NURS 660 EXAM 3 REVIEW QUESTIONS AND ANSWERS 2023 ADHD

NURS 660 EXAM 3 REVIEW QUESTIONS AND ANSWERS 2023 ADHD. Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls? Peer Answers Your Answer A. The pattern (i.e., order) of cortical maturation is different 7% B. The timing of cortical maturation is different 35% C. The pattern and timing of cortical maturation are different 51% D. Neither the pattern nor the timing of cortical maturation are different 5% B - Correct. There are differences in the timing of cortical maturation between children with and without ADHD that are apparent as early as age 7. That is, cortical maturation in children with ADHD seems to lag behind that of healthy children. In fact, the median age by which 50% of the cortical points achieve peak thickness is delayed by 3 years in children with ADHD. Delay is most prominent in the superior and dorsolateral prefrontal regions, which are particularly important for control of attention and planning. Delay is also seen in subcortical structures. A large cross-sectional mega-analysis demonstrated that the delay in brain maturation is not attributable to medication use. 5. A clinician is considering treatment options for a 26-year-old man with ADHD who has a history of alcohol and marijuana abuse. Which of the following accurately explains the effects of different stimulant formulations on neuronal firing? Peer Answers Your Answer A. Pulsatile stimulation amplifies undesirable phasic dopamine (DA) and norepinephrine (NE) firing, which can lead to euphoria and abuse 46% B. Immediate release stimulants lead to tonic firing, which can lead to euphoria and abuse 22% C. Tonic firing is the result of rapid receptor occupancy and fast onset of action as seen with extended release formulations 1% D. Extended release stimulants result in phasic stimulation of NE and DA signals, but this does not lead to euphoria and abuse 29% A - Correct. Pulsatile delivery of stimulants can cause a frequent and rapid increase in NE and DA, and this amplifies phasic firing. Phasic firing is hypothetically associated with reward, feelings of euphoria, and abuse potential. 6. Scarlet, a 25-year-old bartender, was diagnosed with ADHD at age 10. She has been on and off medication since then; first on immediate-release methylphenidate, then on the methylphenidate patch. She has experimented with illicit drugs during her late adolescence and is still a heavy drinker. After a few years of self-medication with alcohol and cigarettes, she is seeking medical attention again. You decide to put her on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in ADHD. Why does atomoxetine lack abuse potential? Peer Answers Your Answer A. It decreases norepinephrine levels in the nucleus accumbens, but not in the prefrontal cortex 15% B. It increases dopamine levels in the 71% prefrontal cortex but not in the nucleus accumbens C. It modulates serotonin levels in the raphe nucleus 10% D. It increases dopamine in the striatum and anterior cingulate cortex 3% B - Correct. The prefrontal cortex lacks high concentrations of DAT, so in this brain region, DA gets inactivated by NET. Therefore, inhibiting NET in the prefrontal cortex increases both DA and NE. As only a few NET exist in the nucleus accumbens, atomoxetine does not induce an increase in DA and NE in the nucleus accumbens, the reward center of the brain, thus atomoxetine does not have abuse potential. 7. A 15-year-old patient with ADHD has a rare mutation in the gene for the dopamine transporter (DAT). In deciding which treatment to initiate for this patient's ADHD, you know it will be important to avoid treatments that depend on normally functioning DAT. Which of the following drugs are transported into neurons via the dopamine transporter? Peer Answers Your Answer A. Amphetamine 53% B. Atomoxetine 10% C. Methylphenidate 11% D. A and B 14% E. None of the above 9% A - Correct. Amphetamine blocks DAT and the norepinephrine transporter (NET) by binding at the same site that the monoamines bind. Thus, amphetamine is a competitive inhibitor and pseudosubstrate for DAT and NET, such that (at least at high doses) amphetamine is actually transported into the presynaptic DA terminal. 8. A patient with attention deficit hyperactivity disorder (ADHD) has not yet had successful treatment: he has experienced either loss of efficacy toward the end of the day or efficacy but insomnia at night. He is frustrated and wants to know what other treatment options exist. The most recently available new treatments for attention deficit hyperactivity (ADHD) represent: Peer Answers Your Answer A. Novel neurotransmitter targets 3% B. New formulations of existing active ingredients 55% C. A and B 40% B - Correct. The majority of approved treatments for ADHD, and specifically new agents approved recently, are formulation variations of either amphetamine or methylphenidate: Their differences lie not in the active ingredient but rather in how that active ingredient is delivered—i.e., release mechanism. Modified-release formulations are designed to release drug in a controlled and predictable manner that allows for a particular efficacy and safety profile. Modifying the release of drug can improve tolerability by eliminating peaks and troughs in plasma concentration, and can improve efficacy by increasing duration of action as well as by eliminating peaks and troughs. 9. Rita is a 28-year-old patient with untreated ADHD. You are currently deciding between guanfacine and clonidine as potential treatments for this patient. The selective alpha 2A agonist guanfacine appears to be: Peer Answers Your Answer A. Less tolerated than the alpha 2 agonist clonidine 3% B. Better tolerated than the alpha 2 agonist clonidine 78% C. Less efficacious than the alpha 2 agonist clonidine 5% D. More efficacious than the alpha 2 agonist clonidine 12% B - Correct. Guanfacine is better tolerated than clonidine. 10. Aggregate data suggest that, compared to stimulants, nonstimulants have: Peer Answers Your Answer A. Smaller effect sizes 83% B. Approximately the same effect sizes 13% C. Larger effect sizes 2% A - Correct. Multiple meta-analyses assessing the effects of stimulant medications have shown that, as a class, non-stimulants have smaller effect sizes than stimulants. Due to differences in study design, these meta-analyses do not address potential differences in efficacy among specific medications. 11. A 44-year-old man was diagnosed with ADHD-inattentive subtype in college but has not taken medication for the last several years. He is seeking treatment now because of declining work performance following a promotion 7 months ago. Specifically, he complains of difficulty finishing paper and staying focused during meetings and fears that his boss is losing confidence in him. Assessment confirms a diagnosis of ADHD-inattentive subtype. After 2 months treatment on a therapeutic dose of a long-acting stimulant, he states that his focus, sustained attention, and distractibility are much better, but that he still can't get organized and that it takes him longer to complete tasks than it should. At this point, would it be appropriate to raise the dose of the stimulant to try to address his residual symptoms? Peer Answers Your Answer A. Yes 52% B. No 47% B - Correct. If medication dose is high enough to substantially diminish symptoms of inattention and distractibility, then executive function needs to be addressed independently and will not likely response to higher medication dosing. 12. The cumulative data on the effects of physical exercise as an adjunctive treatment for children with ADHD have demonstrated the potential beneficial effects of: Peer Answers Your Answer A. Acute aerobic exercise 12% B. Chronic aerobic exercise 16% C. A and B 66% D. Neither A nor B 4% C - Correct. Comparisons have been made between aerobic/nonaerobic, and acute vs chronic exercise on cognitive and behavioral symptoms in children with ADHD. Numerous published studies on exercise and cognition in children with ADHD have shown that aerobic exercise appears to be the most effective for improvements in executive function (EF). Both acute and chronic exercise have beneficial effects on behavioral and cognitive measures in children with ADHD, when assessed immediately after exercise. Cognitive measures include improved response inhibition, cognitive control, attention allocation, cognitive flexibility, processing speed, and vigilance. 13. A patient with a history of alcohol use disorder has been sober for 6 weeks. He begins medication treatment for adult attention deficit hyperactivity disorder and experiences improvement, but 4 months later relapses with his alcohol use disorder, engaging in 3 binge drinking episodes over a 2-week period. Does this patient need to discontinue medication treatment for ADHD? Peer Answers Your Answer A. Yes, he should be switched to non-medication treatment 10% B. Only if he is currently on a longacting stimulant; non-stimulant medication is acceptable in this scenario 27% C. No, both long-acting stimulants and non-stimulant medications are acceptable in this scenario 61% C - Correct. Non-stimulant and long-acting stimulant medications are both options for ADHD cooccurring with substance use disorders; however, non-stimulants may be preferred as the first-line approach. If a stimulant is prescribed to a patient in early sobriety from substance use and/or continued low-level substance use, then he/she should be monitored closely for misuse of the prescribed medication. 14. A 7-year-old boy has just been diagnosed with attention deficit hyperactivity disorder (ADHD), combined type, and his care provider feels that the best therapeutic choice is a stimulant. Family history is significant for depression and diabetes. The patient’s medical history is significant for asthma; physical exam reveals no abnormalities. According to current recommendations, what should be the care provider’s next step? Peer Answers Your Answer A. Prescribe a stimulant, as no additional tests are indicated for this patient 73% B. Obtain an electrocardiogram (ECG), as this patient’s family history and exam results warrant it 7% C. Obtain an ECG, as this is mandatory prior to prescribing a stimulant to any child 14% D. Prescribe a nonstimulant, as a stimulant would not be appropriate for this patient 4% A – Correct. Current recommendations from the American Heart Association (AHA) are that it is reasonable but not mandatory to obtain an electrocardiogram (ECG) prior to prescribing a stimulant to a child. The American Academy of Pediatrics (AAP) does not recommend an ECG prior to starting a stimulant for most children. DEMENTIA & COGNITIVE FUNCTION