NR 546 Advanced Pharmacology Psychopharmacology
for the Psychiatric-Mental Health Nurse Practitioner
Midterm Exam Study Guide (Week 1 - 4)
1. What should the PMHNP consider when prescribing chemical restraints?: -
-allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemicalrestraint
-state regulations regarding chemical restrains must be reviewed
2. Are the PMHNP and other staff liable if the client has an allergic reaction oradverse
side effects to the drugs used for chemical restraint?: No.
The client has been court-ordered to take the prescribed medications and the standing
order for chemical restraints is approved. The PMHNP and other staff arenot liable if the
patient has an allergic reaction or adverse side effects.
,3. How does reviewing the genetic makeup of a client help guide the PMHNP inselecting
medication for clients?: -Genetic testing can assist by providing more information on
how clients may respond to certain psychotropic medications
-provides information on how a client may break down and metabolize medicationsbased
on the cytochrome P450 system.
4. Tanr1kulu and Erba_ (2020) investigated identical twins to determine the presence of
an inherited link for schizophrenia and why one twin may developschizophrenia when
the other does not. When two people have 100% identicalDNA, why don't both persons
develop the exact illnesses? Studies of identicalDanish twins found that if one twin had
schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia
(Lemvigh et al., 2020). Why is there only half the risk?: Both environmental and
psychosocial stressors can im-pact mental health. Although twins may have identical
genes, their gene expressionmay be different.
There may be an environmental exposure that turned a gene "on" that should havebeen
"off" for one twin to develop schizophrenia and not the other.
5. central sulcus: separates the frontal lobe from the parietal lobe
6. frontal lobe: associated with movement, intelligence, abstract thinking
7. broca's area: speech production
8. temporal lobe: involves object identification and auditory signals
9. cerebellum: coordination
10. wernicke's area: speech comprehension
11. occipital lobe: primary visual area
12. parietal lobe: keeps us alert to what is going on around us
,13. sensory cortex: pain, heat, and other sensations
14. motor cortex: movement
15. hippocampus: involved in both memory and anxiety
16. nucleus accumbens: involved in the reward process
,17. thalamus: involved in sensory organ and motor command processing
18. striatum: involved in complex motor actions, also links cognition to motor actions
19. limbic system: includes circuits that are associated with pleasure and reward
20. basal ganglia: group of structures involved in voluntary motor movements
21. amygdala: involved in emotional regulation and perception of odors
22. corpus callosum: controls the communication between the two brain hemi-
spheres
23. white matter: contains nerve fibers that connect neurons from different regionsinto
functional circuits
24. grey matter: contains nerve cells and dendrites
25. brain tissue: made up of grey matter and white matter
26. dorsal striatum: involved in complex motor actions and linkage of cognition tomotor
actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
27. The field of epigenetics is rapidly growing and can help explain how gene
expression is:: influenced by environmental factors and how epigeneticscontributes
to the manifestation of mental illness
28. How does epigenetics impact a person's mental health?: internal or externalfactors
activate portions of the genome that result in the manifestation of mental health
symptoms
-activation is often a result of a stressful event, which, when combined with thegenetic ris
results in the disease
-genes being on or off
,-occurrence of symptoms may be the result of inheritance of an abnormal gene orof
normal genes being "on" when they should be "off."
29. Types of epigenetic changes:: DNA Methylation
Histone modification
Non-coding RNA
30. The potential legal and ethical issues impacting mental health treatmentmust also
be taken into account, including:: -informed consent
-competence to make healthcare decisions
-off-label prescribing
31. Informed consent: Clients have the right to receive enough information to make
decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly
, medicated if they are violent toward themselves or others and when less restrictive
methods have failed
32. Compliance: A court order may be issued for a client to receive treatment
against their wishes if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive capabilitiesor are
incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and
abiding by them.
33. Off-Label Prescribing: Some clients may benefit from the unapproved use of adrug for
symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved foruse in
this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-label
prescribing.
34. Incidence of mental illness-what factors are increasing the incidence: Psy-chological
and sociological factors
Lifestyle factors such as a client's smoking status, diet, exercise, history of med-ication
adherence, or history of addiction should be considered when prescribingpsychotropic
medications
35. Adherence: Persistence
-taking med over intended time period
for the Psychiatric-Mental Health Nurse Practitioner
Midterm Exam Study Guide (Week 1 - 4)
1. What should the PMHNP consider when prescribing chemical restraints?: -
-allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemicalrestraint
-state regulations regarding chemical restrains must be reviewed
2. Are the PMHNP and other staff liable if the client has an allergic reaction oradverse
side effects to the drugs used for chemical restraint?: No.
The client has been court-ordered to take the prescribed medications and the standing
order for chemical restraints is approved. The PMHNP and other staff arenot liable if the
patient has an allergic reaction or adverse side effects.
,3. How does reviewing the genetic makeup of a client help guide the PMHNP inselecting
medication for clients?: -Genetic testing can assist by providing more information on
how clients may respond to certain psychotropic medications
-provides information on how a client may break down and metabolize medicationsbased
on the cytochrome P450 system.
4. Tanr1kulu and Erba_ (2020) investigated identical twins to determine the presence of
an inherited link for schizophrenia and why one twin may developschizophrenia when
the other does not. When two people have 100% identicalDNA, why don't both persons
develop the exact illnesses? Studies of identicalDanish twins found that if one twin had
schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia
(Lemvigh et al., 2020). Why is there only half the risk?: Both environmental and
psychosocial stressors can im-pact mental health. Although twins may have identical
genes, their gene expressionmay be different.
There may be an environmental exposure that turned a gene "on" that should havebeen
"off" for one twin to develop schizophrenia and not the other.
5. central sulcus: separates the frontal lobe from the parietal lobe
6. frontal lobe: associated with movement, intelligence, abstract thinking
7. broca's area: speech production
8. temporal lobe: involves object identification and auditory signals
9. cerebellum: coordination
10. wernicke's area: speech comprehension
11. occipital lobe: primary visual area
12. parietal lobe: keeps us alert to what is going on around us
,13. sensory cortex: pain, heat, and other sensations
14. motor cortex: movement
15. hippocampus: involved in both memory and anxiety
16. nucleus accumbens: involved in the reward process
,17. thalamus: involved in sensory organ and motor command processing
18. striatum: involved in complex motor actions, also links cognition to motor actions
19. limbic system: includes circuits that are associated with pleasure and reward
20. basal ganglia: group of structures involved in voluntary motor movements
21. amygdala: involved in emotional regulation and perception of odors
22. corpus callosum: controls the communication between the two brain hemi-
spheres
23. white matter: contains nerve fibers that connect neurons from different regionsinto
functional circuits
24. grey matter: contains nerve cells and dendrites
25. brain tissue: made up of grey matter and white matter
26. dorsal striatum: involved in complex motor actions and linkage of cognition tomotor
actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
27. The field of epigenetics is rapidly growing and can help explain how gene
expression is:: influenced by environmental factors and how epigeneticscontributes
to the manifestation of mental illness
28. How does epigenetics impact a person's mental health?: internal or externalfactors
activate portions of the genome that result in the manifestation of mental health
symptoms
-activation is often a result of a stressful event, which, when combined with thegenetic ris
results in the disease
-genes being on or off
,-occurrence of symptoms may be the result of inheritance of an abnormal gene orof
normal genes being "on" when they should be "off."
29. Types of epigenetic changes:: DNA Methylation
Histone modification
Non-coding RNA
30. The potential legal and ethical issues impacting mental health treatmentmust also
be taken into account, including:: -informed consent
-competence to make healthcare decisions
-off-label prescribing
31. Informed consent: Clients have the right to receive enough information to make
decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly
, medicated if they are violent toward themselves or others and when less restrictive
methods have failed
32. Compliance: A court order may be issued for a client to receive treatment
against their wishes if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive capabilitiesor are
incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and
abiding by them.
33. Off-Label Prescribing: Some clients may benefit from the unapproved use of adrug for
symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved foruse in
this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-label
prescribing.
34. Incidence of mental illness-what factors are increasing the incidence: Psy-chological
and sociological factors
Lifestyle factors such as a client's smoking status, diet, exercise, history of med-ication
adherence, or history of addiction should be considered when prescribingpsychotropic
medications
35. Adherence: Persistence
-taking med over intended time period
