NR546 MIDTERM EXAM LATEST 2024 U PDATE {A+ GRADED} ACTUAL EXAM. NEW!!! NEW!!! Carla is a 35 -year-old woman that is currently taking olanzapine for her diagnosed schizophrenia. She has gained 30 pounds in the last 6 months and her waist circumference is 37 inches. She requests a change in medications. Which of the following medicatio ns is less associated with weight gain? - ANS✔✔-aripiprazole -associated with the lowest risk weight gain. amygdala - ANS✔✔-involved in emotional regulation and perception of odors corpus callosum - ANS✔✔-controls the communication between the two brain hemispheres white matter - ANS✔✔-contains nerve fibers that connect neurons from different regions into functional circuits grey matter - ANS✔✔-contains nerve cells and dendrites The field of epigenetics is rapidly growing and can help explain how gene expression is: - ANS✔✔-influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness How does epigenetics impact a person's mental health? - ANS✔✔-internal or external factors activate portions of the genome that result in the manifestation of mental health symptoms -activation is often a result of a stressful event, which, when combined with the genetic risk, results in the disease -genes being on or off -occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes being "on" when they should be "off." Types of epigenetic changes: - ANS✔✔-DNA Methylation Histone modification Non-coding RNA The potential legal and ethical issues impacting mental health treatment must also be taken into account, including: - ANS✔✔--informed consent -competence to make healthcare decisions -off-label prescribing Informed consent - ANS✔✔-Clients have the right to receive enough information to make decisions about treatment. -must also be informed about potential risks associated with medications. -have the right to refuse treatment -cannot be forcibly medicated in non -emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed Compliance - ANS✔✔-A court order may be issued for a client to receive treatment against their wishes if they are considered a danger to themselves or others. -Examples: clients with schizophrenia or sex offenders -Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to make decisions -PMHNPs are responsible for being knowledgeable about their state laws and abiding by them. Off-Label Prescribing - ANS✔✔-Some clients may benefit from the unapproved use of a drug for symptom management. -Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use in this disorder. -potentially raises ethical and legal concerns -PMHNP must remain up to date with the latest recommendations for off -label prescribing. Incidence of mental illness -what factors are increasing the incidence - ANS✔✔-
Psychological and sociological factors Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications Adherence - ANS✔✔-Persistence -taking med over intended time period Compliance -taking med as prescribed left hemisphere - ANS✔✔--speech comprehension -word recognition -grammar -sequential processing -recognition of detail -conscious mental processing right hemisphere - ANS✔✔--prosody of speech -emotional modulation -visual -spatial skills -recognition of facial expression -music -abstract mathematical skills -holistic processing -unconscious mental processing Pharmacokinetics - ANS✔✔-the study of what happens to a drug from the time of administration until the parent drug and all metabolites leave the body CYP450 - ANS✔✔-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed product in the bloodstream, responsible for degradating of a large # of psychotropic drugs -Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing *Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals. *genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers Five of the most important: CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4. ultra rapid metabolizers - ANS✔✔-elevated enzyme activity subtherapeutic drug levels poor efficacy with standard doses genotyping - ANS✔✔-the patient for pharmacogenomic use -genes for these CYP450 enzymes can now be readily measured and used to predict which patients might need to have dosage adjustments -measurement of genes for drug metabolism most common targets of psychotropic drugs - ANS✔✔-G-protein receptors
Psychological and sociological factors Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications Adherence - ANS✔✔-Persistence -taking med over intended time period Compliance -taking med as prescribed left hemisphere - ANS✔✔--speech comprehension -word recognition -grammar -sequential processing -recognition of detail -conscious mental processing right hemisphere - ANS✔✔--prosody of speech -emotional modulation -visual -spatial skills -recognition of facial expression -music -abstract mathematical skills -holistic processing -unconscious mental processing Pharmacokinetics - ANS✔✔-the study of what happens to a drug from the time of administration until the parent drug and all metabolites leave the body CYP450 - ANS✔✔-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed product in the bloodstream, responsible for degradating of a large # of psychotropic drugs -Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing *Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals. *genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers Five of the most important: CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4. ultra rapid metabolizers - ANS✔✔-elevated enzyme activity subtherapeutic drug levels poor efficacy with standard doses genotyping - ANS✔✔-the patient for pharmacogenomic use -genes for these CYP450 enzymes can now be readily measured and used to predict which patients might need to have dosage adjustments -measurement of genes for drug metabolism most common targets of psychotropic drugs - ANS✔✔-G-protein receptors
