NURS 663 PRACTICE MIDTERM EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔Tricyclic side effects - ✔✔Anticholinergic effects (dry mouth, blurred vision,
constipation, urine retention, impotence). Histamine effects (sedation, increased
weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects
(decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and
decrease anxiety).
✔✔Amitriptyline dosing/Class - ✔✔Start at 25 to 50 mg per day, titrate 25 to 50 mg per
day per week, Max dose is 300 mg per day/TCA
✔✔Names of tricyclics 10 - ✔✔Amitriptyline, nortriptyline, clomipramine, imipramine,
protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine
✔✔Tricyclics are useful-2 - ✔✔Pain, migraine
✔✔Tricyclics adverse effects-2 - ✔✔Overdoses are cardiotoxic, high potency increases
the risk of mania
✔✔Nortriptyline mnemonic - ✔✔No-triptyline equals less sedation and hypotension
✔✔Tricyclics mnemonic-2 - ✔✔Think car goes over tricycle to remember that an
overdose is cardiotoxic. Do you remember mechanism think trans =serotonin and
norepinephrine Chans= Na+ and Ca+ Ans= ACH and histamine
✔✔Clomipramine mnemonic/class - ✔✔TCA- think comipramine for obsessive
compulsive disorder
✔✔Imipramine- pneumonic and class - ✔✔I'm peeingamine- nocturnal enuresis
✔✔Unilateral electrode in ECT indications - ✔✔Typically first line because it has less
cognitive side effects but has less efficacy
✔✔What is ECT? - ✔✔The use of electrical shock current delivered to the brain to
induce a seizure that treats depression. Goal is to reverse atrophy.
✔✔ECT is FDA approved for what - ✔✔Bipolar disorder, schizophrenia, schizoaffective
disorder, catatonia, neuroleptic malignant syndrome, treatment resistant refractory
major depressive disorder
✔✔What is ECT schedule - ✔✔Typically Monday Wednesday Friday for 6 to 12
sessions
, ✔✔Bilateral electrode placement in ECT indications - ✔✔Classic placement increases
cognitive side effects but has better efficacy. Reserved for urgency such as life-
threatening depression profound distress and catatonia
✔✔ECT side effects and Risks 8 - ✔✔Cognitive side effects such as memory loss,
head, neck, jaw pain, nausea, myalgia's procedure is low risk
✔✔What is vagus nerve stimulation - ✔✔It's an implant in the chest that stimulates the
left Vegas nerve by Paul stations and it's controlled by an on off switch that is activated
by a magnet
✔✔How does vagus nerve stimulation work - ✔✔Stimulates the brain stem nuclei which
changes serotonin in the limbic and cortical systems
✔✔Vagal nerve stimulation side effects-4 - ✔✔Voice altered, breathlessness, neck pain,
no cognitive side effects
✔✔Vagus nerve stimulation is FDA approved for what in under investigation for what -
✔✔FDA approved for epilepsy and under investigation for major depressive disorder
and bipolar disorder
✔✔What is trans cranial magnetic stimulation - ✔✔Placement of rapid alternating
magnets on scalp cause impulse to structures and is focused
✔✔Goal of trans cranial magnetic stimulation - ✔✔Firing of neurons will alter pathology
✔✔Trans cranial magnetic stimulation is FDA approved for and not approved for -
✔✔Approved for refractory treatment resistant depression It is not approved for bipolar
disorder or schizophrenia
✔✔What is cognitive therapy based on - ✔✔Negative thinking increase his depression
vulnerability, this therapy challenges beliefs and assumptions related to depression
✔✔Cognitive therapy indications 11 - ✔✔Depression, anxiety, PTSD, schizophrenia,
phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders,
substance abuse disorders
✔✔Cognitive therapy interventions - ✔✔Automatic thought restructuring, provide
evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater
than just antidepressants and anti-depressants are greater than just cognitive
behavioral therapy in efficacy
✔✔What is interpersonal therapy based on - ✔✔Based on the theory that depression
Arises from problematic patterns and relationships
ANSWERS GRADED A+
✔✔Tricyclic side effects - ✔✔Anticholinergic effects (dry mouth, blurred vision,
constipation, urine retention, impotence). Histamine effects (sedation, increased
weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects
(decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and
decrease anxiety).
✔✔Amitriptyline dosing/Class - ✔✔Start at 25 to 50 mg per day, titrate 25 to 50 mg per
day per week, Max dose is 300 mg per day/TCA
✔✔Names of tricyclics 10 - ✔✔Amitriptyline, nortriptyline, clomipramine, imipramine,
protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine
✔✔Tricyclics are useful-2 - ✔✔Pain, migraine
✔✔Tricyclics adverse effects-2 - ✔✔Overdoses are cardiotoxic, high potency increases
the risk of mania
✔✔Nortriptyline mnemonic - ✔✔No-triptyline equals less sedation and hypotension
✔✔Tricyclics mnemonic-2 - ✔✔Think car goes over tricycle to remember that an
overdose is cardiotoxic. Do you remember mechanism think trans =serotonin and
norepinephrine Chans= Na+ and Ca+ Ans= ACH and histamine
✔✔Clomipramine mnemonic/class - ✔✔TCA- think comipramine for obsessive
compulsive disorder
✔✔Imipramine- pneumonic and class - ✔✔I'm peeingamine- nocturnal enuresis
✔✔Unilateral electrode in ECT indications - ✔✔Typically first line because it has less
cognitive side effects but has less efficacy
✔✔What is ECT? - ✔✔The use of electrical shock current delivered to the brain to
induce a seizure that treats depression. Goal is to reverse atrophy.
✔✔ECT is FDA approved for what - ✔✔Bipolar disorder, schizophrenia, schizoaffective
disorder, catatonia, neuroleptic malignant syndrome, treatment resistant refractory
major depressive disorder
✔✔What is ECT schedule - ✔✔Typically Monday Wednesday Friday for 6 to 12
sessions
, ✔✔Bilateral electrode placement in ECT indications - ✔✔Classic placement increases
cognitive side effects but has better efficacy. Reserved for urgency such as life-
threatening depression profound distress and catatonia
✔✔ECT side effects and Risks 8 - ✔✔Cognitive side effects such as memory loss,
head, neck, jaw pain, nausea, myalgia's procedure is low risk
✔✔What is vagus nerve stimulation - ✔✔It's an implant in the chest that stimulates the
left Vegas nerve by Paul stations and it's controlled by an on off switch that is activated
by a magnet
✔✔How does vagus nerve stimulation work - ✔✔Stimulates the brain stem nuclei which
changes serotonin in the limbic and cortical systems
✔✔Vagal nerve stimulation side effects-4 - ✔✔Voice altered, breathlessness, neck pain,
no cognitive side effects
✔✔Vagus nerve stimulation is FDA approved for what in under investigation for what -
✔✔FDA approved for epilepsy and under investigation for major depressive disorder
and bipolar disorder
✔✔What is trans cranial magnetic stimulation - ✔✔Placement of rapid alternating
magnets on scalp cause impulse to structures and is focused
✔✔Goal of trans cranial magnetic stimulation - ✔✔Firing of neurons will alter pathology
✔✔Trans cranial magnetic stimulation is FDA approved for and not approved for -
✔✔Approved for refractory treatment resistant depression It is not approved for bipolar
disorder or schizophrenia
✔✔What is cognitive therapy based on - ✔✔Negative thinking increase his depression
vulnerability, this therapy challenges beliefs and assumptions related to depression
✔✔Cognitive therapy indications 11 - ✔✔Depression, anxiety, PTSD, schizophrenia,
phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders,
substance abuse disorders
✔✔Cognitive therapy interventions - ✔✔Automatic thought restructuring, provide
evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater
than just antidepressants and anti-depressants are greater than just cognitive
behavioral therapy in efficacy
✔✔What is interpersonal therapy based on - ✔✔Based on the theory that depression
Arises from problematic patterns and relationships
