NSG 552/ NSG552 Exam 2 V2 – Psychopharmacology Review | Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 552/ NSG552 Exam 2 V2 – Psychopharmacology Review | Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A Where is Norepinephrine made in the brain? And what is its' function? Locus Cerulus(Brain stem, responsible for medicating SYMPATHETIC nervous system and stress responses) Hyperactivity of the norepinephrine system/increased locus cerulus system is common in those with anxiety. -Leads to hypervigilance, increased arousal, panic, and exaggerated stress responses. What is the main function of GABA? Primary function is inhibition at post synaptic neuron -Induces calmness, relaxation, big role in anxiety disorders -Acted directly on by BDZ and barbituates -Gaba_A and GABA_B What is agoraphobia and how is it treated? -Fear of public places; where escape or obtaining help may be difficult -Tx via CBT and SSRI GAD Tx? 1st Line - SSRI (Escitalopram, Paroxetine, Duloxetine) 2nd line - Buspar (Partial serotonin agonist at pre and post synapses) and SNRI (Venlafaxine) -Can consider short term course of BDZ Rx Panic attack initial treatment? Benzodiazepines Panic Disorder 1st and 2ndline tx? 1st line - SSRI or SNRI (Fluoxetine, Sertraline, or Venlafaxine) 2nd line - TCAs (Clomipramine, imipramine) Adjunct tx- Benzodiazepines, SHORT term only until other medications reach therapeutic efficacy, Alprazolam SPECIFICALLY is FDA approved) Social Phobia (Ex. performance Anxiety) Fear of scrutiny by others or fear of acting in a humiliating or embarrassing way -CBT 1st line - SSRI or SNRI Betablockers (Atenolol 50-100mg) and Propranolol (20-40mg one hour prior to performance or public speaking) - AVOID in patients with COPD due to bronchospasm risk -Benzodiazepines can be used scheduled or PRN Specific Phobia Rx - Fluvoxamine, Paroxetine, Sertraline, or Venlafaxine. (Hence SSRI or SNRI) CBT (Exposure type specifically) Obsessive compulsive disorder (OCD) Obsessions and/or compulsions that are time consuming, distressing and impairing 1st line - Fluvoxamine (50-300mg this one is FDA approved, with common side effects being N/V). Sertraline, Fluoxetine, 2nd line - SNRI (Venlafaxine), maybe TCA (Clomipramine, this is also approved for OCD treatment) -Can AUGMENT with atypical antipsychotic in severe cases. Panic attack treatment Use Benzodiazepine short term, in ADDITION to long term SSRI until the SSRI kicks in to bridge the gap. *Patients tend to discontinue SSRIs while taking benzodiazepines. Continuous education is REQUIRED to continue BOTH SSRI and Benzodiazepine UNTIL Benzodiazepine is tapered. -Taper Benzodiazepine by reducing ~10% weekly, can also switch to LONG acting Benzodiazepine from short acting to facilitate taper Most commonly prescribed Benzodiazepines? Alprazolam (short acting) Lorazepam (Intermediate acting) Benzodiazepines - MOA? Potentiates effects of GABA, enhances activity of GABA at GABA-A Receptor. -causes drowsiness, cognitive impairment, dampening of fear and anxiety, impaired balance, motor control, decrease muscle tone, impaired coordination, anterograde amnesia ELDERLY - Increases fall risk, hip fracture risk, and increases risk of dementia with chronic use. -Big potential for both abuse and addiction, patient can become physically dependent and build tolerance easily; used to treat akathisia -A known limitation of benzodiazepines are rebound insomnia. How to choose specific Benzodiazepine? Depends on desired time of onset, duration of action, and method of metabolism. Short - TOMA (Temazepam, Oxmazepam, midazolam, alprazolam) Intermediate - CETL "Settle" - Clonazepam, temazepam, estazolam, Lorazepam Long acting - DC^2F - Diazepam, Chlordiazepoxide, Clonazepam, Flurazepam Benzodiazepines, which are metabolized outside the liver? (And hence can be used in EtOH use disorder or liver failure?) LOT Lorazepam, Oxazepam, Temazepam) What are side effects of Benzodiazepines? Anticholinergic effects, such as Dry mouth, constipation, blurry vision, urinary retention, confusion, delirium, odd behaviors, hallucinations, day time somnolence, amnesia -Can also cause REBOUND insomnia What is Benzodiazepine withdrawal most like? Alcohol withdrawal Insomnia anxiety hand tremors irritability anorexia N/V Autonomic hyperactivity (Diaphoresis, tachycardia, HTN) Tonic-clonic seizures -Abrupt cessation after chronic use can be life threatening, requires both a PHYSICAL and behavioral taper. Taper ~10% of total dose per week, with common strategy being converting from short acting to long acting benzodiazepine for more comfortable taper Buspirone MOA? Onset? Partial 5HT_1A (Serotonin) agonist, causes neural adaptations at pre and post synapses resulting in decreased serotonergic activity -Slower onset, takes several weeks -Used in conjunction with SSRIs -LOW potential for abuse/addiction, dosed 2-3x daily. -NO PRN doses Endocrine conditions that mimic or exacerbate anxiety? (Endocrine) Hyper and hypo thyroidism Pheochromocytoma Cushings Dz. Addisons Dz Meno Pause DM Cardiovascular conditions that mimic/exacerbate anxiety? ACS Arrhythmia CHF HTN Mitral Valve Prolapse Neurologic conditions that mimic or exacerbate anxiety? Epilepsy Cerebrovascular Dz Meniere's Dz Multiple Sclerosis Migraine Encephalitis Early Dementia Metabolic Conditions that worsen or mimic anxiety? Porphyria DM Pulmonary conditions that mimic or worsen anxiety? Asthma COPD Pulmonary Embolism PNA PTSD - What is typically heightened? What parts of the brain? Definition? Development of multiple symptoms s/p exposure to one or more traumatic events (With threat of death, injury, violence) -Norepinephrine which is produced in the LC or Locus Cerulus is highly elevated, with these responses contributing to intrusive memories, significant hyperarousal and sleep disturbances that may culminate in night terrors or nightmares. -Hippocampus is embedded in TEMPORAL lobe - which has a major role in both learning and memory; heavily involved in encoding the time and place of a specific traumatic event. -The Amygdala(Fear center of brain) - has increased activity PTSD - How is this treated? 1st Line - SSRIs - Sertraline, Paroxetine, also celexa. (Think the P.S in PTSD, both paroxetine and sertraline are FDA approved) Also SNRI (Venlafaxine). For night terrors, hypervigilance and flashbacks - Use Prazosin which is an Alpha-1 receptor antagonist - Hence it is essential to monitor blood pressure with this medication -Can augment Tx with atypical antipsychotic in severe/treatment resistant cases. -CBC therapy, exposure therapy **AVOID BENZODIAZEPINES - There is a very high rate of substance use disorders and lack of efficacy; this ALSO interferes with psychological processes necessary to benefit from CBT DID - Dissociate Identity Disorder (Multiple personality disorder) Predominantly in victims of significant and chronic childhood trauma, patients with DID often cope with PTSD as well -Have more than one distinct personality state; due to fragmented sense of self -70%+ of patients attempt suicide with high frequency and self mutilate -Psychotherapy is standard treatment, with SSRIs to target comorbid depressive and PTSD symptoms Prazosin - Reduce nightmares (Again watch BP with this as it is Alpha 1 agonist) Naltrexone - Opioid antagonist that REDUCES self injurious behaviors -ECT is NOT contraindicated in DID, can be considered as a viable option in combination with psycho therapy as DID patients have depressive symptoms. Sleep onset medications? TEZ. T^2, E^2, Z. Temazepam, triazolam Eszopiclone Zolpidem Zaleplon Ramelton (MT1 MT2 antagonist, safe for elderly) Sleep Maintenance Rx? SEZTD (SEZ TD) Suvorexant (DORA) Eszopiclone Zolpidem CR Temazepam Doxepin (TCA) Narcolepsy definition? Etiology? Excessive daytime somnolence, falling asleep in inappropriate places -Characterized by cataplexy(Brief episodic loss of muscle tone) -Hallucinations/sleep paralysis at the beginning or end of sleep episodes are common -More common in male vs females -Etiology is loss of hypothalamic neurons that produce hypocretin Narcolepsy management and Pharmacologic tx? Non-Pharmacologic - Sleep hygiene, scheduled daytime naps, avoiding shift work Rx - Modafinil 1st line Tx. (Inhibits dopamine reuptake) -Can use ACTIVATING antidepressants that suppress REM - SSRI and SNRIs (D.A.V.F - Fluoxetine, Duloxetine, Atomoxetine, Venlafaxine) Treating Cataplexy in narcolepsy? Sodium oxybate (AKA GHB) - Avoid use with alcohol and other CNS depressants -Can also use TCAs (Imipramine, desipramine, clomipramine) -Can use ACTIVATING antidepressants that suppress REM - SSRI and SNRIs (D.A.V.F - Fluoxetine, Duloxetine, Atomoxetine, Venlafaxine) -Non-Benzodiazepines do NOT affect REM sleep Tolerance to OTC sedative/hypnotics, how quickly do they develop? They develop quickly, typically 1 week, and change sleep architecture; hence if they are not working quite quickly within a short period of time, it is efficacious and best to discontinue. Ramelteon MOA? Selective MT1 and MT2 (Melatonin Agonist) -Effective and safe sleep aid; there are NO issues with TOLERANCE and DEPENDENCY, so this is the safest sleep aide for the ELDERLY. Does NOT act on Benzodiazepine receptors, acts on melatonin receptors. Sleep apnea Tx Weight Loss Avoid EtOH CPAP Uvulopalatopharyngoplasty RLS - Restless leg syndrome definition and characteristics, risk factors? Urge to move legs with unpleasant sensation in legs; the unpleasant sensation is relieved with movement, aggravated with inactivity. -1.5-2x more likely in males -Occurs or worsens in the evening Risk factors - Age, Iron deficiency, ACTIVATING antidepressants(D.A.V.F, but Venlafaxine in particular), antipsychotics, dopamine blocking antiemetic (Promethazine, prochlorperazine, metoclopramide), antihistamines, strong familial(genetic) component RLS - Restless Leg Syndrome Treatment? Remove offending agent (Which can be activating antidepressants, antipsychotics, antihistamines, dopamine antagonizing antiemetics), Iron rerplacement 1st Line - Dopamine AGONIST - Pramipexole, Ropinirole. (P.R for RLS! Personal record). and Benzodiazepines. -Gabapentin (Careful with substance abuse patients, this has street value), Pregabalin -IF treatment refractory, try low potency opioids. Is Sedative/Hypnotic use SAFE in elderly patients? Use sleep hygiene as first line Tx, always. Sedatives and hypnotics are more likely to cause side effects such as memory impairment, ataxia, paradoxical excitement and rebound insomnia. If sleep medications must be used Trazodone and Ramelteon are safer options in depressed elderly patients. Anorexia Nervosa Characteristics Preoccupation with weight, body image and thinness. -TWO types, restricting type and binge eating/purging type -Intense FEAR of gaining weight or becoming fat -Restriction of calorie intake, low body weight Anorexia Nervosa Tx -CBT, family therapy -Can use SSRIs for COMORBID anxiety and depression -Can Tx preoccupation with and food with Olanzipine -Can use Premeal anxiolytic (Alprazolam) - to encourage eating by decreasing anticipatory anxiety **-Pharmacotherapy overall may NOT be a useful treatment modality for most anorexia nervosa patients Bulimia Nervosa Characteristics -Binge eating with behaviors intended to counteract weight gain (Vomiting, laxative use, enema/diuretics, fasting, excessive exercise) -Essentially, binging with counteracting compensatory behavior -Patients are typically embarrassed by their binge eating, and overly concerned with body weighty -Bodyweight is typically normal, or perhaps overweight Bulimia Nervosa Treatment -Antidepressant + Therapy 1st Line SSRI(Fluoxetine 60-80mg) FDA Approved Tx -Otherwise nutritional counseling and education binge eating disorder characteristics No fixation on body shape, body weight -Recurrent episodes of binge eating -NO COMPENSATORY BEHAVIORS (Such as vomiting, laxatives, excessive exercise) -Usually obese (Think the B in binge as in BIG) Treatment of Binge Eating Disorder 1st line - SSRI - Escitalopram Vyvanse - (FDA APPROVED, stimulant that suppresses appetite) Topamax - Causes weight loss Orlistat - Inhibits Lipase enzyme from pancreas, decreasing amount of fat absorbed from GI tract -Psychotherapy, CBT, IPT Bupropion in eating disorders Avoid use in ALL eating disorders as this lower seizure threshold! What class of medications can help reduce obsessions and fearful preoccupations associated with psychosomatic disorders? SSRIs for the comorbid anxiety and depression. Anything else psychotropic.