QQ N7310 Flashcards
Preliminary data suggest that a large hippocampus is BLANK in the development of PTSD
a neuroprotective factor
The body’s reaction to an acutely stressful situation is activation of the BLANK (fast) and activation of BLANK (not as fast)
sympathetic nervous system/endocrine
Activity in the amygdala, hippocamps, and insula are implicated in which scenario?
Dreading personal interactions in which you will be the focus of attention
The PMHNP understands that any drug or other substance that is tightly controlled by the government because it may be abused or cause addiction is called a:
controlled substance
The PMHNP understands that alpha-2-delta ligands:
bind on the alpha-2-delta subunit of voltage sensitive calcium channels
The PMHNP understands that when prescribing benzodiazepines
tolerance can develop with prolonged use
All of the following are pharmacologic effects of oral benzodiazepines except
profound hypotension
Which of the following structures are not thought to be involved in obsessive-compulsive disorders?
Cerebellum, Globus pallidus, putamen, caudate nucleus
Cerebellum
Lorazepam is a first line agent for
generalized anxiety disorder
The PMHNP understands that the following statements about norepinephrine and stress response are true except:
- blocking norepinephrine reuptake paradoxically increases anxiety
- norepinephrine stimulates the release of corticotropin-releasing hormone
- cell bodies of involved NE neurons are in the locus coeruleus
- peripheral norepinephrine produces somatic symptoms of anxiety
blocking norepinephrine reuptake paradoxically increases anxiety
The PMHNP understands that the feeling that one is not in control resides in the
medial prefrontal cortex
Flumazenil
blocks benzodiazepine receptors at ligand-gated chloride channel complexes
Feelings of fear are regulated by overaction of reciprocal connections between the amygdala and which structures?
the anterior cingulate cortex and the orbitofrontal cortex
Activating GABA neurons
calms down the brain
Benzodiazepines modulate excessive (BLANK) by (BLANK) actions of inhibitory interneurons in the CSTC circuits
worry/increasing
The initial dose and usual range for escitalopram when treating generalized anxiety disorder are:
initial dose 10 mg once/day and usual range 20 mg/day
Which type of GABA receptor are targets of benzodiapzines?
GABA-A
The PMHNP understands that normal anxiety responses:
include avoidance, hypervigilance, and increased arousal
What DEA schedule are preparations containing not more than 200 miligrams of codeine per 100 mL or per 100 g?
Schedule V
What DEA schedule are opioid medications, stimulants, and cocaine?
Schedule II
What DEA schedule are benzodiazepines, Darvon
Schedule IV
What DEA schedule are marijuana, heroin, ecstasy?
Schedule I
What DEA schedule are combination products containing less than 15 mg of hydrocodone per dosage unit and products containing not more than 90 mg of codeine?
Schedule III
Once receiving initial licensure from the state, the PMHNP applies to the Drug Enforcement Administration for which business activity?
Dispensing or Instructing
Once receiving licensures from the state, the PMHNP initially registers with the DEA by submitting which form?
Form 224
Once receiving licensure from the state the PMHNP applies to the DEA to prescribe which schedules of substances?
schedule II thru V
The application fee for a new registration with the DEA for a licensed PMHNP is
731 dollars
The registration period with the DEA for a licensed PMHNP is
3 years
The PMHNP understand that stimulation of the periaqueductal gray inducing analgesia is evidence of:
top-down control of pain by descending pathways
In the gate theory of pain:
Ascending pain signals can be modified by descending fibers
The PMHNP understands that all the following characteristics apply to the affective-motivational domain of ascending pathways except?
- signals travel up the anterolateral spinal cord region
- proceeds to bilateral aspects of the brain
- synapses terminate on the visual cortex
- answers the question How much does it hurt?
-synapses terminate on the visual cortex
The classic triad of morphine toxicity includes:
pinpoint pupils, respiratory depression, CNS suppression
The prescribing NP understand that oxycodone OP formulation:
cannot be dissolved into an injectable solution
Free nerve endings that respond to a broad range of physical and chemical stimuli at intensities that can cause damage are called?
nociceptors
The mechanoreceptors are also called
A-beta fibers
Non-opioid analgesics for migraines include
serotonin 1B/1D receptor agonists
Early signs associated with the abrupt discontinuation of morphine are:
yawning, rhinorrhea, sweating
The PMHNP understands that the properties of naloxone as a pure opioid antagonist include all the following except:
- antagonist at kappa receptors
- antagonist at mu receptors
- maintains analgesic effects
- reversal of respiratory and CNS depression
maintains analgesic effects
The opioid receptors are found throughout the body, but are concentrated in all but which of the following areas that are well known for pain?
cerebral cortex
Post-synaptic opioid receptors have a BLANK affinity for a partial agonist than for the endogenous ligand or agonist and has a BLANK rate of dissociation than endogenous ligands and agonists.
higher/lower
The BLANK opioid receptor is thought to play a role in modulating chronic pain and is activated by BLANK
delta/enkephalins
The PMHNP understands that all are characteristics of tramadol except:
- blocks uptake of serotonin
- blocks uptake of norepinephrine
- is weak agonist at mu opioid receptors
- is fully antagonized by naloxone
is fully antagonized by naloxone
The PMHNP understands that all of the following characteristics apply to the sensory-discriminative domain of ascending pathways except:
- synapse in the medial thalamus
- answer the question, where does it hurt?
- signals travel up the spinothalamic tract
- proceed to the somatosensory cortex
synapse in the medial thalamus
The potency of an opioid medication is directly correlated to its binding affinity for
mu receptors
Regarding the spectrum of congenital insensitivity to pain, the PMHNP understands that
frank congenital insensitivity to pain is associated with missing peripheral A-delta and C fibers
Doses of morphine
case headaches if metabolites build up
The PMHNP understands that evidence that the chronic use of opioids might not be beneficial and might even make pain worse does not include:
- opioid induced hyperalgesia develops in some patients with long-term use
- tolerance to analgesic and euphoric effects quickly requires dose escalation
- persistent pain sensitivity induced by morphine may explain how acute pain can transition to chronic pain
- rapid development of tolerance for respiratory depression
rapid development of tolerance for respiratory depression
The PMHNP understands that patients with a family history of schizophrenia
show elevated pain thresholds and tolerance
Dull pain matches with what type of fiber?
C fibers
Fast pain signals matches with what type of fiber?
A-delta fibers
Myelinated fibers are?
C fibers
Pain signals synapse in the dorsal horn of the spinal cord are?
A delta fibers AND c fibers
Pain signals transverse the dorsal root ganglia?
A delta fibers AND c fibers
Sharp pain match what type of fiber?
C fibers
Slow signals match which type of fiber?
A delta fibers
Synapse to neurons that cross to the contralateral side of the brain are?
A delta fibers AND c fibers
Consistent with health care needs and social norms
use
inconsistent with health care needs or social norms
abuse
abrupt withdrawal of a drug will cause an abstinence syndrome
physical dependence
continued use despite physical, psychological, or social harm
addiction
The PMHNP understands that Lembroexant is not
- FDA approved for insomnia in the US
- A selective orexin 2 antagonist
- an activator of histaminergic neurons in the TMN
- an antagonist at orexin A and orexin B receptors
a selective orexin 2 antagonist
The sleep/wake switch comprises wake-promoter neurons in the BLANK nuclei that use BLANK as the neurotransmitter and sleep-promoter neurons in the BLANK nuclei that use BLANK as the neurotransmitter
tuberomammillary, histamine, ventrolateral preoptic, GABA
The neurotransmitter circuits of the ascending reticular activating system or RAS
is linked to histamine, dopamine, norepinephrine, serotonin, and acetylcholine neurotransmitters
Trazadone
is highly effective as a hypnotic at lower doses given once a day at night
Which of the following is the correct pairing of neurotransmitter and location of cell bodies that mediate arousal?
Cholinergic/Nuclei of pons-midbrain junction
REM sleep behavior disorder:
often precedes the mergence of a neurodegenerative disorder
What is a frequent feature to distinguish the antianxiety effects and hypnotic effects of anxiolytics?
Doses of anxiolytics are higher for antianxiety effects than for hypnotic effects
Which of the following proteins does not participate in the control of circadian rhythms?
- BMAL2
- CRY
- PER
- CLOCK
BMAL2
Which of the following is not a change seen in sleep with aging?
Ability to function on fewer hours of sleep
Which of the following is suspected regarding depression and circadian rhythms?
Insomnia resolves with effective treatment of depression
Which of the following are FDA approved as second line benzodiazepine hypnotic agents for treating insomnia?
Temazepam
Which of the following does not describe the relationship between bipolar disorder and sleep?
- Manic episodes are characterized in part by delay of sleep onset and reduction in sleep duration
- Lithium can shorten the circadian period
- Rapid cycling of bipolar disorder can be interrupted by synchronizing and stabilizing circadian rhythms
- Decreasing need for sleep can precede a manic episode
lithium can shorten the circadian period
Histamine:
is produced in histamine neurons by the conversion of histine by the enzyme histidine decarboxylase
The properties of barbiturates when interacting at the blood brain barrier include:
barbiturates are lipid soluble and cross the BBB
During sleep, memory consolidation occurs for:
procedural memory, but not for declarative memory
Eszopiclone
is FDA approved for management of insomnia
Night terrors
are characterized by extreme terror and inability to be awakened
Diphenhydramine’s side effects are likely due to
potent antagonism of muscarinic cholinergic receptors
Which of the following pairs of purposes of sleep is incorrectly matched?
-restorative/pruning
-restorative/immune function
-information processing/neurogenesis
information processing/memory consolidation
Restorative/pruning
Ramelteon:
Improves sleep onset by activating melatonin receptors and thus decreasing the suprachiasmatic nucleus sleep signals
Deep sleep occurs during
stage 3
Disruption of atonic and motor generation circuits during sleep occurs
during REM
A person will feel drowsy during which stage of sleep?
Stage 1
A person will have EEG sleep spindles during which stage of sleep?
stage 2
There will be sequences of EEG K complexes during tage?
Stage 4
The PMHNP understand that caffeine induces wakefulness by promoting the stimulating effects of dopamine indirectly through the mechanism of BLANK the BLANK of D2 receptors by BLANK by antagonizing BLANK receptors
blocking, antagonism, adenosine, purine
the PMHNP understands that ADHD can be viewed as an interruption of signal-to-noise balance due to
low dopamine and low norepinephrine signaling
The PMHNP understands that in ADHD the norepinephrine system plays which of these important role?
arousal modulation
the PMHNP understands that guanfacine
is highly selective for alpha-2A receptors in the prefrontal cortex
The PMHNP understands that evidence for rhythmic tapping as a treatment supports the involvement primarily of the
cerebellum
The PMHNP understands that the subcortical structures involved in affective and cognitive components of executive control in ADHD include all the following structures except the
- hypothalamus
- caudate nucleus
- putamen
- nucleus accumbens
hypothalamus
The PMHNP understands that non-stimulant medication used to treat ADHD does not include:
- guanfacine
- clonidine
- methylphenidate
- atomoxetine
-methylphenidate
The PMHNP understands that in ADHD, the dopamine system plays which of these important roles:
activation
The PMHNP understands that the pharmacologic effects of central nervous system stimulants in ADHD are due to release of
norepinephrine
Attention
is correlated with degree of myelination of some CNS neurons
The PMHNP understands that the cortical region that is linked to its appropriate role in ADHD is
parietal cortex/ orientation of attention
The PMHNP understands that adverse effects of central nervous system stimulants do not include
- psychosis
- sedation
- hypertension
- decreased appetite
sedation
The PMHNP understands that fatal overdoses of central nervous system stimulants are not typically due to
hypotension
The PMHNP understands that lisdexamphetamine
is available in a sustained release formula
The PMHNP understands that methylphenidate forms that release over time are not available as
chewables
The PMHNP understands that methylphenidate BLANK transported back into the cell using active transporters and amphetamine BLANK transported back into the cell using active transporters
is not/is
The PMHNP understands that in ADHD, abnormal anticipation and response to reward involve the following structures except the:
- ventral striatum
- amygdala
- orbitofrontal cortex
- dorsomedial prefrontal cortex
dorsomedial prefrontal cortex
Concentration of dopamine transporter receptors in adolescents with ADHD is
similar to younger patients without ADHD
The PMHNP understands that CNS stimulants amplify tonic NE/DA actions and phasic NE/DA actions via all the following except:
- duration of transporter occupancy
- rate of stimulant drug delivery
- degradation of endogenous ligands
- degree of transporter occupancy
-degradation of endogenous ligands
Evidence of the impact of neurofeedback as a treatment for ADHD includes BLANK scores on measures of attention and BLANK activation of the anterior cingulate cortex
improved/increased
The PMHNP understands that fidgeting, leaving one’s seat, running/climbing, being constantly on the go, and having trouble playing quietly are behaviors evidence of dysfunction of
cortico-striato-thalamo-cortical loop
The PMHNP understands that the default mode network fluctuates 180 degrees out of phase with fluctuations in networks that become activated during
externally oriented tasks
The PMHNP understands that in ADHD, which of the following functions is least impaired when executive control and cortico-cerebellar networks are underactivated and have lower internal functional connectivity?
focused attention
1/3 of all atomoxatine is used by
children/adolsecents
There is 4-5% prevalence of ADHD in
adults
There is a inaccurate recall of onset for ADHD in
adults
In this group ADHD is most often diagnosed by PMHNPS
Both children/adolescents and adults
Non-stimulants are often prescribed first line for ADHD for
adults
2/3 of stimulants are prescribed for
children/adolescents
This group is harder to diagnose ADHD for
adults
Levels of identification and treatment for this group are greater than 50%
children/adolescents
A patient asks about nicotine patches for smoking cessation and wants to know the difference between the 24 hour patch and the 16 hour patch. Which response by the PMHNP is correct?
The 16 hour patch simulates usual nicotine ingestion patterns
What is the most problematic issue for a person who is addicted to a substance
intense craving that leads to relapse
In discussing the rationale for using methadone to ease opioid withdrawal, the PMHNP would explain that it has which pharmacologic properties?
Methadone can prevent abstinence syndrome
Which medication blocks mu-opioid receptors that contribute to the euphoria of heavy drinking?
Naltrexone
Evidence for permanence of drug induced brain adaptations include all exceptincreased GABA-A is released during relapse.
increased glutamate is released during relapse.
inactivation of the PFC prevents relapse.
blocking glutamate receptors at the NAc prevents relapse.
increased GABA-A is released during relapse
Which statement is least correct?
Alcohol s reinforcing effects are mediated at opioid synapses within the mesolimbic reward circuitry.
Alcohol s reinforcing effects are mediated at opioid synapses within the mesolimbic reward circuitry.
Alcohol enhances inhibition at GABA synapses and increases excitation at glutamate synapses.
Alcohol receptors are present on presynaptic cannabinoid receptors at both glutamate and GABA synapses.
Alcohol inhibits glutamate release at presynaptic metabotropic glutamate receptors and presynaptic voltage-sensitive calcium channels.
Alcohol enhances inhibition of GABA synapses and increases excitation at glutamate synapses
A PMHNP is caring for a drug-addicted patient. The PMHNP knows that the ideal goal of drug rehabilitation for this patient is:
abstinence from the drug
The PMHNP gave a patient who is addicted to opioids and who has undergone detoxification with buprenorphine (subutex) a prescription for buprenorphine with naloxone (suboxone). The patient asks why the drug was changed. Which response by the PMHNP is correct?
buprenorphine with naloxone (suboxone) has a lower risk of abuse
The PMHNP understands that:
receptor downregulation increases craving when the receptors are resensitizing.
desensitizing nicotinic receptors causes neurons to downregulate the number of receptors.
nicotine is likely the most addicting substance known.
actions of nicotine on postsynaptic alpha-7-nicotinic receptors in the prefrontal cortex may be linked to addictive actions.
nicotine is likely the most addicting substance known
Compulsivity is:
inability to adapt behavior after negative feedback
Which of the following statements is least consistent with how addiction to drugs and to behaviors develop?
Dopamine neurons stop responding to the primary reinforcer and instead begin to respond to the conditioned stimulus.
Dopamine increases shift from ventral striatum and nucleus accumbens to the dorsal striatum.
Dopamine increases shift from the drug or behavior to the conditioned response and environmental trigger.
Dopamine neurons prune their dendritic spines in response to the environmental trigger.
Dopamine neurons prune their dendritic spines in response to the environmental trigger.
A PMHNP is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching?
Neural remodeling leads to decreased dopamine release, leaving users with feelings of lifelessness and depression.
With the use of a drug over time, the brain undergoes synaptic remodeling.
Over time, the brain will develop reduced responses to many addictive drugs.
Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits.
Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits
A PMHNP orders clonidine (catapres) for a patient withdrawing from opioids. When explaining the rationale for this drug choice, the PMHNP will tell this patient that clonidine is used to:
relieve symptoms of nausea, vomiting, and diarrhea
Which of the following is false about adolescence?
Addictions rarely commence during adolescence.
Adolescence is a time for novelty seeking.
The brain is more inclined to approach during adolescence.
The brain is less inclined for restraint during adolescence.
Addictions rarely commence during adolesence
A patient arrives in the emergency department acutely intoxicated and difficult to arouse. The patient’s friends tell the PMHNP that the patient took a handful of diazepam [Valium] pills while at a party several hours ago. The PMHNP will order which drug?
Flumazenil [Romazicon]
A patient who is a heroin addict is admitted to a methadone substitution program. After being given the first dose of methadone, the PMHNP notes that the patient shows signs of euphoria and complains of nausea. What will the PMHNP do?
Suspect that the patient exaggerated the amount of heroin used.
Impulsivity is:
linked to the ventromedial prefrontal cortex.
A patient who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The patient reports feeling anxious and jittery. The PMHNP understands that this response is due to:
withdrawal syndrome.
Global impairments of persons addicted to alcohol include all except:
frontal lobe reduction in volume.
overall reduction in brain gray matter.
downregulation of D2 receptors.
declines in memory and cognition.
downregulation of D2 receptors.
