Midterm Exam
1) These questions are very similar to what you will see on boards.
2) Neuroscience matters-Know what area of the brain is associated with
presenting symptoms AND how the medication works on that area of the brain to
treat that symptom (the medication mechanism of action)
3) Use this study guide-As you use your study guide and medication sheets to
prepare for the exams, take note of outliers and unique properties. What
medication in that class has the most adverse effects? Who should not take that
medication? Which medication has no CYP450 interactions? Which medication is
first line? What area of the brain is affected by these medications?
Week 1
Functional neuroanatomy- brain anatomy and physiology
• If a particular area of the brain is affected, what is the expected response? What
symptoms would you expect to see?
• Link the assessment to the affected brain area. For example, if a client comes to
your office with complaints of (fill in physical complaint) what are of the brain is
affected? Focus on those specific examples within the Explore section and your
readings.
• A client cannot copy a written word or drawing, what area of the brain is affected?
Ethical issues- covered in both the course Explore section and readings
• Informed Consent Clients have the right to receive enough information to make
decisions about treatment. They must also be informed about potential risks
associated with medications. Clients have the right to refuse treatment and
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 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
include clients with schizophrenia or sex offenders. Guardians can also provide
consent for clients who have limited cognitive capabilities or are incompetent to
make decisions. Ultimately, PMHNPs are responsible for being knowledgeable
about their state laws and abiding by them.
• Off-Label Prescribing Some clients may benefit from the unapproved use of a
drug for symptom management. For example, many selective serotonin reuptake
inhibitors (SSRIs) are used to treat anxiety and obsessive-compulsive disorder
, but are not FDA approved for use in this disorder. Off-label prescribing potentially
raises ethical and legal concerns; the PMHNP must remain up to date with the
latest recommendations for off-label prescribing.
Epigenetics- covered in both the course Explore section and readings.
• Why is epigenetics important?
• How does epigenetics impact a person’s mental health? Each person inherits
genetic code from their parents, including genetic markers (a risk or
predisposition) for certain diseases. Throughout a person’s life, chemical
compounds that have been added to the entirety of each person's DNA (genome)
regulate the activity of all the genes within the genome. This gene modification is
known as epigenetics. The epigenome chemical compounds are not part of the
DNA sequence but are attached to DNA. Epigenetic modifications can remain as
cells divide and some modifications can be passed to offspring in subsequent
generations. Epigenetics is an important consideration in mental health when
internal or external factors activate portions of the genome that result in the
manifestation of mental health symptoms. In the case of mental health,
activation is often a result of a stressful event, which, when combined with the
genetic risk, results in the disease. Stahl (2021) refers to this as genes being on
or off. The occurrence of symptoms may be the result of inheritance of an
abnormal gene or of normal genes being "on" when they should be "off."
Conducting a complete history, including the client’s social and family history, will
provide clues to the mental health diagnosis. It is not uncommon for the client
and family to request information on the genetic risks associated with mental
health conditions. The PMHNP must be prepared to address their concerns.
Genetics- the CYP 450 impact is discussed in course Explore section.
How does the CYP450 affect pharmacodynamics and pharmacokinetics? The cytochrome P450
enzyme system is responsible for metabolizing many psychotropic medications. Drug metabolism
is influenced by client factors such as age, smoking, caffeine intake, or other medications. Older
adults’ drug metabolization is decreased, so dosages may need to be reduced to prevent toxicity.
Other drugs and substances such as nicotine or caffeine can be either inducers, which increase
the rate of drug metabolism, or inhibitors, which decrease the rate of drug metabolism.
Polypharmacy is another factor which is common in the care of clients with psychiatric disorders.
Not only do clients withpsychiatric disorders often need more than one medication to control
symptoms,particularly in those with the diagnosis of schizophrenia or bipolar illness, but they
often need subsequent medications to manage side effects
1) These questions are very similar to what you will see on boards.
2) Neuroscience matters-Know what area of the brain is associated with
presenting symptoms AND how the medication works on that area of the brain to
treat that symptom (the medication mechanism of action)
3) Use this study guide-As you use your study guide and medication sheets to
prepare for the exams, take note of outliers and unique properties. What
medication in that class has the most adverse effects? Who should not take that
medication? Which medication has no CYP450 interactions? Which medication is
first line? What area of the brain is affected by these medications?
Week 1
Functional neuroanatomy- brain anatomy and physiology
• If a particular area of the brain is affected, what is the expected response? What
symptoms would you expect to see?
• Link the assessment to the affected brain area. For example, if a client comes to
your office with complaints of (fill in physical complaint) what are of the brain is
affected? Focus on those specific examples within the Explore section and your
readings.
• A client cannot copy a written word or drawing, what area of the brain is affected?
Ethical issues- covered in both the course Explore section and readings
• Informed Consent Clients have the right to receive enough information to make
decisions about treatment. They must also be informed about potential risks
associated with medications. Clients have the right to refuse treatment and
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 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
include clients with schizophrenia or sex offenders. Guardians can also provide
consent for clients who have limited cognitive capabilities or are incompetent to
make decisions. Ultimately, PMHNPs are responsible for being knowledgeable
about their state laws and abiding by them.
• Off-Label Prescribing Some clients may benefit from the unapproved use of a
drug for symptom management. For example, many selective serotonin reuptake
inhibitors (SSRIs) are used to treat anxiety and obsessive-compulsive disorder
, but are not FDA approved for use in this disorder. Off-label prescribing potentially
raises ethical and legal concerns; the PMHNP must remain up to date with the
latest recommendations for off-label prescribing.
Epigenetics- covered in both the course Explore section and readings.
• Why is epigenetics important?
• How does epigenetics impact a person’s mental health? Each person inherits
genetic code from their parents, including genetic markers (a risk or
predisposition) for certain diseases. Throughout a person’s life, chemical
compounds that have been added to the entirety of each person's DNA (genome)
regulate the activity of all the genes within the genome. This gene modification is
known as epigenetics. The epigenome chemical compounds are not part of the
DNA sequence but are attached to DNA. Epigenetic modifications can remain as
cells divide and some modifications can be passed to offspring in subsequent
generations. Epigenetics is an important consideration in mental health when
internal or external factors activate portions of the genome that result in the
manifestation of mental health symptoms. In the case of mental health,
activation is often a result of a stressful event, which, when combined with the
genetic risk, results in the disease. Stahl (2021) refers to this as genes being on
or off. The occurrence of symptoms may be the result of inheritance of an
abnormal gene or of normal genes being "on" when they should be "off."
Conducting a complete history, including the client’s social and family history, will
provide clues to the mental health diagnosis. It is not uncommon for the client
and family to request information on the genetic risks associated with mental
health conditions. The PMHNP must be prepared to address their concerns.
Genetics- the CYP 450 impact is discussed in course Explore section.
How does the CYP450 affect pharmacodynamics and pharmacokinetics? The cytochrome P450
enzyme system is responsible for metabolizing many psychotropic medications. Drug metabolism
is influenced by client factors such as age, smoking, caffeine intake, or other medications. Older
adults’ drug metabolization is decreased, so dosages may need to be reduced to prevent toxicity.
Other drugs and substances such as nicotine or caffeine can be either inducers, which increase
the rate of drug metabolism, or inhibitors, which decrease the rate of drug metabolism.
Polypharmacy is another factor which is common in the care of clients with psychiatric disorders.
Not only do clients withpsychiatric disorders often need more than one medication to control
symptoms,particularly in those with the diagnosis of schizophrenia or bipolar illness, but they
often need subsequent medications to manage side effects
