NURS 660 EXAM 2 Questions with Complete Solutions

NURS 660 EXAM 2 Questions with Complete Solutions Which medication has the SE of losing hair - ANSWER Lithium The pt is bipolar, and had a partial response to depakote and now is going to be augmented with an atypical antipsychotic, the effects of atypical antipsychotics in non-psychotic mania may be due to what - ANSWER indirect effect on glutamate release via 5H2A antagonism A pt has had some success with his current antidepression medication, has tried many different antidepressants, so you decide to augment with L-methyl-folate. What is the hypothesis behind L methyl Folate boosting the therapeutic efficacy of antidepressants...what is the MOA? - ANSWER boosts monamine neurotransmitter function in bipolar disorder You have a pt that has been very depressed and has insomnia problems with concentrations, weight loss and SI. You start them on an AD and his symptoms have abated, however which of the following symptoms is the most likely to be residual following the successful tx of other symptoms? - ANSWER insomnia Which class of antidepressant have a lower incidence of sexual SE? What medication is used in the tx of BP/mania and is used in prophylaxis as well as antidepressant augmentation? Which medication is this? - ANSWER Wellbutrin What medication is a very potent CYP450 inhibitor and can dangerously elevate lamotrigine? - ANSWER Valproate Which class of antidepressant has the worst discontinuation syndrome? - ANSWER Cymbalta You have a female pt complaining of lactating and is not pregnant w/ no children. She has been taking risperidone. Which medication would you avoid if you were to switch her to another med?" - ANSWER Paliperidone A pt is on Prozac and it has stopped working. Patient has been on many other antidepressants and wants to try an MAOI now. How long do you need to stop Prozac before starting MAOI? - ANSWER 5-6 weeks What neurotransmitter are affected by TCAs? - ANSWER Serotonin, dopamine, norepinorphrenie, 5HT What TCA medication should absolutely not be used in combination with any other MAOI? - ANSWER chlomipramine Please know what is the most potent property of trazodone by what neurotransmitter? - ANSWER SEDATION; 5H2A Patient prescribed Clomipramine suddenly stops taking medication. What side effects could be shown? - ANSWER Cardiovascular, coma, seizure, death What neurotransmitters are effected by tricyclic antidepressants - ANSWER increase levels of norepinephrine and serotonin, and block the action of acetylcholine You have a patient that has rapid cycling bipolar disorder. Which combination that should be given together? - ANSWER lithium and lurasideon, lamotrigine and quetiapine You have a patient that has rapid cycling bipolar disorder. Which combination that should not be given together? - ANSWER carbamazepine lurasidone, valproate and quetiapine What medication is safe to take with MAOI - ANSWER Lithium What are the two factors that are most useful for determining if a presenting depressive episode is unipolar or bipolar? - ANSWER family history, input from someone close The only atypical approved for bipolar depression - ANSWER quetiapine A 28 yr old woman presents with depression. She has been treated with manic episode before however is not taking medication. Whhat meds work the best to tx bipolar depression? - ANSWER Lamictal Does clozapine increase TCA A levels? - ANSWER true Cigarette smoking decrease TCA levels - ANSWER false How many half-lives do you have to wait before you can initiate MAOI inhibitor medication - ANSWER 5 half lives Which antidepressant and drug class has a higher incident of gaining weight out of all the Antidepressants - ANSWER paxil: SSRI Which medication can cause hypothyroidism? - ANSWER Lithium Patient comes into the office for smoking cessation education also has a seizure disorder. Which of the following medications WOULD NOT be appropriate - ANSWER Wellbutrin Wellbutrin is contraindicated in clients with what disorders? - ANSWER eating disorders What is the proposed theory when pt starts taking Prozac and w/in a day or two is feeling more energized and feels their cognition and attention have significantly increased. - ANSWER antagonism of 5HT2C increasing neurotransmission of norepinephrine and dopamine You have a pt that is bipolar and has been stabilized on lithium and is now a long-distance runner and works construction. Informs you he is running 30 mins 5x a week. Which lab would be indicated? - ANSWER renal, sodium, lithium, electrolyte labs MOA of carbamazepine? What does it do to sodium channels, GABA and AMPA. What does it do to neurotransmitters) - ANSWER blockage of sodium dependent voltage channels SSRI or SNRI which medication is more prone to hypertension - ANSWER SNRI 26 year old patient has been diagnosed with BPD valproate has been selected for her treatment what tests do you expect to order? What are you monitoring for? - ANSWER urine pregnancy test, neural tube defects