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PMHNP > NEUROBIOLOGY/PSYCHOPHARMACOLOGY FINAL EXAM REVIEW > Flashcards

NEUROBIOLOGY/PSYCHOPHARMACOLOGY FINAL EXAM REVIEW Flashcards

1
Q

Valerian

A

Used for sleep and anxiety

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2
Q

GABA

A

Used for Sleep and Anxiety

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3
Q

St. John’s Wort

A

Depression

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4
Q

SAM-E

A

Depression/anxiety(mainly depression)

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5
Q

Black Cohosh

A

Perimenopause, PMS, Vasomotor symptoms

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6
Q

Antipsychotic uses

A

Bipolar
Psychosis
Delirium
Anxiety
Depression

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7
Q

Clozapine Monitoring

A

Monitor ANC weekly x 6 months
Biweekly x 6 months
Then monthly
Looking for Agranulocytosis

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8
Q

When do you stop Clozaril?

A

ANC <1000

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9
Q

Lithium Normal drug range

A

0.6-1.2

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10
Q

What class is Lithium?

A

Mood Stabilizer (oldest mood stabilizer in use). Gold standard for Bipolar 1 treatment.

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11
Q

What do you need to educate patient on regarding Lithium?

A

-Educate patient about side effects and signs of lithium toxicity
-Let provider know about coarse hand tremor
-Identify medications that could increase toxicity
-Regular lithium levels
-Assess risk factors for lithium toxicity in special populations
-Take at same time daily
-Mild side effects are usually transient
-Report side effects
-Lithium should be taken at night and levels drawn in the morning(8-12 hours after last dose).

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12
Q

Lithium

A

MOA: Unknown, possibly neuroprotective and neuroproliferative effect to preserve gray matter.
-protective against suicide.
-Monitoring: Baseline serum level after each dose change and then annually.

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13
Q

What condition does Lithium treat?

A

Bipolar(most effective for mania).
Has anti-suicide action.

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14
Q

When do you stop Lithium? (and contraindications):

A

Pregnancy (risk for Ebstein’s anomaly)
Renal failure
Untreated hypothyroidism
Significant fluid loss(increases risk of toxicity)
Geriatric patients

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15
Q

Common side effects of lithium:

A

Nausea: may improve with food or ER formulations
Dry mouth/Thirst: Offer ice chips, sugarless gum, hydration.
Acne: resolves after 1 month
Alopecia: check thyroid functions
Mild fine Tremor: avoid caffeine, treat with propranolol.
Polyuria/Polydipsia(nephrogenic diabetes insipidus)
Weight gain: behavior modification/counseling.
Psoriasis: common over 50 y.o., order topicals, refer to dermatology, consider different agent.

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16
Q

Mild lithium Toxicity

A

-T-wave depression noted on EKG(generally mild and treatable)
-Toxic level is 1.5-2.0
-Muscle twitching
-Coarse hand twitching, muscle weakness
-Lethargy
-Nausea, vomiting, diarrhea.

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17
Q

Moderate Lithium toxicity

A

2.0-2.5:
-Severe nausea, vomiting, diarrhea
-Confusion, slurred speech,
-Ataxia, muscle twitching
-EKG changes
-Seizures
-Oliguria
-Circulatory Failure
-Coma
-Death

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18
Q

Severe lithium toxicity

A

2.5+
-Impaired LOC, coma
-Increased DTR’s
-Syncope
-Seizures
-Death

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19
Q

What is the main side effect of Risperidone?

A

Hyperprolactinemia. Prolactin levels are increased due to action on tuberoinfundibular pathway(Dopamine neurons from hypothalamus to pituitary).

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20
Q

Which medication most commonly causes QT prolongation?

A

Ziprasidone, best practice to get an EKG before starting medication.

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21
Q

When should Austedo be started?

A

Ideally at first sign of EPS.

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22
Q

How should Ziprasidone be taken?

A

With a 350 calorie meal to allow proper absorption. If not taken with food absorption will be about half.

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23
Q

What are the most common side effects with Seroquel?

A

Sleepiness and metabolic syndrome.

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24
Q

What is the treatment for parkinsonism?

A

Benztropine(cogentin)

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25
Q

What causes parkinsonism?

A

D2 blockade in Nigrostriatal pathway.

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26
Q

What medications are given for Tardive dyskinesias

A

Think “AI for TD’s”

Austedo
Ingrezza

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27
Q

What are the most common side effects of SSRI’s

A

GI Symptoms(Diarrhea, nausea, constipation)
Weight Gain
Sexual side effects

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28
Q

How is serotonin synthesized?

A

Tryptophan is converted to 5HTP(serotonin)

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29
Q

What are the positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Disorganized thoughts
Agitation
Inappropriate emotions
perception disturbances

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30
Q

What are the negative symptoms of schizophrenia?

A

5 A’s:
blunted AFFECT
AMBIVALENCE
ALOGIA (Limited speech)
ANHEDONIA
ASOCIALITY

Class Notes: Anhedonia
Blunted emotions
Lack of feeling

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31
Q

What are the cognitive symptoms for schizophrenia( remember they are similar to ADHD)

A

Difficulty with memory
Difficulty with new learning
Trouble focusing

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32
Q

What are the Mood symptoms of Schizophrenia?(MISS D)

A

MISS D:
MOTIVATION
INSIGHT
SOCIAL WITHDRAWAL
SUICIDE

DEMORALIZATION

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33
Q

Acute dystonia

A

-Spasm of muscles of tongue, face, neck, back. May mimic seizures.
-Occurs after 1-5 days on medication
-Antiparkinsonian agents are diagnostic and curative

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34
Q

Parkinsonism

A

-Bradykinesia, rigidity, variable tremor, mask-like facies, shuffling gait.
-occurs at 5-30 days of treatment
-Treatment is antiparkinsonian agents.

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35
Q

Neuroleptic malignant syndrome

A

Mneumonic: FEVER
Fever
Encephalopathy
Vital Sign Instability
Elevated WBC, CPK
Rigidity.

-Catatonia, stupor, fever, unstable blood pressure, myoglobinemia, can be fatal.
-occurs after weeks of treatment. can persist for days after treatment.
-Treatment is hospitalization, stopping the drug, Dantrolene or bromocriptine may help. Antiparkinsonian agents are NOT effective.

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36
Q

Tardive dyskinesia

A

-Oral-facial dyskinesia, widespread choreoathetosis or dystonia
-occurs after months or years on treatment(worse on withdrawal)
-prevention crucial, FDA approved drugs (i.e. valbenazine).

37
Q

Perioral tremor (Rabbit syndrome)

A

-May be a late variant of parkinsonism, generally occurs after months or years of treatment. Antiparkinsonian agents often help

38
Q

What is Akathisia?

A

-Motor restlessness, not anxiety or agitation
-occurs after 5-60 days of treatment

39
Q

What is the Treatment for akathisia?

A

Treatment is to reduce or change drug. Antiparkinsonian agents, benzos, propranolol may help.

40
Q

How are the positive symptoms of psychosis treated?

A

Treat with antipsychotics which work by blocking dopamine in the mesolimbic pathway.

41
Q

Which class of drugs are TD’s most common with?

A

First-generation antipsychotics

42
Q

What causes Tardive dyskinesia?

A

D2 receptor blockade on nigrostriatal pathway

43
Q

What are SSRI’s used for?

A

-Premenstrual dysphoric disorder
-Major depressive disorder
-Generalized anxiety disorder
-Obsessive-compulsive disorder
-Post-traumatic Stress disorder

44
Q

What SSRI’s are approved to treat OCD in teens and pediatrics?

A

Sertraline and fluoxetine

45
Q

What SSRI’s are approved to treat Anxiety in teens and peds?

A

Lexapro
(Teens are so L.A.: Lexapro for anxiety)

46
Q

What SSRI’s are approved to treat major depressive disorder in teens and peds?

A

Lexapro
Sertraline
Fluoxetine

47
Q

What is the elderly warning for elavil(amitriptyline) and other TCA’s?

A

Anti-cholinergic effects.
Specifically confusion, dry mouth, difficulty urinating.

48
Q

What criteria do we need to consider with elderly patients?

A

BEERS criteria.

49
Q

Beers Criteria

A

Recommendations for medications which are inappropriate and should be avoided in older adults.
Recommendations can be categorized as Strong, Weak, or Insufficient.

50
Q

Dementia

A

Loss of intellectual abilities that interfere with function in at least one of the following categories:
-abstract thinking
-Impaired judgment
-personality change
-cortical dysfunction

51
Q

Mild cognitive impairment (Clinical Presentation)

A

One of the following domains impaired(but remains able to perform ADL’s):
-May lose valuables
-Difficulty with executive functioning
-Loss of recent and remote memory

52
Q
A
53
Q

What 2 classes of medications are used to treat ADHD in children?

A

Stimulants
Non-stimulants

54
Q

What are the non-stimulant medications used in pediatrics?

A

Clonidine
Guanfacine

55
Q

In addition to stimulants, what other medications are used for ADHD in adults?

A

non-stimulants
Strattera
Welbutrin

56
Q

What are the signs of Metabolic syndrome?

A

-Increased waist circumference
-Elevated blood sugar
-elevated lipids
-Hypertension

57
Q

What side effect do all second generation antipsychotics have in common?

A

Increase risk of metabolic syndrome

58
Q

Which second generation antipsychotic has the lowest risk for metabolic syndrome?

A

Latuda.

59
Q

Justice

A

Doing what is fair. Fairness in all aspects of care

60
Q

Beneficience:

A

Promoting well-being and doing good. Doing what is best for the patient.

61
Q

Non-maleficience

A

Doing no harm

62
Q

Fidelity:

A

Being truthful, keeping your promises, being virtuous.

63
Q

Autonomy

A

The patient’s ability/right to make decision’s for him/her self.

64
Q

Veracity

A

Conveying the truth without bias, deceit or omission.

65
Q

Respect

A

Treating everyone with equal respect

66
Q

Confidentiality

A

Do not disclose information without the patient’s consent.

67
Q

Alzheimer’s:

A

-Ventricles will tend to enlarge and the cortex will tend to shrink
-Medications: Namenda, Aricept, Rivastigmine

68
Q

Delirium

A

-Acute onset/sudden
-Causes may be: intoxication, electrolyte imbalances, infections, metabolic disturbances
-most common causes are UTI and dehydration.

69
Q

Non-Alzheimer’s dementia

A

Chronic and progressive, decline in cognitive function(for example after a stroke)

70
Q

How do you adjust the dose of olanzapine after a patient stops smoking?

A

Decrease the dose.

71
Q

Zolpidem

A

Zolpidem (Ambien)
Formulation: tab 5mg, 10mg
CR-ER tab 6.25mg, 12.5mg

Schedule IV drug (controlled substance)
Alpha 1 isoform agonist (subtype of benzodiazepine receptor)
Enhances inhibitory effects of GABA
FDA approved: Short term treatment of insomnia; CR indication not restricted to short-term use
Half life is 2½ hours
Side effects: abnormal dreams, confusion, retrograde amnesia, decreased in CR product

Black box warning: May cause sleepwalking, sleep driving or other complex sleep behaviors, even death.
Beers List: Avoid in elderly patients with delirium

72
Q

Lunesta

A

Eszopiclone (Lunesta)
Formulation: tab 1mg, 2mg, 3mg

Schedule IV drug (controlled substance)
Alpha 1 isoform agonist (benzodiazepine receptor)
Enhances inhibitory effects of GABA
FDA: Insomnia

Initial insomnia: 1mg at bedtime, Terminal insomnia: 2 mg at bedtime
Maximum dose is 3mg at bedtime
Half-life of 6 hours; peaks in one hour
Unpleasant taste is a reported side effect

Black box warning: May cause sleepwalking, sleep driving or other complex sleep behaviors, even death.
Beers List: Avoid in elderly patients with delirium

73
Q

Sonata

A

zaleplon (Sonata)
Benzodiazepine receptor agonist hypnotic
Formulation: cap 5mg, 10mg

Schedule IV drug (controlled substance)
Alpha 1 isoform agonist (benzodiazepine receptor)
Enhances inhibitory effects of GABA

FDA approved: Short term treatment of insomnia, not intended for long term use
Half-life is ONE HOUR
Can be used for middle of the night awakening;
Sonata 10mg QHS; maximum dose 20mg
Black box warning: May cause sleepwalking, sleep driving or other complex sleep behaviors, even death.
Beers List: Avoid in elderly patients with delirium

74
Q

Ramelteon

A

Agonist of Melatonin 1 and 2 receptors

75
Q

SSRI names

A

Fluoxetine (Prozac)
Citalopram (celexa)
Sertraline (Zoloft)
Escitalopram(Lexapro)
Paroxetine (Paxil)
Vilazodone(vibryd)
Fluvoxamine (luvox)
Vortioxetine(trintellix)

76
Q

SNRI names

A

Venlafaxine( effexor)
Desvenlafaxine(Pristiq)
Duloxetine(cymbalta)

77
Q

Tricyclic antidepressant names

A

CANDI Acronym:

Clomipramine(anafranil)
Amitripytline (elavil)
Notriptyline(pamelor)
Doxepin(sinequan)
Imipramine(tofranil)

78
Q

NDRI (norepinephrine Dopamine reuptake inhibitors)

A

Bupropion

79
Q

Serotonin Modulator

A

Mirtazapine(remeron)
Trazodone (desyrel)
Nefazodone (Serzone)
Vilazadone(Viibryd)
Vortioxetine(trintellix)

80
Q

MAOI’s

A

PISTacronym:
Phenelzine(nardil)
Isocarboxazid (marplan)
Selegiline transdermal(EMSAM)
Tranylcypromine(parnate)

81
Q

Extrapyramidal symptom types:

A

ADAPT
Acute Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia

82
Q

Phenomenology of Schizophrenia: (w/mneumonic)

A

HD BS Network:
HALLUCINATIONS
DELUSIONS
disorganized BEHAVIOR
disorganized SPEECH
NEGATIVE SYMPTOMS

2-4-6-OPHRENIA
You need 2 symptoms 4 at least 6 months.

83
Q

What value would indicate a prolonged QT interval on an EKG?

A

> 450 milliseconds.

84
Q

L-methylfolate

A
85
Q

Which anticonvulsant for Bipolar 2 does NOT require blood monitoring?

A

Lamictal

86
Q

Lithium has an inverse serum relationship with which element?

A

Sodium

87
Q

Z Drug Black box warning

A
88
Q

Names of the Z drugs

A
89
Q

Names of the Antipsychotics

A

First Generation:
-Chlorpromazine-thorazine
-Haloperidol-Haldol

Second Generation:
-Clozapine-Clozaril
-Lurasidone-Latuda
-Olanzapine-Zyprexa
-Quetiapine-Seroquel
-Risperidone-Risperdal
-ziprazidone-Geodon
-Aripiprazole-Abilify
-Asenapine-Saphris

PMHNP (15 decks)

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