NSG 555/ NSG555 Exam 2 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 555/ NSG555 Exam 2 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A Agoraphobia treatment CBT and SSRIs Generalized Anxiety Disorder (GAD) a disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance Generalized anxiety disorder treatment SSRIs, SNRIs (first line); buspirone (second line) Can consider augmenting with short term use of benzodiazepines or Buspar panic disorder An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. What are the common behavioral therapies for panic disorder? Behavioral therapy, CBT, psychodynamic therapy, psychoeducational approach What are the common pharmacological treatments for panic disorder? SSRI, SNRI, TCAs (through limited use), Benzos (use with caution, short-term) What is the FDA-approved benzodiazepine for panic disorder? Alprazolam (Xanax) social phobia (social anxiety disorder) fear of interacting with others or being in social situations that might lead to a negative evaluation or embarrassment. What are the common treatments for social phobia? Cognitive behavioral therapy, social skills training, medication What type of therapy is commonly used to treat social phobia? Cognitive behavioral therapy What medications are commonly prescribed for social phobia? Xanax (benzodiazepines), SSRIs, SNRIs, Prozac What are some examples of medications used to reduce anxiety in social phobia? Xanax (benzodiazepines), SSRIs, SNRIs, Prozac What type of medications are beta blockers and how are they used in social phobia treatment? Beta blockers like atenolol and propranolol are used 1 hour before performance or public speaking to reduce anxiety Specific phobia a disorder that involves an irrational fear of a particular object or situation that markedly interferes with an individual's ability to function Specific phobia treatment exposure therapy, Luvox, Paxil, Zoloft, Effexor CBT w/exposure obsessive-compulsive disorder An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Obsessive compulsive disorder treatment meds+CBT 1st line = SSRI (often need high doses of Zoloft, prozac): Luvox 2nd line = SNRI (e.g. Venlafaxine) (Clomipramine = Anafranil) ECT in debilitating, treatment resistant cases Fluvoxamine (Luvox) for OCD 50-300 mg SSRI FDA approved for OCD Common s/e nausea, vomiting Clomipramine (Anafranil) for OCD TCA approved for treatment in OCD Clomipramine dose 25 mg per day up to 100 mg per day. What is the mechanism of action of benzodiazepines? Facilitates GABA action by increasing frequency of chloride channel opening. Potentiates the effects of GABA. What are the common side effects of benzodiazepines? Drowsiness, cognitive impairment, dampening of fear and anxiety, impaired balance, motor control, muscle tone and coordination, anterograde amnesia. How do benzodiazepines affect REM sleep? They decrease REM sleep. What is the significance of the half-lives and active metabolites of benzodiazepines? Benzodiazepines generally have long half-lives and active metabolites, except for triazolam, oxazepam, and midazolam which are short-acting and have a higher addictive potential. Benzodiazepines in elderly Elderly have reduced ability to metabolize long-acting benzodiazepines and their active metabolites; 6-10 weeks to become drug-free after stopping the drug. Side effects: Dementing; Depressive Increase rates of falls and hip fractures Benzodiazepine continued Enhance activity of GABA at GABA-A receptor Potential for abuse and addiction Patient become physical dependent and build tolerance Can be used to treat Akathisia Choice of benzo is based on onset to action duration of action method of metabolism OTL = Outside the liver (Lorazepam, Oxazepam, Temazepam) = not metabolized by the liver Benzodiazepine side effects Mild side effects include headache, amnesia, drowsiness, paradoxical excitement or nervousness, dizziness, vertigo, cognitive impairment, lethargy, and "hangover effect". Potentially significant risk for falls in the elderly. Drug withdrawal can cause rebound insomnia, unusual behaviors and hallucinations. Benzodiazepine withdrawal Rebound anxiety, seizures, tremor, insomnia, irritability, nausea/vomiting, autonomic hyperactivity (diaphoresis, tachycardia, HTN) Tonic - colonic seizures = life threatening Note: Abrupt abstinence after chronic use can be life threatening. Taper - 10% total dose/week (physical and behavioral taper) Common strategy to convert from SA to LA to facilitate more comfortable taper Buspirone MOA 5HT1A partial agonist decreases serotonergic activity Slower onset of action than typical benzos (takes several weeks) Lowe potential for abuse/addiction Dosed 2-three times per day No PRN Medical conditions that mimic or worsen anxiety symptoms: Endocrine conditions Hyperthyroidism Hypothyroidism Pheochromocytoma Cushing's disease Addison's disease Menopause Medical conditions that mimic or worsen anxiety symptoms: Cardiovascular Acute Coronary Syndrome Arrhythmia CHF Hypertension Mitral Valve Prolapse Medical conditions that mimic or worsen anxiety symptoms: Neurological Epilepsy Cerebrovascular disease Menier's disease Multiple Sclerosis Migraine Encephalitis Early Dementia Medical conditions that mimic or worsen anxiety symptoms: Metabolic Porphyria Diabetes Medical conditions that mimic or worsen anxiety symptoms: Pulmonary Asthma COPD Pulmonary Embolism Pneumonia post-traumatic stress disorder an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience Hippocampus function learning and memory embedded deep into the temporal lobe. It has a major role in learning and memory PTSD symptoms - Flashback episodes, where the event seems to be happening again and again. - Repeated upsetting memories of the event; repeated nightmares of the event. - Emotional "numbing"; feeling detached; inability to remember important aspects of the trauma. - Having a lack of interest in normal activities. - Avoiding places, people, or thoughts that remind you of the event. - Difficulty concentrating. - Agitation or excitability; insomnia. Hippocampus and PTSD There is a smaller hippocampus volume in people with PTSD, though the good news is that it can recover. What are some common treatments for PTSD? CBT, Eye movement desensitization, flooding, group therapy, hypnotherapy, pharmacotherapy, psychodynamic therapy, psychoeducation, psychotherapy, support groups Name some FDA-approved medications for PTSD. Sertraline (Zoloft) and Paroxetine (Paxil) Which medication acts as an Alpha-1 receptor antagonist in PTSD treatment? Prazosin In severe or treatment-resistant cases of PTSD, what type of medication may be added? Atypical antipsychotic What type of therapy is recommended for PTSD treatment to avoid addictive medications? Exposure therapy (part of CBT) Why should benzodiazepines be avoided in PTSD treatment? Due to a high rate of comorbid substance use disorders Prazosin moa selective alpha 1 antagonist dissociative identity disorder (DID) a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder. dissociative identity disorder characterized by Predominantly develops in victims of significant and chronic childhood trauma Patients with DID often cope with PTSD More than one distinct personality state resulting from a fragmented sense of self What is the focus of DID treatment? Reintegration of identities What is the role of SSRIs in DID treatment? Target comorbid depressive and/or PTSD symptoms What is the purpose of Prazosin in DID treatment? To address nightmares How does Naltrexone contribute to DID treatment? Reduces self-injurious behaviors Is ECT contraindicated in people with Dissociative Identity Disorder? No, ECT can be considered as a viable option, especially in combination with psychotherapy Medications for sleep onset 2017 guidelines Eszopiclone Zaleplon (Sonata) Zolpidem Triazolam (Halcion) Temazepam Ramelteon (Rozerem) Medications for Sleep Maintenance 2017 guidelines Suvorexant (Belsomra) Eszopiclone (Lunesta) Zolpidem (Ambien) Temazepam (Restoril) Doxepin (Silenor) Narcolepsy A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. Characterized by cataplexy (brief episodes of sudden bilateral loss of muscle tone) Hallucinations and/or sleep paralysis at the beginning or end of sleep episodes are common Slightly more in males than females narcolepsy etiology Loss of hypocretin in the hypothalamic neurons that may have an autoimmune component Narcolepsy management Brief daytime naps no longer than 20 minutes to help reduce feelings of sleepiness Follow regular exercise program Practice good sleep habits Avoiding shifts in sleep Eat light meals high in protein Practice deep breathing Chewing gum Taking vitamins -Avoid factors that increase drowsiness Amphetamines (D-amphetamine, methamphetamine) Modafinil - 1st line pharmacologic treatment Cataplexy (narcolepsy) drug choice Sodium oxybate (avoid use with alcohol and other CNS depressants); Others: TCA (imipramine, desipramine, clomipramine) Sodium oxybate (Xyrem) - C-III (Narcolepsy) - C-I (abuse) REMS program: This is a 'date rape' drug (Sedative, called GHB that requires strict measures to ensure it is going to narcolepsy with cataplexy patients only BBW - Respiratory depression - Sodium oxybate is a salt form of hydroxybutyrate (GHB), a drug of abuse SE - dizziness, nausea, somnolence, enuresis (dose-related), daytime hangover effect Sodium Oxybate MOA Decrease presynaptic dopaminergic neuronal firing REM suppression drugs SSRI, SNRI (Prozac, Cymbalta, atomoxetine, venlafaxine) Ramelteon (Rozerem) Sedative / Hypnotic Insomnia SOMNABULISM - sleep driving/eating/walking/sex Ramelteon MOA Agonist at MT1 and MT2 melatonin receptors Effective and safe sleep aid d/t no tolerance or dependence does not act on benzodiazepine receptors Sleep Apnea a sleep disorder characterized by temporary cessations of breathing during sleep and repeated momentary awakenings Sleep Apnea non-pharmacologic treatments weight loss avoidance of ETOH CPAP Uvulopalatopharyngoplasty restless leg syndrome sleep disorder in which the sufferer has uncomfortable sensations in the legs when trying to fall asleep that are relieved by moving the legs Restless leg syndrome prevalence 2-7.2% 1.5-2 times more likely in males Restless leg syndrome risk factors -Family history consistent with autosomal dominant inheritance -Conditions associated with iron deficiency -End-stage renal disease (hemodialysis patients); associated factors that have been posited to play a role include anemia, iron deficiency, elevated serum calcium, and alterations in central nervous system dopamine. -DM, Multiple sclerosis, Parkinson's Disease pt What are the common dopamine agonists used to treat restless leg syndrome? Pramipexole (Mirapex) and Ropinirole (Requip) Name some medications other than dopamine agonists used to treat restless leg syndrome. Benzodiazepines, Gabapentin (Neurontin), Pregabalin (Lyrica) What type of medication is recommended for treatment-refractory restless leg syndrome? Low-potency opioids Supplement for restless leg syndrome iron 325 mg QD or QOD Sedative use in elderly patients always consider sleep hygiene as first-line What are some common side effects of sedative-hypnotics in the elderly? Memory impairment, ataxia, paradoxical excitement, and rebound insomnia Which sedative-hypnotics are considered safer options for elderly patients, especially those with depression? Trazodone and Remeron What is Anorexia Nervosa (AN)? A disorder with both psychologic and physiologic components that begins with dieting to lose weight and manifests into an inappropriate self-control behavior; continued restrictive eating may lead to starvation and eventually death. What are the two types of Anorexia Nervosa? Restricting type & Binge-eating/purging type What are some common characteristics of individuals with Anorexia Nervosa? Preoccupation with their weight, body image, and being thin, intense fear of gaining weight or becoming fat, restriction of calorie intake, low body weight What are the common treatments for Anorexia Nervosa? CBT, family therapy, SSRI for comorbid anxiety and depression, Zyprexa, premeal anxiolytic How is CBT used in the treatment of Anorexia Nervosa? To address the psychological aspects of the disorder When is Zyprexa used in the treatment of Anorexia Nervosa? To treat preoccupation with weight and food What is the purpose of using a premeal anxiolytic in Anorexia Nervosa treatment? To encourage eating by decreasing anticipatory anxiety Bulimia Nervosa (BN) antidepressant + therapy (CBT, IPT, group therapy) First line= SSRIs Prozac (60-80mg /day) is the only FDA approved med Others: Nutritional counseling and education binge eating disorder Not fixated on their body shape and weight• Recurrent episodes of binge eating• No compensatory behaviors (i.e. vomiting and laxative use) • Usually, obese What is the first-line treatment for binge eating disorder? SSRIs (e.g., Lexapro) What are some psychotherapy options for treating binge eating disorder? Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) Which medication is FDA approved for treating binge eating disorder and suppresses appetite? Vyvanse (a stimulant) What is the association of Topamax with binge eating disorder treatment? Topamax is associated with weight loss in this context How does Orlistat (Xenical) work in the treatment of binge eating disorder? Orlistat inhibits pancreatic lipase, decreasing the amount of fat absorbed from the gastrointestinal tract Bupropion (Wellbutrin) NOTE: Avoid Bupropion (Wellbutrin) in all eating disorder patients = lowers seizure threshold What class of medications can help reduce obsessions and severe fearful preoccupations associated with psychosomatic disorders• SSRI for comorbid anxiety & depressive symptoms; other appropriate psychotropic medications anxiety disorder specific phobia social anxiety disorder panic disorder agoraphobia generalized anxiety disorder separation anxiety disorder cortico-striatal thalamic -cortical circuit worry - anxious misery - apprehension - expectation - obsessions amygdala centered circuit fear, panic (phobia) Neurotransmitters involved in worry NE increased GABA decreased Serotonin Decreased What are some factors contributing to anxiety? - Life experiences - Psychological traits - Genetic factors - Chronic exposure/response to stress What are some factors contributing to anxiety? - Life experiences - Psychological traits - Genetic factors - Chronic exposure/response to stress How can neurotransmitter levels and brain regions affect anxiety? - Decrease in serotonin/increased dopaminergic activity - Defects in the limbic system, midline brain, and sections of the cortex Neurobiological deficits of anxiety decreased levels of GABA and increased norepinephrine First lane treatment for chronic anxiety / GAD / panic disorder SSRI How can neurotransmitter levels and brain regions affect anxiety? - Decrease in serotonin/increased dopaminergic activity - Defects in the limbic system, midline brain, and sections of the cortex Benzodiazepine uses anti-convulsant, anti-anxiety, sedative hypnotic (help sleep), status epilepticus (extended brain seizure) muscle spasms, seizures, sleep disorders, ETOH withdrawal, anesthesia induction alprazolam, lorazepam intermediate acting benzodiazepines / most commonly prescribed Benzodiazepines MOA Faciliate GABAa action by increasing frequency of chloride channel opening Decrease REM sleep Long half-lives and active metabolites (except: triazolam, oxazepam, and midazolam are short acting-- higher addictive potential) Benzodiazepines in elderly Elderly have reduced ability to metabolize long-acting benzodiazepines and their active metabolites; 6-10 weeks to become drug-free after stopping the drug. Side effects: Dementing; Depressive Increase rates of falls and hip fractures Choice of benzodiazepine time of onset, duration of action and method of metabolism (OTTL = outside the liver (Lorazepam, Oxazepam, Temazepam) = not metabolized by the liver S/E: Anticholinergic, unusual behaviors, hallucinations, daytime drowsiness, amnesia How are benzodiazepines used in anxiety disorders during the initial weeks of SSRI/SNRI initiation? They are useful to rapidly reduce anxiety What is a concern when co-prescribing benzodiazepines with antidepressants in anxiety disorders? Patients tend to discontinue the antidepressant When using benzodiazepines in anxiety disorders, what patient populations require caution? Patients with a history of substance abuse, personality disorder, or chronic pain Short acting benzodiazepines Midazolam (Versed) Triazolam (Halcion) Alprazolam (Xanax, Niravam) Oxazepam (Serax) Intermediate acting benzodiazepines alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril) Clonazepam (Klonopin) intermediate/long Long acting benzodiazepines Chlordiazepoxide (Librium) Clorazepate (Tranxene) Diazepam (Valium) Flurazepam (Dalmane) What are the uses of short-acting benzodiazepines? Quick acting for seizure disorders and panic attacks Where is midazolam (Versed) commonly used? In medical and surgical settings Why does Alprazolam (Xanax) have a high potential for abuse? Due to its short half-life leading to rapid onset What are some examples of intermediate-acting benzodiazepines with a 6-20-hour half-life? Lorazepam (Ativan), Oxazepam (Serax) What is Lorazepam (Ativan) commonly used for? Insomnia and anxiety How is Lorazepam (Ativan) used in medical treatment? To treat panic attacks, alcohol (ETOH) and sedative-hypnotic detox, and in combination with haldol for acute agitation What is the medical use of Oxazepam (Serax)? Alcohol (ETOH) and sedative-hypnotic detox Which benzodiazepine has a long half-life (20 hours) and is good for moderate-severe anxiety as well as alcohol withdrawal? Diazepam (Valium) What is Diazepam (Valium) commonly used for? Generalized Anxiety Disorder (GAD), severe alcohol withdrawal, and seizures Which benzodiazepine has a rapid onset but is less commonly prescribed for anxiety due to its euphoric effects? Clonazepam (Klonopin) What should be avoided when prescribing Clonazepam (Klonopin)? Renal dysfunction Why is Clonazepam (Klonopin) dosed 1-2 times daily? Due to its longer half-life Benzodiazepine side effects Mild side effects include headache, drowsiness, paradoxical excitement or nervousness, dizziness, vertigo, cognitive impairment, lethargy, and "hangover effect". Potentially significant risk for falls in the elderly. Drug withdrawal can cause rebound insomnia. Flumazenil (Romazicon) Benzodiazepine antidote Flumazenil MOA competitive antagonist at GABA receptor Chlordizepoxide (Librium) dose - 15-40mg half-life 20-110 hour half life onset intermediate Diazepam (Valium) Dose 15-40mg Half-life 30-100 hours onset - fast Clonazepam/Klonopin 0.5-4mg 20-50 hours half life intermediate onset Lorazepam (Ativan) 1-6mg 14-hour half life Intermediate onset Oxazepam (Serax) 15-120mg 9 hours half life slow-intermediate Alprazolam (Xanax) 1-4mg 14 hours half life intermediate Known limitation of benzo rebound insomnia Buspirone (Buspar) function as anxiolytic agonist at the serotonin 5HT1A receptor also has some D2 antagonist effects Slower onset of action than typical benzos (i.e takes several weeks) Augmentations: Often used in combination with another agent (e.g. SSRI) Low potential for abuse/addiction Dosed 2-three times per day NO PRN Hydroxyzine (Atarax) An antihistamine = anticholinergic s/e Quick acting = for patients who cannot take Benzos Barbiturates (Phenobarbital) Rarely used d/t lethality of overdose, significant withdrawal potential, potential for abuse and side effect profile Propranolol (Inderal) Beta blocker Used off-label Useful for panic attacks and performance anxiety related effects (i.e palpitations, sweating and tachycardia) Also used for Akathisia S/E: Bradycardia, hypotension Beta blockers can be fatal in cocaine overdose Contraindicated in asthma or COPD d/t bronchospasm risk Hydroxyzine (pamoate - Vistaril, capsules; hydrochloride = Atarax tablets Fairly wide dosage range Individuals respond quite differently to different doses For some, 12.5mg is not tolerated, for others 50mg is minimally effective Generally, start at 25mg once or twice daily, sometimes splitting tablet in half for lower dose Sedating (can help with sleep) Sometimes weight gain sometimes paradoxical response Better if benzo naive What physiological symptoms are associated with anxiety? - Hyperactivity of the autonomic nervous system (increased BP, diaphoresis, tremors, pupil dilations, increased respiratory rate) What physiological symptoms are associated with anxiety? - Hyperactivity of the autonomic nervous system (increased BP, diaphoresis, tremors, pupil dilations, increased respiratory rate) Gabapentin (Neurontin) MOA Appears to potentiate GABA and also affects N-type voltage gated calcium channels. Pregabalin (Lyrica) Anticonvulsant/Antineuralgic Pregabalin MOA Binds alpha-2-delta subunit of calcium channels reducing neurotransmitter release Tiagabine (Gabitril) Antiepileptic middle sleep Stage 2; sleep spindles sleep onset the stage between wakefulness and sleep