Neuro Meds 2 (textbook) Flashcards
Atypical antipsychotics can be preferred over typical antipsychotics due to their improved adverse effect profile. Which of these describes this profile?
A. Better patient tolerability, less cognitive impairment, and fewer extrapyramidal symptoms
B. Improved selectivity and blood pressure regulation and less crossing of placenta barrier
C. Better glycemic control and lipid profiles and reduced cardiovascular risks
D. Less immunosuppression, somnolence, and weight gain
A. The typical antipsychotics may be better in treating severe psychosis, but the atypical antipsychotics generally have better patient tolerability, less cognitive impairment, and fewer extrapyramidal symptoms.
Alterations in cardiac conduction are a significant risk when prescribing tricyclic antidepressants (TCAs). Which mechanisms cause this risk?
A. Increased availability of serotonin and histamine are contributing factors of cardiac conduction alterations.
B. Over time, regular use of TCAs can cause fibrosis of the heart muscle from its histamine interaction.
C. Increased availability of norepinephrine, anticholinergic effects, and a slowing of depolarization are contributing factors of cardiac conduction alterations.
D. Over time, regular use of TCAs can cause hypertension due to beta-adrenergic agonism, which leads to cardiac conduction problems.
C. Increased availability of norepinephrine, anticholinergic effects, and a slowing of depolarization are contributing factors of cardiac conduction alterations.
Which malignant neoplasm is carbidopa-levodopa known to activate?
A. Colon cancer
B. Lung cancer
C. Melanoma
D. Leukemia
C. Studies suggest that carbidopa-levodopa can activate malignant melanoma; for that reason, it is contraindicated.
Bipolar disorders, which present with depression and mania, are treated with which type of medication?
- Benzodiazepines
- Dopaminergics
- Anorexiants
- Mood stabilizers
- Mood stabilizers
A 3-year-old patient with Lennox-Gastaut syndrome is being treated with valproate sodium, but seizures are not well controlled. Lamotrigine (Lamictal) is being started as adjunctive therapy. Which serious adverse drug reaction is riskier when lamotrigine is coadministered with valproate sodium?
- Electrocardiogram (ECG) changes become an adverse effect when lamotrigine is administered with valproate.
- Oligohidrosis can lead to hyperthermia and heatstroke when lamotrigine and valproate are coadministered.
- Stevens-Johnson syndrome (SJS) is a risk of lamotrigine, and the combination of valproate increases the risk further.
- Alopecia has been reported when lamotrigine is coadministered with valproate.
- Lamotrigine has a black box warning of SJS and toxic epidermal necrolysis. This risk is higher for pediatric patients. Coadministration with valproate increases this risk.
Parkinson’s disease involves the deficiency of which neurotransmitter?
- Serotonin
- Norepinephrine
- Gamma-aminobutyric acid (GABA)
- Dopamine
- Dopamine. Insufficient dopamine is responsible for the imbalance and musculoskeletal incoordination of Parkinson’s disease.
Which doses of zolpidem (Ambien) are recommended for women versus men?
- The dose for women and men is the same.
- The dose for women is 5 mg and for men is 10 mg.
- The dose for women is 10 mg and for men is 5 mg.
- The dose for women is 5 mg, but zolpidem is contraindicated for men with fertility potential.
- Women need less of a dose then men.
A 45-year-old male patient is complaining of feeling tired for 2 weeks. He states he cannot fall asleep. Which initial treatment should be employed?
- Ramelteon (Rozerem)
- Zolpidem (Ambien)
- Triazolam (Halcion)
- Sleep hygiene
- Sleep hygiene only for short-term insomnia should be employed before considering medications. This includes using relaxation techniques 1 hour before bed, avoiding caffeine and television before bed, and keeping the room dark.
A patient with bipolar disorder is prescribed lithium. Which medical complication could increase the lithium level and cause toxicity for the patient?
- Gastroenteritis
- Diabetic ulcer
- Water intoxication
- Asthma
- Vomiting due to gastroenteritis can cause dehydration, which has a risk for lithium toxicity.
A 22-year-old female patient with bipolar disorder is treated with valproate (Depakote). She has a positive human chorionic gonadotropin (hCG) test. Which action taken by the APN is most appropriate?
- Change the valproate to a nonclassified mood stabilizer and avoid the first trimester.
- Continue the therapy as previously ordered.
- Lower the dose of valproate until the plasma level is less than 50 mcg/mL.
- Taper the valproate and switch to lithium.
- Based on the pregnancy registry, there is no evidence of harm to the fetus with the use of non-classified mood stabilizers.
Which pharmacokinetics are unique to levetiracetam compared with other antiepileptic drugs?
- It has a highly variable half-life, which requires careful monitoring with drug levels.
- It is highly protein bound and extensively metabolized by CYP450 enzymes, which gives it many drug–drug interactions.
3.To be effective, the concentration of levetiracetam needs to be close to toxic due to the short half-life. - It is unbound and metabolized by hydrolysis and does not use CYP450 enzymes.
- These characteristics make levetiracetam almost devoid of drug–drug interactions.
The nurse practitioner is evaluating a patient who is prescribed lithium for bipolar disorder. Which laboratory result suggests that a lower dose or change of medication should be considered?
- Creatinine 2.7 mg/dL
- Potassium 4.2 mEq/L
- Sodium 133 mEq/L
- Lithium level of 0.9 mEq/L
- A high creatinine level is suggestive of renal impairment. Lithium can cause renal failure with long-term use or toxic levels. The therapeutic level for lithium is 0.6 to 1.5 mEq/L.
A patient is dependent on lorazepam (Ativan), which has been prescribed for a year. Which strategy should be employed to reduce the risk of severe withdrawal symptoms?
- Decrease the dose by 0.5 mg per week, then by 0.25 mg for the last few weeks.
- Switch the patient to an equivalent dose of clonazepam, then titrate the dose.
- Concurrently use an antihistamine agent for 3 days and then discontinue.
- Coadminister a barbiturate for 3 days and then discontinue.
- The therapeutic level for lithium is 0.6 to 1.5 mEq/L.
Historically, barbiturates were used to treat seizure disorders, anxiety, and insomnia, but new agents have fewer adverse effects. Which risk associated with barbiturates represents the biggest concern for using them over other anxiolytics or sedative-hypnotics?
- Their risk for tolerance and dependence
- Their risk for intractable nausea and vomiting
- Their risk for megacolon
- Their risk for tardive dyskinesia
1.
Which medication can be used for treatment of neuropathic pain?
- Gabapentin
- Cyclobenzaprine
- Acetaminophen
- Naproxen
- Treatment of neuropathic pain includes anticonvulsants, and gabapentin (Neurontin) and pregabalin (Lyrica) are recommended for diabetic neuropathy, postherpetic neuralgia, and fibromyalgia.
