MH701 exam 1 Exam Study Guide Questions And Answers Verified 100% Correct

MH701 exam 1 Exam Study Guide Questions And Answers Verified 100% Correct What is next steps after a treatment failure? - ANSWER Increase dose, try another medication in same class, or if failure of #2 in same class - try a different class, add an additional medication Dysthymia (Persistent Depressive Disorder) - ANSWER A form of depression that is not severe enough to be diagnosed as major depression. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable, and duration must be at least 1 year. Dysthymia treatment options - ANSWER (SSRIs) venlafaxine and bupropion are an effective treatment for patients. Individual insight-oriented psychotherapy is the most common treatment method for dysthymia Bupropion (Wellbutrin) MOA NDRI - ANSWER Blockade of norepinephrine and dopamine reuptake increases the available pool of these amines in the synaptic cleft. Contraindications: Hx of seizures Anorexic or bulimic Hx of substance abuse Therapeutics: MDD Seasonal affective disorder Nicotine addiction ADHD Cocaine detox Hypoactive sexual desire disorder. Mirtazapine (Remeron) - ANSWER Boosts NE and serotonin (5HT) activity Contradictions: Can cause fatal serotonin syndrome when combined with MAOIs May lower WBC May increase cholesterol Seizures Causes weight gain Causes sedation Therapeutics: Can help patients who need to gain weight Can help with anxiety and sleep-related to sedation Can boost the efficacy of other antidepressants Depression (especially patients with insomnia) Anxiety Nightmare suppression Helpful for sleep with children/adolescents. MAOIs (monoamine oxidase inhibitors) - ANSWER Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion ( aged and fermented foods), so care must be taken to avoid these substances. Educate the client to avoid all medications until discussed with provider. Many food/drug interactions Therapeutics: Depression, panic disorder, Bulimia, and PTSD - if all other classes have failed and pt appropriate. ACTION is on NE, SE, Epinephrine, Dopamine, and tyramine Trazodone (Desyrel) Nefazadone (Serzone) - ANSWER Enhances 5HT activity Therapeutics: Depression, anxiety - off label sleep, these are best as augmenting therapies and not monotherapy Contraindications: Hepatic impairment, taking MAOI, carbamazepine can decrease effects significantly, can lower the seizure threshold with other antidepressants, can interfere w potency of HTN drugs, can interfere with warfarin Can cause priapism (TrazeBONE) What is the significance of understanding about CYP 450 when prescribing various medications that may affect this? - ANSWER CYP450s are a family of enzymes that can determine how our body metabolizes certain medications. By isolating these genotypes/phenotypes in appropriate patients, as clinicians we can have a foundation to prescribe medications related to whether the pt is an ultra-metabolizer or poor metabolizer. This aids in the determination of which drug and what dose. It can also help when you have a patient on multiple medications to attempt to predict any reaction. An UM may need a higher dose to start, and a PM may need a lower dose to start. CYP450 testing can also help to understand why one patient has increased S/E as well as which ethnic populations have shown poor efficacy or toxicity in regard to certain medications. As PMHNPs, numerous genotypes/phenotypes have been isolated for psychotropics, antidepressants, neuroleptics and opioids. There are even guidelines that have been established for specific TCAs and SSRIs based on CYP450 testing. Of note, the utilization has not been perfected since CYP450 is not the only factor in pharmacokinetics. Lifestyle, substance abuse, polypharmacy, diet are only a few other factors that may limit CYP450 genotypes/phenotypes from being the final determination in prescribing. Dopamine - ANSWER A neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system. Called the pleasure chemical ● Too much dopamine in area of the brain and too low in another area of the brain has been associated with schizophrenia ● Too little is associated with some forms of depression as well as the muscular rigidity and tremors found in Parkinson's disease. Serotonin (5-HT) - ANSWER Plays a role in mood, anxiety, emotions, appetite, ● sleep, appetite, and impulsive and aggressive behavior ● Too little serotonin is associated with depression Norepinephrine - ANSWER ● Neurotransmitter associated with arousal and Fight or flight ● Too much of this w/ no actual danger can leave a person anxious and hyperactive ● Too little norepinephrine has been associated with depression Histamine - ANSWER *Histaminergic cell bodies are found in the tuberomamillary neurons. The firing of these neurons has to do with the sleep wake cycle.