ANCC IQ Domains 1-5 Qbank answered all correctly answered; latest updated summer 2022.

1. 2 yr. old child with Fetal Alcohol Syn- drome (FAS) small head, short eye lid opening, flat midface, smooth philtrum, un- derdeveloped jaw, thin upper lip, and short nose 2. Neuroleptic Malignant Syndrome (NMS) - Acute mental status change, muscular rigidity, and autonomic instability (fever) 3. Elderly pt c/o tinnitus; the PMHNP would associate which of the following find- ings with an acoustic neuroma? 4. Brain structure is activated in patients - Unilateral tinnitus (ringing in the ears) may be the first symptom of an acoustic neuroma - Sx/sx infection of the ear - perfo- ration of tympanic membrane, in- flammation of the middle ear, and suppuration of the labyrinth - Amygdala is important in medi- with severe anxiety (fear, panic, extreme ation of fear, anxiety, and panic anxiety) 5. Which of the following does not reflect current understanding of neurotrans- mitter pathways implicated in anxiety disorders? -FALSE: decreasing GABA in the mesolimbic cortex diminishes symp- toms of anxiety -TRUE: increasing serotonergic activity in the amygdala diminishes symptoms of anxiety -TRUE: decreasing norepinephrine in the locus ceruleus diminishes symp- toms of anxiety -TRUE: increased levels of CRF in the amygdala, hippocampus and locus ceruleus increases symptoms of anxi- ety -FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety Rationale: GABA (Gam- ma-aminobutyric acid) is the most abundant inhibitory neurotrans- mitter in the brain. Decreas- ing GABA would increase anxi- ety. Benzodiazepines are used to bind with GABA receptors to po- tentiate the anxiolytic (calming) effects of GABA. The other re- sponses are all accurate regard- ing effect on anxiety symptoms. 6. While treating a 12-year-old boy for ADHD, the PMHNP observes which of the following physical features that raise concerns for genetic evaluation for Fragile X Syndrome? -obesity, small stature, small hands and feet, hypotonia -café au lait spots on face and arms, neurofibromas -long head and ears, short stature, hy- perextensible joints -small stature, short palpebral fissure, inner epicanthal folds 7. Which of the following patients with generalized anxiety disorder is most likely to be a CYP 2C19 poor metabo- -long head and ears, short stature, hyperextensible joints Rationale: Etiological factors in mental retardation can be primar- ily genetic, developmental, ac- quired, or in combination. Ge- netic causes included chromo- somal and inherited conditions. Many of these genetic disorders have characteristic physical fea- tures that warrant genetic testing for confirmatory diagnosis. Frag- ile X Syndrome occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The typical phenotype includes a large, long head and ears, short stature, hy- perextensible joints, and postpu- bertal macroorchidism. The men- talretardation ranges from mild to severe. There is high rate of co- morbid ADHD, learning disorder, and pervasive developmental dis- orders, such as autism. Café au lait spots and neurofibromas are common in von Recklinghausen's disease. Obesity, small stature, small hands and feet, hypotonia, and hypogonadism are charac- teristic of Prader-Willi Syndrome. Small head, short palpebral fis- sure, and inner epicanthal folds are characteristic of fetal alcohol syndrome. -40-year-old Asian male Rationale: The frequency of poor metabolizers of CYP 2C19 is low lizer and have an exaggerated response among Caucasians (3%), inter- to diazepam (Valium) 5 mg TID with in- creased sedation, central nervous sys- tem, and cognitive side effects? -40-year-old Asian male -30-year-old African American male 20-year-old African American male 50-year-old Caucasian male 8. Which serotonin receptor antagonism makes an antipsychotic "atypical"? -5HT2A -5HT1A -5HT4A -5HT3A 9. Which mood stabilizer is most associ- ated with a potentially life-threatening rash? 10. Which of the following findings would raise concern in a pre-school wellness exam for a 5-year-old girl? mediate among African Ameri- cans (18%), and higher in Asian and Japanese populations (up to 20%). -5HT2A Rationale: The mechanism of ac- tion that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. -5HT1A -5HT4A -5HT3A -lamotrigine (Lamictal) Lamotrigine is associated with a rare, serious, and potential- ly life-threatening rash (Steven Johnsons syndrome height 43 inches, weight 55 lbs Rationale: Body Mass Index (BMI) calculated for this height and weight is 21, which is greater than 95th percentile for her age, placing her in overweight cat- egory. Calculation: Weight (lbs) /Stature (inches) / Stature (inch- es) x 703 = BMI BMI = 703 x weight (lbs) = 703 x 55 [Height (in)]2 432 Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI. BMI = weight (kg) 11. Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? -decreased electrical activity in the frontal lobes -decreased total brain volume -decreased size of cerebral ventricles -decreased glutamate and GABA re- lease 12. A client is suffering from schizophre- nia. Which of the FF would be the ap- propriate question for the PMHNP to ask when assessing side effects pro- duced by dopamine antagonism in the tuberoinfundibular pathway? - are you experiencing drooling? [height (m)]2 Further evaluation is indicated: 1) assessment of daily activity level and dietary intake; 2) lab work to rule out medical etiolo- gy such as hypothyroidism and diabetes mellitus; and 3) family history of obesity, diabetes, hy- pertension, etc. Parental counsel- ing for child's nutritional and ex- ercise needs to begin addressing childhood obesity and prevention of secondary medical problems. Other vital signs are within nor- mal limits and immunizations are complete for a 5-year-old. -Completed immunizations: MMR, Varicella, DTap, IPV, PCV, Hib, HepB Blood pressure 92/52 Pulse 102, respirations 30 -decreased size of cerebral ven- tricles Rationale: Individuals with schiz- ophrenia have enlarged cerebral ventricles. There is decreased electrical activity in frontal lobes, decreased glutamate and GABA release, and decreased total brain volume. -are you experiencing breast dis- charge? Rationale: Galactorrhea is caused from dopamine blockade in the tuberoinfundibular pathway by antipsychotic drugs. -are you experiencing dizziness? -are you experiencing breast dis- charge? Rationale: Galactorrhea is caused from dopamine blockade in the tuberoin- fundibular pathway by antipsychotic drugs. -are you experiencing tremors? 13. You have a 17-year-old female patient who suffers with bipolar disorder. The patient has a history of impulsive acting out and promiscuity. You make a deci- sion to add Folic acid 0.8 mg to her med- ication regimen of Lamotrigine (Lamic- tal) 200 mg PO QHS and Quetiapine XR (Seroquel XR) 50 mg PO QHS. Why is it important? - The folic acid is important to help her with her hypotension induced by the Quetiapine XR (Seroquel XR) 50 mg PO QHS. - The folic acid supports neural tube de- velopment during the first month that a woman is pregnant. - The folic acid is important for the continuing development of the patient's neuroendocrine system. - The folic acid is important to help her with the sleepiness induced by her bipo- lar medications. 14. 1. Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia? - Negative symptoms are related to DA deficit in the mesolimbic system; pos- itive symptoms are related to DA ex- - The folic acid supports neural tube development during the first month that a woman is pregnant. Rationale: The patient's acting out behaviors may include sexual act- ing out. This could lead to preg- nancy. The United States Preven- tive Services Task Force (USP- STF) recommends that all women planning or capable of pregnancy take a daily supplement contain- ing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. This recommenda- tion is an A level recommenda- tion. The purpose is to lower the number of neural tube defects in fetuses. - Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accum- bens and mesolimbic system Rationale: Negative symptoms and cognitive impairment are cess in the substantia nigra and ventral tegmental area - Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ven- tral tegmental area - Negative symptoms are related to DA deficit in the mesolimbic system; pos- itive symptoms are related to DA ex- cess in the substantia nigra and ventral tegmental area - Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolim- bic system 15. Which cytochrome (CYP) enzyme is im- plicated as a tobacco inducer when an individual is treated on clozapine? - 2D6 - 2C19 thought to be related to hypoactiv- ity of the mesocortical dopamin- ergic tract, which by association with the prefrontal and neocortex contributes to motivation, plan- ning, sequencing of behaviors in time, attention, and social behav- ior. Positive symptoms of schizo- phrenia (hallucinations and delu- sions) are thought to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates memory and emotion. This hy- peractivity could result from over- active modulation of neurotrans- mission from the nucleus ac- cumbens. Another explanation for dopaminergic hyperactivity in the mesolimbic tract is the hypoac- tivity of the mesocortical tract, which normally inhibits dopamine activity in the mesolimbic tract by some type of feedback mecha- nism. In schizophrenia, the prima- ry defect may be in the meso- cortical tract, where dopaminer- gic function is diminished, there- by decreasing the inhibitory ef- fects on the mesolimbic tract. This disinhibition may be responsible for the overactivity of dopamine in the mesolimbic tract, resulting in positive symptom cluster. - 1A2 Rationale: When an individual is treated on clozapine and de- creases tobacco use, the clozap- ine level will increase, as the to- - 1A2 - 2C9 16. If given during pregnancy, lithium can cause which of the following medical problems in the baby? - Neural tube defect - Cleft palate - Spina bifida - Ebstein's anomaly bacco is an inducer to the cloza- pine, and the patient no longer needs the higher dose of clozap- ine. When patients enter the hospital, they may have to stop smoking abruptly if the hospital has a 'no smoking' policy. Abrupt smoking cessation can affect the metabo- lism of drugs. Cigarette smoking induces the activity of human cytochromes P450 (CYP) 1A2 and 2B6. These enzymes metabolise several clin- ically important drugs, includ- ing clozapine, olanzapine and methadone. Decreased CYP1A2 activity after smoking cessation increases the risk of adverse drug reactions, with reports of increased toxici- ty from clozapine and olanzapine. Predicting the required dose re- duction of drugs metabolised by CYP1A2 after smoking cessation is challenging. Therapeutic drug monitoring should be used when possible. Nicotine replacement therapy does not influence CYP1A2 activ- ity - Ebstein's anomaly Rationale: Lithium can cause Eb- stein's anomaly in the infant if giv- en to a pregnant woman. Ebstein anomaly is a rare heart defect in which the tricuspid valve — the valve between the up- 17. Which of the following medications has a unique mechanism of action in that it is both a dopamine and norepinephrine reuptake inhibitor? 18. Arcus senilis when seen before the age of 40 years, is associated with which of the following disorders? per right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn't formed properly. As a result, blood leaks back through the valve and into the right atrium. This connection allows unoxy- genated ("blue") blood to flow from the right atrium to the left atrium, bypassing the lungs and going directly to the body. This will result in lower oxygen levels in the blood. This is why children with Ebstein anomaly may be blue or "cyanotic," and have low oxygen saturations. - Bupropion (Wellbutrin) Rationale: Bupropion boosts neurotransmitters norepineph- rine/noradrenaline and dopamine. Bupropion works by inhibiting the reuptake of dopamine, serotonin, and norepinephrine; an action that results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. A neurotransmitter is a chemical messenger that carries, boosts, and balances signals between neurons (also known as nerve cells) and target cells. Hyperlipidemia Rationale: Arcus senilis is a gray opaque band in the cornea, 1.0 - Syphilis - Hypertension - Hyperlipidemia - HIV infection 19. As a psychiatric mental health nurse practitioner, you are aware of antipsy- chotic medication side effects. Which of the following side effects of antipsy- chotic medications has an insidious, de- layed-onset typically 1 to 2 years after initiation of the medication? - Tardive dyskinesia - Dry mouth - Sedation - Weight gain 20. 1. A 74-year-old female presents for an evaluation. The psychiatric nurse practi- tioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to cor- rectly draw the face of the clock. Which area of the brain is likely to have com- promised functioning? - Left hemisphere - Right hemisphere - Wernicke's area - Corpus callosum 21. What is a rare but serious side effect of trazodone (Desyrel)? - Rash - Tremor to 1.5 mm wide, separated from the limbus by a narrow clear zone. Early on only a segment of the cir- cumference is involved; later the circle is completed. It is present to some degree in most persons old- er than 60 years of age; it is bilat- eral. If seen before age 40, hyper- lipidemia should be suspected. - Tardive dyskinesia Rationale: Tardive dyskinesia (TD) is a delayed-onset involun- tary movement disorder associ- ated with antipsychotic medica- tions. A typical clinical course of TD is marked by insidious onset, usually after 1-2 years of continu- ous exposure to antipsychotics. - Right hemisphere Rationale: The right hemisphere of the brain is involved with recog- nition of facial expressions, mu- sic, and visual images. When the right hemisphere is compro- mised, there are disturbances in drawing, such as clock drawing. - Priapism Rationale: Painful persisting pe- nile erection (priapism) is a rare - Confusion - Priapism 22. Which of the following statements re- flects current understanding of neu- rodevelopment and best explains risk-taking behaviors of adolescent males? - Pruning of serotonin circuits in the adolescent brain is associated with in- creased impulsivity. - Maturation of the prefrontal cortex continues into mid-20's and early 30's. - Hormonal flooding, especially testos- terone and oxytocin, increase dopamine levels in the brain. - Stimulant and substance use impairs judgment and cognitive appraisal. 23. 1. You are on call for your service. You arrive at the Emergency Department to find a 22-year-old male patient com- but serious side effect which can occur with trazodone. Maturation of the prefrontal cortex continues into mid-20's and early 30's. Rationale: The prefrontal cortex acts to inhibit impulsive and mo- tivational drives, yet this struc- ture doesn't fully mature until the mid-20's or early 30's. While the other three responses are true, it is the cognitive inhibitory "brakes" to control one's impulses that is lacking or still in development that best explains adolescent risk-tak- ing behavior. - Discontinue the Aripiprazole and give Benztropine Mesylate (Co- gentin) 1 mg IM. Have him take plaining of having trouble with his eyes. Benztropine Mesylate 1 mg PO His vitals are stable. He is 5 foot 7 inch- es tall; his weight is 140 pounds; and, his labs are all in the normal range. He states that he has been taking Aripipra- zole (Abilify) for the last 2 months for his Bipolar 1 disorder. He had the dose raised to 15 mg PO QAM 4 days ago to BID for 5 days. Have him return to his provider for a different med- ication for his bipolar disorder the next day. Rationale: This is an Aripipra- zole-induced oculogyric crisis (acute dystonia) (i.e., muscle manage a manic episode. He states that spasms and contractions that can one to three times a day for the past 2 days his eyes will roll upwards for 10 to 15 minutes and he will have trouble seeing until they roll back down. When you examine his eyes, he is able to fully open his eyes but he is not able to focus his eyes on you. His eyes are rolled up- wards about 2/3rds of the way towards cause strange posturing of the body depending on the muscle groups affected). This is not as common with atypical antipsy- chotic medications as with the older antipsychotic medications. Aripiprazole has a half-life of 75 hours. Aripiprazole is the third his upper eyelid. After examination you decide to: - Continue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg generation atypical antipsychotic and a dopamine serotonin sys- tem stabilizer (DSS) that is ef- fective against positive and neg- IM. Have him take Benztropine Mesylate ative symptoms of schizophrenia. (Cogentin) 1 mg PO BID. Have him re- turn to his provider for further manage- ment of his bipolar disorder the next day. - Discontinue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg It has a low propensity for ex- trapyramidal side effects, caus- es minimal weight gain or se- dation, produces no elevation in serum prolactin levels and does not cause prolongation of QTc in- IM. Have him take Benztropine Mesylate terval. 1 mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day. - Begin a cross titration downward of the Aripiprazole and upwards of Haloperi- dol (Haldol). Have him return to his provider for further management of his bipolar disorder. - Discontinue the Aripiprazole and be- gin the patient on a gradually increas- ing regimen of Lamotrigine 25 mg 1 PO QHS for 1 week. Have him return to his provider for further management of his bipolar disorder. 24. Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar 1 disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trilep- tal) 900 mg PO QHS. Her labs are nor- mal except for a blood sugar of 114 and her Hemoglobin A1c is 5.6. She has a normal energy level and states that her mood is stable but complains of exces- sive urination and thirst. You suspect: - Side effects of Oxcarbazepine (Trileptal) Rationale: In patients taking Ox- carbazepine, some side effects can come at the beginning or later in therapy. When the blood sugar is up but the HgbA1c is normal, suspect the medication as the cul- prit. - Possible polydipsia - Possible diabetes 2 - Possible hyponatremia - Side effects of Oxcarbazepine (Trilep- tal) 25. 1. Which of the following antidepres- sants is associated with dose-related cardiovascular adverse effects which require adherence to maximum recom- mended dosing, unless higher doses are deemed appropriate despite risks? - Mirtazapine (Remeron) - Sertraline (Zoloft) - Citalopram (Celexa) - Venlafaxine (Effexor) 26. 1. In evaluating a 4-year-old, one would expect which of the following delays in Asperger's Disorder? - Cognitive development - Motor skills coordination - Social skills development - Language development 27. Which of the following statements most - Citalopram (Celexa) Rationale: Citalopram should no longer be prescribed at dos- es greater than 40 mg/day be- cause it can cause abnormal changes in the electrical activi- ty of the heart. Some controver- sy with FDA dosage limit of 40 mg/day, and higher doses may be prescribed by experts. Social skills development Rationale: Unlike autistic disor- der, in Asperger's disorder no significant delays occur in lan- guage, cognitive development, or age-appropriate self-help skills. The primary clinical features in- volve qualitative social impair- ment: markedly abnormal nonver- bal communicative gestures, fail- ure to develop peer relationships, the lack of social or emotional rec- iprocity, and an impaired ability to express pleasure in other per- son's happiness. - Genetic predisposition of accurately reflects the predominant risk first-degree family member factors of antisocial personality disor- ders? - Childhood abuse and trauma from do- mestic violence Rationale: Antisocial personality disorder is five times more com- mon among first-degree relative of men with the disorder than the - Genetic predisposition of first-degree family member - Gang affiliation and early substance abuse - Lower socioeconomic status from sin- gle-parent families 28. 1. Which of the following findings would raise concern in an annual sports exam for a 15-year-old girl? - Pulse 60, respirations 26 - Blood pressure 86/56 - Height 67 inches, weight 102 lbs - Scar tissue from hymenal tear at 11 o'clock (reported biking injury) 29. 29. general population, making ge- netic predisposition the greater risk factor than any other. Con- cordance rates for monozygotic twins are much higher than dizy- gotic twins for personality disor- ders from investigations of 15, 000 twin pairs in U.S. Moreover, according to one study, monozy- gotic twins reared apart are about as similar as monozygotic twins reared together. - Height 67 inches, weight 102 lbs Rationale: Calculated Body Mass Index (BMI) is 16, which is less than 5th percentile for her age, placing her in underweight cat- egory. Calculation: [Weight (lbs)/ Stature (inches)2] x 703 BMI = 703 x weight (lbs) = 703 x 102 = 16 [Height (in)]2 672 Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI. BMI = weight (kg) [height (m)]2 Further evaluation is indicated for eating or body dysmorphic dis- order, anemia, or other underly- ing medical problems: 1) assess daily nutrition and exercise activ- ities; 2) assess for anorexia with or without binging and purging; 3) lab work for CBC with differ- ential, electrolytes, thyroid panel, and urinalysis. What direct-acting receptor agonist is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS) to help lower the dopamine receptor blockade? - Bromocriptine (Parlodel) - Benztropine (Cogentin) - Trihexyphenidyl (Artane) - Dantrolene (Dantrium) - Bromocriptine (Parlodel) Rationale: Parlodel is the recom- mended direct acting dopamine receptor agonist to help decrease the dopamine blockade. Dantri- um is a muscle relaxant, and Co- gentin and Artane are anticholin- ergic medications used for ex- trapyramidal side effects (EPS). 30. 1. A 17-year-old female presents to your - Bulimia clinic reporting anhedonia, decreased energy, and hopelessness for the past 2 years. She denies drinking alcohol, smoking, or using illegal substances. Her physical examination results are within normal limits and she denies sui- cidal ideations. As the treating psychi- atric mental health nurse practitioner, you decide to prescribe her bupropion (Wellbutrin). Of the following, which is a contraindication for bupropion? - Dysthymia - Fatigue - Smoking - Bulimia 31. 1. The PMHNP would expect to see which of the following during a physical exam for a patient with bulimia nervosa? - Alopecia areata - Erosion of dental enamel - Obesity tachycardia Rationale: Do not use bupropion if patient is bulimic, either current- ly or in the past. Prohibition for use in eating disorders due to in- creased risk of seizures. - Erosion of dental enamel Rationale: Erosion of dental enamel from repeated self-in- duced vomiting, although some patients are able to vomit at will. Weight is usually normal, sometimes slightly underweight or slightly overweight, but typical- ly not obese. Hair lost is not a predominant clinical feature and not in circular (areata) pattern for bulimia nervosa. While cardiac 32. 1. The risk of bleeding on selective sero- tonin reuptake inhibitors, non-steroidal anti-inflammatory drugs (NSAIDS), or aspirin, is an example of which of the following principles? - Pharmacodynamic - Distribution - Absorption - Pharmacokinetic 33. 1. A 37-year-old patient with schizophre- nia is started on a high dose of chlor- promazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in blood pres- sure and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing - Decreased sweating - Orthostatic hypotension - Respiratory depression - Dry mouth 34. Which area of the brain has been im- plicated to modulate pain and can help explain how transcranial magnetic stim- ulation can help decrease pain? - Dorsolateral prefrontal cortex - Anterior cingulate cortex arrhythmias are more common in anorexia nervosa with severe weight loss, it is not a common or expected finding in bulimia ner- vosa with weight typically within normal range. - Pharmacodynamic Rationale: Interaction is due to the risk of inhibition of platelet aggre- gation, an example of pharmaco- dynamics. Pharmacokinetics is the study of what the body does to the drug, and Pharmacodynamics is the study of what the drug does to the body. - Orthostatic hypotension Rationale: Orthostatic hypoten- sion, a drop in blood pressure while standing, is a side effect from alpha 1-adrenergic block- ade. This is especially trouble- some with chlorpromazine and clozapine and is best handled by raising doses slowly - Prefrontal cortex Rationale: It has been shown that the prefrontal cortex modulates pain and the perception of pain; loss of gray matter has been as- sociated with chronic pain, pos- sibly due to a predisposition, or - Prefrontal cortex - Insula cortex 35. 1. Mr. Smith is a 56-year-old white male who has been successfully treated on Selegiline for over 4 years. Mr. Smith is going in for an elective surgical proce- dure. Which medication is strictly con- traindicated with Selegiline? - Meperidine (Demerol) - narcotic - Non-steroidal anti-inflammatory drugs (NSAIDs) - Codeine - Morphine 36. 1. Which of the following statements regarding disulfiram (Antabuse) is cor- rect? - A disulfiram-alcohol reaction can oc- cur up to 1 week after discontinuing disulfiram. chronic medication use may be toxic to gray matter. - Meperidine (Demerol) - narcotic Rationale: Meperidine is strictly prohibited when a patient is treat- ed on a monoamine oxidase in- hibitor (MAOI), due to the risk of hypertensive crisis and death. - Avoid anything containing al- cohol (i.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing. Rationale: Disulfiram should not - Avoid anything containing alcohol (i.e., be taken for at least 12 hours after vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing. - Disulfiram can lower liver function tests so monitoring is necessary. - Disulfiram should not be taken at least 6 hours after drinking alcohol. 37. Norepinephrine is a neurotransmitter that is implicated in alertness and anx- iety. What area of the brain has a large majority of norepinephrine neurons? - locus coeruleus - Hippocampus - Amygdala - Nucleus accumbens drinking alcohol. A disulfiram-al- cohol reaction can occur up to 2 weeks after discontinuing disul- firam. Disulfiram can elevate liv- er function tests so monitoring is necessary. - locus coeruleus Rationale: There are two areas in the brain that produce norep- inephrine neurons, one is locus coeruleus and the other is the medullary reticular formation. 38. 38. When studying pharmacodynamics in- volving receptors, you know that an in- verse agonist produces the following ef- fect: - Causes the opposite effect of agonist, and causes the receptor to close the ion channel. - Does not fully activate the receptor and causes only limited actions. - Activates a biological response, and opens the ion channel. - Blocks the agonist from opening the channel, and does not activate a biolog- ical response. 39. A 43-year-old male is treated for Bipo- lar I on lithium. Which of the following hematologic changes is associated with lithium? - Leukopenia - Agranulocytosis - Anemia - Leukocytosis - Causes the opposite effect of agonist, and causes the receptor to close the ion channel. Rationale: Inverse agonists do the opposite of agonists. It causes the receptor to close the ion channel. - Leukocytosis Rationale: While the mechanism of action is not clear, the use of lithium can raise white blood cell counts and, therefore, CBC should be monitored in patients treated on lithium.