NURS 660 FINAL EXAM QUESTIONS WITH
CORRECT DETAILED ANSWERS ||
ALREADY GRADED A+ RECENT VERSION
Dorsolateral prefrontal cortex symptoms - ANSWER Hypoactive in
schizophrenia, leading to cognitive symptoms, planning ahead, and controlling
impulses.
Amygdala function - ANSWER Part of the limbic system, involved in memory,
emotion, fear, and aggression.
Ventromedial prefrontal cortex function - ANSWER Involved in affective
symptoms and controlling emotional responses from the amygdala in decision-
making.
Orbitofrontal cortex function - ANSWER Involved in impulse control.
, Positive symptoms of schizophrenia - ANSWER Hallucinations, delusions,
disorganized thoughts, distortions and exaggerations in language and
communication, disorganized speech and behavior, catatonic behavior.
Negative symptoms of schizophrenia - ANSWER 5 A: Affective, Alogia
(poverty of speech), Asociality, Apathy, Anhedonia (decreased social drive), less
than normal behavior or an absence.
Aripiprazole MOA - ANSWER Partial agonism of D2 and some antagonism for
5HT1A receptors.
Aripiprazole on positive symptoms - ANSWER Reduces dopamine output
when concentrations are high.
Aripiprazole on negative symptoms - ANSWER Increases dopamine output
when concentrations are low.
Common length of time for efficacy of antipsychotic medication -
ANSWER Symptom improvement typically occurs within 1 week.
Efficacy determination time - ANSWER 4-6 weeks to determine efficacy, rare
16-20 weeks
Preliminary research suggests that paroxetine is safe in cardiovascular patients
,Treating depression with SSRIs in patients with acute angina or following
myocardial infarction may reduce cardiac events and improve survival as well as
mood
Paroxetine pregnancy risks - ANSWER Not generally recommended for use
during pregnancy, especially during first trimester
Epidemiological data have shown an increased risk of cardiovascular
malformations (primarily ventricular and atrial septal defects) in infants born to
women who took paroxetine during the first trimester (absolute risk is small)
Unless the benefits of paroxetine to the mother justify continuing treatment,
consider discontinuing paroxetine or switching to another antidepressant
Paroxetine use late in pregnancy may be associated with higher risk of neonatal
complications, including respiratory distress
At delivery there may be more bleeding in the mother and transient irritability or
sedation in the newborn
Must weigh the risk of treatment (first trimester fetal development, third trimester
newborn delivery) to the child against the risk of no treatment (recurrence of
depression, maternal health, infant bonding) to the mother and child
For many patients this may mean continuing treatment during pregnancy
SSRI use beyond the 20th week of pregnancy may be associated with increased
risk of pulmonary hypertension in newborns, although this is not proven
Exposure to SSRIs late in pregnancy may be associated with increased risk of
gestational hypertension and preeclampsia
Neonates exposed to SSRIs or SNRIs late in the third trimester have developed
complications requiring prolonged hospitalization, respiratory support, and tube
feeding; reported symptoms are consistent with either a direct toxic effect of SSRIs
and SNRIs or, possibly, a drug discontinuation syndrome, and include respiratory
distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty,
vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness,
irritability, and constant crying
, Paroxetine neurotransmitters and moa - ANSWER -Boosts neurotransmitter
serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A auto receptors
-Presumably increases serotonergic neurotransmission
-Paroxetine also has mild anticholinergic actions
-Paroxetine may have mild norepinephrine reuptake blocking actions
Fluvoxamine (Luvox) SSRI Major Side Effects
Commonly Prescribed for
Obsessive-compulsive disorder (OCD) (fluvoxamine and fluvoxamine CR)
Social anxiety disorder (fluvoxamine CR) - ANSWER *Fluvoxamine's sigma 1
agonist properties may contribute to sedation and fatigue in some patients
Notable Side Effects
Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and
women: decreased sexual desire, anorgasmia)
Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth)
Mostly CNS (insomnia but also sedation, agitation, tremors, headache, dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders may
be more vulnerable to CNS-activating actions of SSRIs
Autonomic (sweating)
Bruising and rare bleeding
Rare hyponatremia
CORRECT DETAILED ANSWERS ||
ALREADY GRADED A+ RECENT VERSION
Dorsolateral prefrontal cortex symptoms - ANSWER Hypoactive in
schizophrenia, leading to cognitive symptoms, planning ahead, and controlling
impulses.
Amygdala function - ANSWER Part of the limbic system, involved in memory,
emotion, fear, and aggression.
Ventromedial prefrontal cortex function - ANSWER Involved in affective
symptoms and controlling emotional responses from the amygdala in decision-
making.
Orbitofrontal cortex function - ANSWER Involved in impulse control.
, Positive symptoms of schizophrenia - ANSWER Hallucinations, delusions,
disorganized thoughts, distortions and exaggerations in language and
communication, disorganized speech and behavior, catatonic behavior.
Negative symptoms of schizophrenia - ANSWER 5 A: Affective, Alogia
(poverty of speech), Asociality, Apathy, Anhedonia (decreased social drive), less
than normal behavior or an absence.
Aripiprazole MOA - ANSWER Partial agonism of D2 and some antagonism for
5HT1A receptors.
Aripiprazole on positive symptoms - ANSWER Reduces dopamine output
when concentrations are high.
Aripiprazole on negative symptoms - ANSWER Increases dopamine output
when concentrations are low.
Common length of time for efficacy of antipsychotic medication -
ANSWER Symptom improvement typically occurs within 1 week.
Efficacy determination time - ANSWER 4-6 weeks to determine efficacy, rare
16-20 weeks
Preliminary research suggests that paroxetine is safe in cardiovascular patients
,Treating depression with SSRIs in patients with acute angina or following
myocardial infarction may reduce cardiac events and improve survival as well as
mood
Paroxetine pregnancy risks - ANSWER Not generally recommended for use
during pregnancy, especially during first trimester
Epidemiological data have shown an increased risk of cardiovascular
malformations (primarily ventricular and atrial septal defects) in infants born to
women who took paroxetine during the first trimester (absolute risk is small)
Unless the benefits of paroxetine to the mother justify continuing treatment,
consider discontinuing paroxetine or switching to another antidepressant
Paroxetine use late in pregnancy may be associated with higher risk of neonatal
complications, including respiratory distress
At delivery there may be more bleeding in the mother and transient irritability or
sedation in the newborn
Must weigh the risk of treatment (first trimester fetal development, third trimester
newborn delivery) to the child against the risk of no treatment (recurrence of
depression, maternal health, infant bonding) to the mother and child
For many patients this may mean continuing treatment during pregnancy
SSRI use beyond the 20th week of pregnancy may be associated with increased
risk of pulmonary hypertension in newborns, although this is not proven
Exposure to SSRIs late in pregnancy may be associated with increased risk of
gestational hypertension and preeclampsia
Neonates exposed to SSRIs or SNRIs late in the third trimester have developed
complications requiring prolonged hospitalization, respiratory support, and tube
feeding; reported symptoms are consistent with either a direct toxic effect of SSRIs
and SNRIs or, possibly, a drug discontinuation syndrome, and include respiratory
distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty,
vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness,
irritability, and constant crying
, Paroxetine neurotransmitters and moa - ANSWER -Boosts neurotransmitter
serotonin
-Blocks serotonin reuptake pump (serotonin transporter)
-Desensitizes serotonin receptors, especially serotonin 1A auto receptors
-Presumably increases serotonergic neurotransmission
-Paroxetine also has mild anticholinergic actions
-Paroxetine may have mild norepinephrine reuptake blocking actions
Fluvoxamine (Luvox) SSRI Major Side Effects
Commonly Prescribed for
Obsessive-compulsive disorder (OCD) (fluvoxamine and fluvoxamine CR)
Social anxiety disorder (fluvoxamine CR) - ANSWER *Fluvoxamine's sigma 1
agonist properties may contribute to sedation and fatigue in some patients
Notable Side Effects
Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and
women: decreased sexual desire, anorgasmia)
Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth)
Mostly CNS (insomnia but also sedation, agitation, tremors, headache, dizziness)
Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders may
be more vulnerable to CNS-activating actions of SSRIs
Autonomic (sweating)
Bruising and rare bleeding
Rare hyponatremia
