality of nursing care and could be improved upon with improved nursing practices)

145
Q

Gag rule

A

In managed care NP are prohibited from discussing alternative treatments not covered by the plan and discussing limitations of the plan or speaking negatively about the plan.

146
Q

Contraindications for seclusion and restraint.

A
  • Overtly suicidal patients
    -Unstable psychiatric or medical conditions
    -For punishment
    Delirious or demented patient that cannot tolerate decreased stimulation
  • patient with severe drug reactions or overdose
147
Q

Alzheimer’s (DAT) characteristics

A
  • usually occurs in 6th decade of life (onset in 4th/5th) most likely familial.
  • most prevalent type
  • gradual onset & progressive decline
  • without focal neurological deficits
  • definitive diagnosis by autopsy only with amyloid deposits and neurofibrillary tangles.
148
Q

Lewy Body Dementia

A

-Characterized by abnormal clumps of proteins causing neuronal malfunction

  • commonly occurring in patients with Alzheimer’s and Parkinson’s disease.
  • characterized by visual hallucinations of small creatures

*exacerbated by antipsychotic medication!

149
Q

Picks disease

A

-Frontotemporal dementia
-onset 5th and 6th decade of life
- marked by personality change
-cognitive decline occurs later in the disease process

150
Q

Kluver Bucy syndrome

A
  • Type of frontotemporal dementia
    -uninhibited, cheery, hypersexual, hyperorality (esp carbs)
151
Q

Creutzfeldt -Jakob disease

A
  • precipitous onset (rapid) prion (mis wrapped proteins)

-sometimes referred to as mad cow disease

  • rapid decline that results in death within 6 months
  • middle aged adults presenting with fatigue, flu-like symptoms, cognitive impairment

-later symptoms aphasia, apraxia, emotional lability, and psychosis

152
Q

Huntingtons disease

A
  • Subcortical dementia characterized by motor abnormalities including psychomotor slowing, choreoathetoid movements, and executive dysfunction

-complicated by impaired language, memory and insight later in disease

153
Q

Vascular dementia

A
  • formerly known as as multi infarct dementia
    -rare under age 65
    -more sudden onset than Alzheimer’s
  • Progressive decline in a stepwise fashion
  • rapid episodic deterioration with intermittent plateaus
  • previously lost function is not regained
154
Q

Dementia in HIV

A
  • poor prognosis death within 6 months
  • in late stages may experience psychosis
    -decline is progressive with motor and behavioral abnormalities
  • secondary disorders may develop such as OCD, PTSD, GAD, depression and mania
  • accompanying symptoms such as mania, mutism, global cognitive impairment, seizures disorder, delusions, hallucinations, apathy and self neglect may raise suspicion for organic etiology
155
Q

What’s a more severe form of HIV associated neurocognitive (HAND) syndrome and characteristics of HAND

A
  • HIV dementia
  • subcortical dementia with parenchymal abnormalities visualized on MRI
156
Q

Most prominent symptom of dementia

A

Impaired immediate and intermediate memory

157
Q

Delirium neurological findings

A

Psychomotor agitation, restlessness, purposeless, random actions, uncoordinated, tremor, myoclonus, nystagmus, asterixis (flapping tremor)

158
Q

Asterixis

A

Flapping tremor

159
Q

Comparing dementia to delirium regarding orientation

A
  • dementia impaired late phase
  • delirium acutely impaired due to LOC
160
Q

Part of brain responsible for orientation

A

Temporal, frontal, cingulate cortex

161
Q

In delirium what does immediate recall look like

A

Acutely impaired inattentive

162
Q

Part of brain responsible for immediate recall

A
  • Wernicke (part of temportal lobe, responsibe for language comprehension)
  • **Broca **(part of frontal lobe, responsible for expressive speech)
163
Q

Language, naming, repetition, reading and comprehension, writing associated with which parts of brain

A

Left temporal, left parietal, wernicke m, Broca

164
Q

Abstract thinking, proverb interpretation, and conceptualization portion of brain

A

Frontal and prefrontal

165
Q

Portion of brain visual processing and what symptom associated with this area.

A

Occipital - hallucinations

166
Q

Etiologies for delirium

A

-nutrition deficiency
- anemia significant enough to cause poor perfusion
- electrolyte abnormalities
- fever
- dehydration
- infection
- constipation
- toxicity
- poor perfusion

167
Q

Cholinesterase inhibitors function

A

Slow loss of function and reduce agitated behaviors (do not prevent progression of disease

168
Q

Side effects of cholinesterase inhibitors

A

Nausea, diarrhea, vomiting, weight loss, insomnia, vertigo

(increase the level of acetylcholine (ACh) in the nervous system by preventing the breakdown of ACh)

169
Q

Examples of cholinesterase inhibitors

A
  • donepezil (aricept) 5-23 mg per day
  • ruvastigmine (Exelon) 1.5- 6 mg bid or 4.5- 13.3 mg daily transdermal patch
170
Q

N methyl d aspartame glutamate receptor antagonist (NMDA receptor antagonist)

A

Believed to enhance cognition preventing over excitement glutamate receptors. Stalking neuro degenerative process and promote synaptic plasticity {ketamine, dextromethorphan, amatadine, phencyclidine, methadone}

171
Q

Name a n methyl d aspartame glutamate receptor antagonist

A

Memanatine (Namenda) 10- 20 mg

172
Q

Medical foods

A

Believed to provide esssential nutrients ( medium chain fatty acids) high concentration of ketones, to cross blood brain barrier

173
Q

Mild TBi recovery

A

Recover fully in 3 months, residual symptoms on 6 months

174
Q

What techniques are used in strategic therapy

A
  • straightforward directives are tasks in anticipation of family members compliance.

-paradoxical directive is negative in nature, assigned when family members are non compliant

-** reframing belief system** is when problematic behaviors are relabeled to have a more positive meaning.

175
Q

An exception finding question is used in what type of therapy

A
  • used in solution focused therapy
176
Q

Miracle question is in what type of therapy

A

Solution based therapy

177
Q

Miracle question is in what type of therapy

A

Solution based therapy

178
Q

What type of therapy is structural mapping used in?

A

Structural family therapy

179
Q

Reaction formation

A

Defense mechanism in which individual expresses feelings or behaviors that are opposite of their true feelings to deny their own feelings which they feel are morally or socially unacceptable

180
Q

Which type of aphasia difficulty comprehending meaning and what are some additional characteristics

A
  • Wernicke’s aphasia also known as receptive aphasia
  • May produce fluent speech devoid of content and may have difficulty understanding spoken or written language
181
Q

When in excess which neurotransmitter results in disorganized thinking, loose associations, tics, and stereotypic behavior

A

Dopamine

182
Q

A decrease in this neurotransmitter results in symptoms of parkinson’s, endocrine alterations, poor spatiality, lack of abstract thought.

A

Dopamine

183
Q

Excess of this transmitter results in restlessness, agitation, myoclonus, VS abnormailities,

A

Serotonin

184
Q

Excess of this neurotransmitter results in over-inhibition, anxiety, somatic complaints, self-conciousness and drooling.

A

Acetylcholine

185
Q

Excess of this neurotransmitter results in hyperalertness, paranoia, and decreased appetite.

A

Norepinephrine

186
Q

Services not covered under Medicare

A
  • Vision care
  • eyeglasses
  • dental care
  • dentures
  • hearing exams
  • hearing aids
  • routine physical exams
  • inpatient psychiatric hospitalizations
187
Q

suicidal patients usually are extremely hopeless and believe that through suicide they will experience

A

secondary gain

188
Q

selective abstraction

A

when individuals take things out of context

189
Q

Circular reasoning

A

logical fallacy where a person begins with what they think they want to end with when making a statement. An arguements conclusion is assumed to be true without providing any evidence. (X is true because X is true)

190
Q

Regarding sodium levels which is more associated with confusion

A

hyponatremia

191
Q

Age trust vs mistrust

A

Erikson - birth to 12 months

192
Q

Age autonomy vs shame and doubt

A

Erikson - 12-18 months to 3 years

193
Q

age initiative versus guilt

A

erikson 3 to 5-6 years

194
Q

Age industry vs inferiority

A

Erikson 5-6 years to adolescence

195
Q

Age Identity vs role confusion

A

Erikson - Adolescence to adulthood

196
Q

Age - intimacy vs isolation

A

Erikson - adulthood

197
Q

Age intamacy vs. isolation

A

Erikson - adulthood

198
Q

Age generativity vs. stagnation

A

Erikson - middle adulthood (40-65)

199
Q

1981 Roger’s vs Oken

A

Patient has the absolute right to refuse treatment but a guardian may authorize it.

200
Q

Characteristics of complex partial seizures

A
  • includes sensory aura and automatic behavior
    -during seizure may fiddle with clothing, blink eyes or lip smack
  • usually result in impaired consciousness
201
Q

What medication can be added to correct neutropenia caused by clozapine and how much does it increase?

A

Lithium - increase by about 2000, not dose related

202
Q

What does intersecting pentagon drawing assess for

A

Assesses visiospatial impairment- function of right parietal lobe, prefrontal cortex, basal ganglia.

203
Q

Orientation to person place and time effects what part of brain

A

Temporal lobe, frontal lobe, and cingulate cortex. Impaired in late phase of dementia.

204
Q

Delayed recall reflects what portion of brain

A

Function of hippocampus, and medial temporal lobe. More common in Alzheimer’s type dementia.

205
Q

What portion of brain affects abstract thinking

A

Frontal and prefrontal regions of the brain.

206
Q

Primary distinguishing factor between delirium and dementia

A

Disturbance of consciousness

207
Q

Mixed delirium characteristics

A

Cyclical manifestation of psychomotor retardation and agitation with disturbance in consciousness. Risk factors include infections, fever and relocation.

208
Q

What is a subtype of frontotemporal dementia (Picks) characterized by uninhibited cheerfulness and hypersexuality..

A

Kulver Bucey Syndrome- subtype of frontotemporal dementia.

209
Q

Creutzfeldt Jakob disease characterized

A

Precipitous onset cognitive decline that rapidly progresses to death. Symptoms include fatigue, cognitive impairment and eventually aphasia, apraxia, emotional lability, and psychosis.

210
Q

Hyperactive delirium

A

Characterized by psychomotor agitation and restlessness, hyper vigilance.

211
Q

Definition of psychosis

A

Disorganized behavior with one of three following
-delusions
-hallucinations
-disorganized speech
Marked by frequent derailment or incoherence.

212
Q

Brief psychotic disorder

A

Lasting 1 day to < 1 month
with at least one of the following
* delusions
* hallucinations
* disorganized speech (derailment or incoherence)
* grossly disorganized or catatonic behavior

213
Q

Schizophreniform disorder

A

Lasting greater than one month but less than 6 months

214
Q

Schizophrenia time frame

A

Lasting greater than 6 months

215
Q

Neurotransmitter characteristics associated with schizophrenia

A
  • Decreased serotonin, gamma aminobutryic acid (GABA), dopamine in mesocortical pathway
    -excess glutamate, dopamine in Mesolimbic pathway
216
Q

Characteristics of schizophrenia in females

A

Age onset 25-35, more associated dysphoria and paranoid delusions with comorbid hallucinations, less prodromal symptoms than men

217
Q

Characteristic of schizophrenia in men

A

Age onset 18-25, more prevalent negative symptoms than women, worse prognosis, more hospitalizations, less responsive to medications.

218
Q

Delusional disorder (including time frame)

A

A deeply held belief despite evidence of the contrary, or a lack of evidence to support the deeply held belief. Without prominent hallucinations. Lasting at least one month.

219
Q

Schizoaffective disorder characterized by

A

Characteristics of schizophrenia (hallucinations, delusions, disorganization) > 2 weeks without prominent mood symptoms. , AND manic or depressive features are present most of the time when not in psychosis.

220
Q

Which SGA least likely to prolong QTc?

A

Aripiprazole (Abilify)

221
Q

Which SGA least likely to cause EPSE

A

Quetiapine - (seroquel)

222
Q

How does smoking affect antipsychotic treatment?

A

Inducer CYP450 pathway reducing antipsychotic efficacy requiring increased dosages.

223
Q

What is ACT?

A

Assertive community treatment - intensive care management with multidisciplinary team includes home visits and long acting injections. Best for med noncompliance, frequent recidivism and failure to go to outpatient appointments.

224
Q

TD

A

Abnormal involuntary movements in a rhythmic pattern affecting face, mouth, tongue (potentially irreversible)

225
Q

When does NMS most often occur

A

More common typical antipsychotic within first two weeks of starting treatment, rapid dose escalation, parental route of administration

226
Q

Treatment NMS

A

bromocriptine, Benzodiazepines, Dantrium (dantrolene) interferes with calcium release from muscle cells- reduces muscle rigidity

227
Q

What causes EPS of antipsychotic

A

When dopamine is blocked from the receptor site, acetylcholine (ACH) is increased

228
Q

Which anticholinergic medications treat akinesia, akathisia, dystonia, pseudo-Parkinson’s

A

Anticholinergics - cogentin (benzotropine), Artane (trihexphenidyl)

229
Q

Which antihistamine used to treat akinesia (inability to perform a voluntary movement), dystonia, pseudoparkinsons

A

Benadryl

230
Q

Dopamine agonist used in akinesia and pseudo-Parkinson’s

A

Symmetrel (amanatadine)

231
Q

BB used in akathisia

A

Inderal (propranolol)

232
Q

Alpha blocker used in akathisia

A

Catapres (Clonidine)

233
Q

Benzos used in akathisia and dystonia

A

Klonopin or Ativan (lorazepam)

234
Q

Dendrites

A

Receive information to conduct toward cell body.

235
Q

Axon

A

Sends information away from cell body

236
Q

Depolarization

A

Initial phase - excitatory response. Calcium and sodium flow into cell.

237
Q

Repolarization

A

Restoration phase (inhibitory response) potassium leaves and chloride enters the cell.

238
Q

Categories of neurotransmitters

A

Monoamines, amino acids, cholinergics, neuropeptides

239
Q

Where is dopamine produced, precursor, how is it removed from synaptic cleft

A

Substantial nigra and Ventral tegmental area, precursor is tyrosine. Removed from cleft by monoamine oxidase (MAO) enzymatic action.

240
Q

Norepinephrine produced where, precursor, how removed. What is it implicated in.

A

Locus ceruleus of the pons. Precursor tyrosine, removed from synaptic cleft via an active reuptake process. Implicated in mood, anxiety, and concentration.

241
Q

Where is epinephrine produced and what system is it also referred to as

A

Adrenal glands adrenergic system.

242
Q

Serotonin is produced in, precursor, how removed from cleft,

A

Raphe nuclei of brain stem, tryptophan, active reuptake process.

243
Q

Major amino acids

A

Glutamate, aspartate, y-aminobutyric acid (GABA), glycine

244
Q

Glutamate, is universal, involved in the process of, implicated in which diseases processes

A

Excitatory neurotransmitter, involved in process of kindling, which is implicated in seizure disorder and bipolar disorder
And imbalance implicated in mood disorders and schizophrenia.

{kindling - theoretical concept where repeated episodes of a condition, like a seizure or a mood swing in bipolar disorder, can gradually lower the threshold for future episodes to occur, potentially making them more frequent and severe over time, even with seemingly smaller triggers; essentially, the brain becomes increasingly sensitive to stimuli that might initially have had little effect, similar to how repeatedly applying a small electrical stimulus to a brain region in animal studies can eventually trigger a full-blown seizure}

245
Q

Aspartate

A

Excitatory neurotransmitter (and amino acid)works with glutamate.

246
Q

GABA is universal, site of action of

A

y-aminobutyric acid, site of action of benzodiazepines, alcohol, barbiturates and other CNS depressants

247
Q

Glycine

A

Inhibitor neurotransmitter works with GABA

248
Q

Acetylcholine - what is it and where is it synthesized

A

Cholinergic - synthesized in nucleus of Meynert

249
Q

Norepinephrine receptors and its basic function in body

A

a1. a2
Attention
Focused alertness, orientation, fight or flight, learning memory

250
Q

Acetylcholine receptors

A

Nicotinic receptors, muscarnic

251
Q

Acetylcholine receptors

A

Nicotinic receptors, muscarnic

252
Q

Acetylcholine general function

A

Attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone

253
Q

Which neurotransmitter is implicated in Extra pyramidal movement, drooling, self- consciousness, somatic complaints, depression, over-inhibition

A

Acetylcholine excess

254
Q

Which neurotransmitter has AMPA, MNDA receptors

A

Glutamate

255
Q

Neurotransmitter implicated in kindling, seizures, anxiety panic

A

Glutamate - in excess

256
Q

Which neurotransmitter is implicated in lack of inhibition, decreased memory, euphoria, antisocial behavior, decreased speech, dry mouth, blurred vision constipation

A

Acetylcholine deficit

257
Q

Which medication requires testing for HLA-B gene for which population?

A

Asian, carbamazepine due to risk of Steven’s Johnson syndrome and toxic epidermal necrolysis (TEN)

258
Q

Common side effects of serotonergic medication side effects

A

*SPAROW-tonin
-Sleep - involved in regulating sleep. Differs from one to the other, activating or sedating

-Platelet dysfunction 10% serotonin is found in platelets where it’s involved with blood clotting. Increases risk for bleeding.

-Abdominal upset 90% of serotonin is found in gut. Causing nausea, diarrhea, stomach discomfort

-Reproductive sexual side effects

-Overdose. Potential to cause overdose.

-Weight gain

259
Q

Common side effects of serotonergic medication side effects

A

*SPAROW-tonin
-Sleep - involved in regulating sleep. Differs from one to the other, activating or sedating

-Platelet dysfunction 10% serotonin is found in platelets where it’s involved with blood clotting. Increases risk for bleeding.

-Abdominal upset 90% of serotonin is found in gut. Causing nausea, diarrhea, stomach discomfort

-Reproductive sexual side effects

-Overdose. Potential to cause overdose.

-Weight gain

260
Q

Where is serotonin produced

A

Raphe nuclei in brain stem

“Ray-phe nuclei brings rays of light to depression”

261
Q

Where is norepinephrine produced

A

Locus ceruleus

“Being cerounded makes your locus ceruleus jump”

262
Q

Where are a-1 adrenergic receptors found and what are main effects?

A

Primarily found in vascular smooth muscle. But also in GU and nervous system. Vasoconstriction.

263
Q

What part of brain is responsible for sleep-wake cycles

A

Hypothalamus

264
Q

What part of brain is responsible for sleep-wake cycles

A

Hypothalamus

265
Q

Which neurotransmitters are associated with sleep wake cycles

A

Serotonin, norepinephrine, acetylcholine

266
Q

Which neurotransmitters are responsible for wakefulness

A
  • HISTAMINE strong contributor to wakefullness. Histamine is produced in the posterior hypothalmus.
  • **norepineprhine **works on locus coeruleus of the brainstem to promote wakefullness (releases norepinephrine)
  • orexin AKA hypocretin orexin producing neurons are located in the lateral hypothalmic region. projects signals to various other parts of the brain to regulate wakefulness, appetite and energy metabolism.
  • sertotonin promotes wakefullnesss and supresses REM sleep
  • **acetylcholine **promotes wakefulness
267
Q

Two phases of sleep cycle

A

Nonrapid eye movement (NREM)
Rapid eye movement (REM)

268
Q

How many stages NREM sleep

A

3

269
Q

Stage 1 NREM

A

Lightest sleep stage, lasts up to 15 minutes, drowsiness easily disrupted, muscle tone begins to relax, Hypnic jerks (head nods, sensations of falling)

270
Q

Stage 2 NREM

A

Accounts for 40-60% of total sleep time, more difficult to Strouse, eye movement slows, activity busts (sleep spindles) and K complexes on ECG. Body temperature and heart rate decrease.

271
Q

Stage 3 NREM

A

5-15% total sleep time (higher during periods of rapid growth and development) deep restorative sleep, delta waves ECG, most difficult to arouse, parasomnias (sleep walking, sleep terrors. Somniloquy (sleep talking) occur

272
Q

When does REM sleep occur

A

Stage 4, 90 minutes after sleep onset and can last 10-15 minutes.

273
Q

Characteristics of REM sleep

A

Eyes move side to side, more active brain waves than 2 and 3. Arousal can occur more easily. Feel most groggy in this stage.

274
Q

Which questionnaire is used to assess excessive daytime sleepiness (EDS)

A

EPworth sleep scale. 0-24 points. > 10 warrants further investigation.

275
Q

Sleep latency

A

Time it takes to fall asleep

276
Q

Sleep efficiency

A

Time spent asleep while in bed

277
Q

Sleep maintenance

A

The ability to stay asleep for desired amount of time.

Disorder- Wake in the middle of the night and inability to go back to sleep (includes early morning insomnia)

278
Q

Polysomnography

A

Standard for evaluation sleep disorders- records brain waves, O2, HR, IM leg movements

279
Q

Multiple sleep latency test (MLST)

A

Monitor daytime napping to determine sleep latency

280
Q

Narcolepsy criteria

A

2 or > episodes of sleep latency less than 8 minutes and or 2 or more episodes with REM periods.

281
Q

What CSF test can be used when assessing for narcolepsy

A

Hypocretin (Orexin) less than 109

282
Q

Criteria for chronic versus short- term insomnia

A

Chronic - present at least 3 times per week for 3 months
Short-term 3 times per week for less than 3 months.

283
Q

Hypersomnolence

A

Dx of exclusion, persistent sleepiness despite getting 7 hrs sleep. Sx includes strong drive to sleep, difficulty waking from sleep accompanied by feelings of confusion, combativeness, or irritability.

284
Q

Risk factors for hypersomnolence disorder

A
  • acute and daily persistent stress
  • excessive alcohol
  • remote history of viral infection
  • hx of head trauma in previous 2 years
  • family hx
  • dementia
  • Parkinson’s disease
285
Q

When is RLS usually triggered and where else can it occur,

A

At the moment of falling asleep that disrupts initiation of sleep. Symptoms may also arise in upper extremities.

286
Q

What is rate of onset of RLS in people before age of 20

A

30%

287
Q

Diagnostic work up

A
  • iron deficiency
  • CMP
  • magnesium
    -TSH and free T4
  • methylmalonic acid (rule out B12 deficiency)
  • Homocysteine (rule out folate deficiency)
288
Q

Dopaminergic agents used to treat RLS

A
  • pramexiprole (Mirapex)
  • bromocriptine
    -levodopa/carbidopa
289
Q

Antileptic drugs to treat RLS

A
  • gabapentine
    -pregablin
290
Q

Besides dopaminergic agents and antileptic agents, what are other treatments for RLS

A
  • Alpha blocker - clonidine
  • nutritional supplement with ferrous sulfate or ferrous gluconate, magnesium oxide
291
Q

Shortest half life and less residual sleepiness sedative hypnotic

A

Zolpidem (ambien)

292
Q

Intermediate half-life sedative hypnotic, residual drowsiness

A

Eszopiclone (lunesta) “lunar easy pic”

293
Q

Melatonin receptor agonist

A

Ramelton (Rozerm) low bioavailability, variable efficacy, low SE, Low incidence of drowsiness

294
Q

Orexin receptor antagonist

A

Suvorexant (Belsomra) - suppress wakefulness, very long half-life, residual drowsiness

295
Q

What stimulants are prescribed for OSA

A

Armodafinil (Nuvigil)
Modafinil (Provigil)

*reduce excessive daytime sleep symptoms, don’t give within 6 hrs of sleep

296
Q

OSA symptoms include

A

Irritability, cognitive impairment, excessive daytime sleepiness. May also worsen glycemic control

297
Q

Narcolepsy is characterized by the tetrad

A
  • hypersomnia (excessive daytime sleepiness)
  • cataplexy (transient loss of muscle tone in the presence of strong emotions-fear, embarrassment)
  • sleep paralysis ( partial or total loss of muscle during sleep-wake transition)
298
Q

Hypersomnia is characterized by

A

Excessive daytime sleepiness not due to an environmental disturbance, underlying medical condition, substance induced disorder, mood disorder and is not associated with sleep paralysis, cataplexy

299
Q

Atypical depressive symptoms

A

-increased appetite
-increased sleep > 10 hours
-Physical sensation of heaviness (like walking through quicksand)
-increased interpersonal sensitivity to rejection leading to social or occupational impairment

300
Q

Time criteria for MDD

A

At least 2 weeks

301
Q

How long is treatment recommended after remission of symptoms in MDD

A

one year (patients with 2 or more episodes may require lifelong medication)

302
Q

Psychopharmacology in MDD usually targets symptoms. Which symptoms is usually targeted first if there are multiple symptoms

A

Sleep

303
Q

Most common side effect with SNRI medication

A

HTN

304
Q

Name most common SNRI medications

A

Venlafaxine (effexor)
duloxetine (Cymbalta)

305
Q

Most important to know about Effexor

A

At higher doses causes HTN, very short half-life severe withdrawal symptoms.

306
Q

What type of medication is bupropion major side effect and absolute contraindication

A
  • NDRI (norepineprine, dopamine reuptake inhibitor)
  • Lowers seizure threshold
  • Absolutely contraindicated in Bulimia due to electrolyte abnormalites that further increase risk for seizures.
307
Q

most common electrolyte side effect with SSRI

A

hyponatremia

308
Q

Name most common TCA’s

A
  • Imipramine (tofranil)
  • Clopiramine (anafranil)
  • Amitryptyline (elavil)
  • Nortriptyline (pamelor)
  • Doxepin (Sinequan)

“Candi”

309
Q

TCA’s mechanism of action

A

TCA
* Transmitters - inhibit reuptake of serotonin and norepineprhine
* Channel - calcium and sodium channel inhibitor
* Antagonize acetylcholine and histamine (anticholinergic effects)

310
Q

Widened QRS is highly specific to what class of medications

A

TÇA’s overdose

311
Q

What is antidote for TÇA overdose

A

bicarbonate
(**car **runs over tricycle)

312
Q

Therapeutic index of TCA

A

7= most deadly toxicity in overdose

313
Q

what is imapramine used 2nd line in

A

enuresis - prevents bladder contraction (I am pee ramine)

314
Q

clomipramine (anafranil (is gold standard for treating ___ after SSRI

A

OCD - most sertonin reuptake blocking med.
(O** ClomipramiD**e)

315
Q

nortriptyline is associated with less of which side effects when compared to other TCA’s

A

less sedation and orthostatic hypotension
(elderly no triptyline)

316
Q

name 4 most common MAOI’s and mechanism of action

A
  1. Phenelzine (nardil)
  2. tranylcypromide (Parnate)
  3. isocarboxazid (Marplan)
  4. selegeline (Emsam)
  • 1-3 work on MAO-A and MAO- B = increase norepinephrine, serotonin, dopamine)
  • Selegeline is specific to MAO-B = increases dopamine only which is why it is sometimes used in Parkinsons
317
Q

What are MAOIs most effective at treating

A

Atypical depresssion (mood reactivity, leaden paralysis, etc.)

318
Q

two lethal side effects of MAOIs

A
  1. Hypertensive crisis (consuming foods containing tryamine, aged cheese, wine) causes widespread vasoconstriction
  2. Serotonin syndrom**e - when prescribed with other serotogen meds, requires 2 week wash out when transitioning except for fluoxetine requries 5 weeks due to long half-life.
319
Q

Symptoms of HTN crisis

A
  • Sudden onset worse headache ever
  • facial flushing
  • palpitations
  • pupillary dilation,
  • fever
  • diaphoresis
320
Q

Treatment of HTN crisis

A

phentolamine 5 to 15 mg IV push

321
Q

Contraindications for ECT

A

cardiac disease, aortic stenosis, pulmonary insufficiency

322
Q

Dysthymia

A

Persistent depressive disorder - a depressed mood a majority of the days for at least 2 years.

323
Q

disruptive mood dysregulation disorder characteristics

A

severe and recurrent temper outbursts verbally or behaviorally that are grossly out of proportion to the provocation with irritable angry mood most of the days between outbursts.

324
Q

Bipolar two disorder characterisitics/criteria

A
  • at least one hypomanic episode and one MDD episode
  • hypomanic episode must be a distinct period of elevated mood or irritablility lasting 4 days plus at least 3 manic symptoms.
  • Change in mood is observable but not so severe to require hospitalization
325
Q

cyclothymic disorder characteristics

A

periods of hypomanic symptoms that do not exceed full criteria and depressive symptoms that do not meet full criteria for MDD. Must have characteristic pattern for at least 2 years (like dysthymia)

Bipolars version of dysthymia

326
Q

Acute intermittent porphyria

A

Commonly occurs after excessive heme demand after alcohol consumption, recreational drug use, stress and fasting. Manifests as manic or psychotic sx, abdominal pain, nausea, vomiting, muscle pain, numbness, tingling, hallucinations, paranoia.

  • test urinary porphoblinogen
327
Q

Capras syndrome

A

Delusional belief people have been replaced by imposters and is associated with psychosis.

PMHNP Exam (7 decks)

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