Pmhnp Study Set For Ancc Rated A+

1. Review the MOA/DOSAGE for pharmacological therapy for a patient on a stimulant medication(s) for ADHD. (p. 747) **Note: medication therapy not first line **Beware of stimulant use for children with tics **Rx'ing stimulants: ALWAYS assess cardiac risk because can lead to sudden cardiac death a. MOA: inhibit reuptake of dopamine and norepinephrine, thereby increasing concentrations in the presynaptic cleft. Amphetamines directly stimulate the release of dopamine and norepinephrine. b. DOSAGE: Start low, titrate up. In adults, extended release preferred to maximize compliance and minimize risk of abuse. In children, start with short acting to gauge tolerability and response, then switch to a longer-acting. Clozapine Chemical Structure SDA - Serotonin 5HT2A Dopamine D2 antagonist. Clozapine S/E 1. NO EPS, NO TD, NO Hyperprolactinemia 2. Life Threatening S/E agranulocytosis 3. Highest risk for MetX/Cardio Metabolic, greatest degree of weight gain 4. Increased risk seizures 5. Sedating, hyper salivation, risk of myocarditis Clozapine Tx Benefits 1. Reduce risk of suicide in Schizo 2. Efficacy in treating aggression and violence 3. Reduce TD severity "gold standard" on resistant symptoms but never first line of tx Olanzapine Chemical Structure Serotonin 5HT2A and D2 Dopamine antagonist MORE POTENT THAN Clozapine Olanzapine s/e 1. Lacks EPS, sedating d/t Antagonist of M1, H1, a1-adrenergic 2. Highest level of cardio-metabolic s/e - weight gain, insulin resistance, triglyceride levels Olanzapine Indications r/t mood