PMHNP Study Guide for ANCC (2023/2024) 100% Pass

PMHNP Study Guide for ANCC (2023/2024) 100% Pass 1. Review the MOA/DOSAGE for pharmacological therapy for a patient on a stimulant medication(s) for ADHD. (p. 747) **Note: medication therapy not first line **Beware of stimulant use for children with tics **Rx'ing stimulants: ALWAYS assess cardiac risk because can lead to sudden cardiac death a. MOA: inhibit reuptake of dopamine and norepinephrine, thereby increasing concentrations in the presynaptic cleft. Amphetamines directly stimulate the release of dopamine and norepinephrine. b. DOSAGE: Start low, titrate up. In adults, extended release preferred to maximize compliance and minimize risk of abuse. In children, start with short acting to gauge tolerability and response, then switch to a longer-acting. Clozapine Chemical Structure SDA - Serotonin 5HT2A Dopamine D2 antagonist. Clozapine S/E 1. NO EPS, NO TD, NO Hyperprolactinemia 2. Life Threatening S/E agranulocytosis 3. Highest risk for MetX/Cardio Metabolic, greatest degree of weight gain 4. Increased risk seizures 5. Sedating, hyper salivation, risk of myocarditis Clozapine Tx Benefits 1. Reduce risk of suicide in Schizo 2. Efficacy in treating aggression and violence 3. Reduce TD severity "gold standard" on resistant symptoms but never first line of tx Olanzapine Chemical Structure Serotonin 5HT2A and D2 Dopamine antagonist MORE POTENT THAN Clozapine Olanzapine s/e 1. Lacks EPS, sedating d/t Antagonist of M1, H1, a1-adrenergic 2. Highest level of cardio-metabolic s/e - weight gain, insulin resistance, triglyceride levels Olanzapine Indications r/t mood Improves mood not only in schizophrenia but also in Bipolar disorder and in treatment resistant depression. Especially with addition of Fluoxetine Quetiapine Chem Structure Serotonin 5HT2A and D2 Dopamine antagonist Not potent binding at D2 receptor H1 biding - enhance sleep especially with M1 and A1 adrenergic Quetiapine Different Dosing Formulations IR immediate vs. XR extended release 300mg IR- least effective dose for antipsychotic (it will occupy D2 at 60% but quickly decreases due to hitting peak quickly (a few hours) requires multiple doses XR - slowly hit its peak, yet rapid enough for the 60% D2 binding Max Dose - 800mg IR form will only occupy D2 receptors for about 12 hours above the 60% threshold Max Dose - 800mg XR maintains fully effective d2 occupancy x 24 hours, has less peak dose sedation and not an ideal hypnotic due to delayed release Quetiapine different doses different actions: Papa Bear - 800mg XR = antipsychotic Mama Bear - 300mg XR = antidepressant Baby Bear - 50mg IR = sleeping Quetiapine FDA Approved for Bipolar depression and augmentation with SSRI/SNRI in unipolar depression Neurotransmitters Chemicals that transmit signals across a junction "synapse" from one neuron to another 'target' neuron Where are neurotransmitters stored? vesicles Full Agonist mimics the effect of the neurotransmitter Partial Agonist Mimic physiologic actions to a lesser degree -Some affinity but only moderate intrinsic activity -Also referred to as "agonist-antagonist" Antagonist blocks the effect a neurotransmitter inverse agonist