NR546 Midterm Exam
ANS-Benzodiazepines (BZOs) increase GABA's inhibitory activity, resulting in decreased
excitatory neurotransmitter output and the negative effects associated with their use. The
hypothetical fear and worry circuits are all influenced by ANS-Serotonin, norepinephrine,
alpha-2 delta ligands, and GABA, which are all important modulators. Anxiety disorders will
affect __% of the population, or ANS-30%. 2 dones and a rone - ANS--more potently to the 5HT
2A receptor than to D2 or bine equally between the 2 receptors.
- less sedative and less likely to make you gain weight, but they are more likely to cause
hyperprolactinemia and EPS. 2 pips and a rip—ANS-pips—have a lower risk of metabolic side
effects and weight gain, bind to D2 receptors more effectively than 5HT-2A, and they may cause
EPS. -rips binds equally to both D2 and 5HT-2A receptors, have low risk for metabolic disorders
5HT - ANS-Serotonin
-help control one's mood -makes relaxed, comfortable, decreases stress, regulate sleep,
arousal, libido, aggression, pain perception
Abnormal Involuntary Movement Scale (AIMS) - ANS-tool used to monitor involuntary
movements and tardive dyskinesia in clients who take antipsychotic medication
-best practice/recommendation to document the AIMS at minimum every 6 months for patients
taking an antipsychotic agent/dopamine blocker
abrupt cessation of benzodiazepines - ANS-can lead to severe withdrawal symptoms
-convulsions and death Ach - ANS-acetylcholine
-affects arousal, motivation, attention, learning, REM sleep, sleep, pain perception, and
memory in the central nervous system -in PNS: causes salivation and sweating -link between
brain and muscles
-not enough: Alzheimer's, Parkinson's, Schizophrenia
-too much: Depression
-Action in addiction -Receptors: nicotinic & muscarinic
Adding 5HT2A antagonists: - ANS- Enhance D2 blockade's antipsychotic efficacy and reduce
its side effects Additional adverse effects of excessive D2 receptor blockade (D2 antagonist
actions) include: - ANS--cardiac concerns: QT prolongation, torsades de pointes, and sudden
cardiac death
-blood dyscrasias (neutropenia, leukopenia, and agranulocytosis)
-aspiration and dysmotility of the esophagus -a higher chance of falling Persistence - adhesion
- ANS - Taking the medication for the prescribed time Compliance
-taking med as prescribed
The reciprocal connections between the amygdala and the orbitofrontal cortex (OFC) and
anterior cingulate cortex (ACC) regulate the affect of fear in the ANS. agonists - ANS-fully
stimulate G-protein-linked receptors
akathisia - ANS-Inner restlessness leading to repetitive motion (rocking, tapping fingers).
Alex is a returning client who reports leaking fluid from his nipples. Which of the following is
most likely responsible for these undesirable side effects? - ANS-Risperidone
, -highest risk for galactorrhea, due to hyperprolactinemia.
all forms of psychosis are linked to the neurotransmitter systems: - ANS-dopamine, serotonin,
and glutamate
Alogia - ANS-dysfunction of communication
- speech insecurity Alpha 2 Delta Ligands, also known as ANS, are an off-label treatment for
GAD. -bind with glutamate calcium channel blockers (Glu-CB) to inhibit the release of several
neurotransmitters. --Pregabalin has anxiolytic properties with selective binding to the α-2-delta
subunit of voltage-gated calcium channels.
-pregabalin (Lyrica)
-gabapentin (Neurontin)
Alpha 2 Delta Ligands: adverse effects - ANS--sedation
-dizziness
-impaired attention
-confusion
-dry mouth
-constipation
-blurred vision
-possible weight gain
Alpha 2 Delta Ligands: clinical pearls - ANS--works quickly to reduce anxiety symptoms
-pregabalin reduces anxiety with a similar onset to alprazolam.
Precautions and Contraindications for Alpha 2 Delta Ligands - ANS - suicidal thoughts
-substance abuse
- heart disease -renal impairment
Contraindications:
-myopathy
-Do not prescribe with benzodiazepines (BZOs) at the same time. Alprazolam is an anxiolytic
and ANS. BENZODIAZEPINE
GABA positive allosteric modulator
-Indication: Generalized anxiety disorder, other anxiety disorders, panic disorder, premenstrual
dysphoric disorder, irritable bowel syndrome, insomnia, acute mania, acute psychosis,
catatonia.
-Dosing:
• Anxiety: alprazolam IR: 1-4 mg/day (start at 0.75-1.5, 3 divided doses)
• Panic: alprazolam IR: 5-6 mg/day (start at 1.5, 3 divided doses)
• Panic: alprazolam XR: 3-6 mg/day (start at 0.5-1 QD AM)
Risks:
-Sedation, fatigue, depression
-Slurred speech, ataxia, and dizziness -Forgetfulness, confusion
- Hyperactivity and nervousness Pearls:
-not advised during pregnancy, particularly in the first trimester -Either a D/C drug or a bottle
feed was recommended. alprazolam IR (Xanax) - ANS-Short-acting
Use: GAD, panic disorder
Half-life: 12-15 hours
Equivalence: 0.5 mg
, Dosage:
-anxiety: 0.75-1.5mg/day in divided doses; max dose 4 mg/day
-panic: 1.5 mg/day in divided doses; the maximum daily dose may exceed 4 mg; gradually
increase -rapid onset, less sedating
-can cause sedation, fatigue, forgetfulness, hypersalivation
-useful adjunct to SSRI/SNRI
-recommended use: the smallest possible effective dose for the shortest possible time -risk for
respiratory depression, especially when taken with CNS depressants
-contraindicated in angle-closure glaucoma
-tapered dosing when discontinuing, risk of seizures with withdrawal
also known as "2 ligands" because they bind to the "2" subunit of presynaptic N and P/Q
VSCCs. These ligands prevent the release of excitatory neurotransmitters like glutamate when
neurotransmission is too high, as was thought to cause fear in the amygdala (Figure 8-17A) and
in CSTC circuits that cause worry, such as ANS-Gabapentin and pregabalin. amygdala -
ANS-involved in emotional regulation and perception of odors
The reciprocal connections that the amygdala shares with key areas of the prefrontal cortex
that regulate emotions, namely the orbitofrontal cortex and the anterior cingulate cortex, may
regulate fear - ANS-affect or feeling of fear. Amygdala-centered circuit - ANS-Fear
-panic
-phobia
Andrea, 65, comes to the doctor because "her nerves are a mess." Her husband has less than
a month to live after receiving the news this week that he has stage IV pancreatic cancer.
Andrea can not eat or sleep. She continually weeps and "her heart is broken." Andrea is on no
medications. Which is the best choice for the PMHNP to prescribe? - ANS-citalopram daily and
alprazolam #15 tabs PRN
Justification: The best options are alprazolam and citalopram. It is appropriate to begin an SSRI
with a PRN benzodiazepine to assist with coping while awaiting the full effects of citalopram.
Venlafaxine, an SNRI, contains norepinephrine which can increase anxiety. Trazadone may
help with sleep, but the dosing required for depression and anxiety would result in increased
sedation, which can increase fall risk in older adults. When the loss of appetite lasts less than a
week, mirtazapine is an option. Mirtazapine is associated with weight gain and is not a first-line
treatment for anxiety.
anhedonia - ANS-a diminished ability to experience pleasure
The antagonist, ANS, alters the conformation of the receptor, stabilizing it in its baseline state
and rendering it "silent." -blocks the action of a neurotransmitter
antipsychotic meds - ANS-primarily used for schizophrenia & psychotic disorders
-also used as adjunctive medications to treat depression and other conditions that resist
antidepressants. -not curative
-decrease/control symptoms/improve quality of life
Antipsychotics are prescribed based on their: - ANS--pharmacological properties
-side effect profiles
-adverse effects according to the unique symptoms and needs of individuals across the lifespan
Anxiety - ANS-response to situations that are perceived as stressful or dangerous
, -prepares the body to respond to perceived threatening environmental stimuli by increasing
alertness, heart rate, and respirations. *when symptoms of anxiety persist and become intense
or excessive, a diagnosis of an anxiety disorder may be warranted, and treatment is required
ANS is more prevalent in women than in men. -one of the most common mental health
concerns in the United States
-Pathological anxiety affects about 25% of people in their lifetime. -can be debilitating and
negatively impact the quality of life
Anxiety: Medication management - ANS-Antidepressants
-SSRIs
-SNRIs
Anxiolytics
-azrapirones
-benzodiazepines
Other
-alpha 2 delta ligands
-beta blockers
-histamine receptor agonists
any abnormal motor symptoms caused by D2 receptor blockers are lumped together and called
collectively: - ANS-extrapyramidal symptsom (EPS)
-motor side effects of D2 antagonists
appropriate first-line medication treatment information for anxiety disorder's: Generalized
anxiety disorder: - ANS-Generalized anxiety disorder:
SSRIs
SNRIs
buspirone
Drug Therapy at least 1 year
appropriate first-line medication treatment information for anxiety disorder's:
obsessive-compulsive disorder - ANS-Obsessive-compulsive disorder
fluoxetine
fluvoxamine
sertraline
paroxetine
clomipramine
Drug therapy for at least 1 year
appropriate first-line medication treatment information for anxiety disorder's: PTSD -
ANS-Post-traumatic stress disorder
paroxetine
sertraline
Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side
effects to the drugs used for chemical restraint? - ANS-No.
The client has been court-ordered to take the prescribed medications and the standing order for
chemical restraints is approved. If the patient experiences side effects or an allergic reaction,
neither the PMHNP nor any other staff members are responsible. One of the neuronal pathways
that is known to be affected here is the _____________ from the _____________ and the
ANS-Benzodiazepines (BZOs) increase GABA's inhibitory activity, resulting in decreased
excitatory neurotransmitter output and the negative effects associated with their use. The
hypothetical fear and worry circuits are all influenced by ANS-Serotonin, norepinephrine,
alpha-2 delta ligands, and GABA, which are all important modulators. Anxiety disorders will
affect __% of the population, or ANS-30%. 2 dones and a rone - ANS--more potently to the 5HT
2A receptor than to D2 or bine equally between the 2 receptors.
- less sedative and less likely to make you gain weight, but they are more likely to cause
hyperprolactinemia and EPS. 2 pips and a rip—ANS-pips—have a lower risk of metabolic side
effects and weight gain, bind to D2 receptors more effectively than 5HT-2A, and they may cause
EPS. -rips binds equally to both D2 and 5HT-2A receptors, have low risk for metabolic disorders
5HT - ANS-Serotonin
-help control one's mood -makes relaxed, comfortable, decreases stress, regulate sleep,
arousal, libido, aggression, pain perception
Abnormal Involuntary Movement Scale (AIMS) - ANS-tool used to monitor involuntary
movements and tardive dyskinesia in clients who take antipsychotic medication
-best practice/recommendation to document the AIMS at minimum every 6 months for patients
taking an antipsychotic agent/dopamine blocker
abrupt cessation of benzodiazepines - ANS-can lead to severe withdrawal symptoms
-convulsions and death Ach - ANS-acetylcholine
-affects arousal, motivation, attention, learning, REM sleep, sleep, pain perception, and
memory in the central nervous system -in PNS: causes salivation and sweating -link between
brain and muscles
-not enough: Alzheimer's, Parkinson's, Schizophrenia
-too much: Depression
-Action in addiction -Receptors: nicotinic & muscarinic
Adding 5HT2A antagonists: - ANS- Enhance D2 blockade's antipsychotic efficacy and reduce
its side effects Additional adverse effects of excessive D2 receptor blockade (D2 antagonist
actions) include: - ANS--cardiac concerns: QT prolongation, torsades de pointes, and sudden
cardiac death
-blood dyscrasias (neutropenia, leukopenia, and agranulocytosis)
-aspiration and dysmotility of the esophagus -a higher chance of falling Persistence - adhesion
- ANS - Taking the medication for the prescribed time Compliance
-taking med as prescribed
The reciprocal connections between the amygdala and the orbitofrontal cortex (OFC) and
anterior cingulate cortex (ACC) regulate the affect of fear in the ANS. agonists - ANS-fully
stimulate G-protein-linked receptors
akathisia - ANS-Inner restlessness leading to repetitive motion (rocking, tapping fingers).
Alex is a returning client who reports leaking fluid from his nipples. Which of the following is
most likely responsible for these undesirable side effects? - ANS-Risperidone
, -highest risk for galactorrhea, due to hyperprolactinemia.
all forms of psychosis are linked to the neurotransmitter systems: - ANS-dopamine, serotonin,
and glutamate
Alogia - ANS-dysfunction of communication
- speech insecurity Alpha 2 Delta Ligands, also known as ANS, are an off-label treatment for
GAD. -bind with glutamate calcium channel blockers (Glu-CB) to inhibit the release of several
neurotransmitters. --Pregabalin has anxiolytic properties with selective binding to the α-2-delta
subunit of voltage-gated calcium channels.
-pregabalin (Lyrica)
-gabapentin (Neurontin)
Alpha 2 Delta Ligands: adverse effects - ANS--sedation
-dizziness
-impaired attention
-confusion
-dry mouth
-constipation
-blurred vision
-possible weight gain
Alpha 2 Delta Ligands: clinical pearls - ANS--works quickly to reduce anxiety symptoms
-pregabalin reduces anxiety with a similar onset to alprazolam.
Precautions and Contraindications for Alpha 2 Delta Ligands - ANS - suicidal thoughts
-substance abuse
- heart disease -renal impairment
Contraindications:
-myopathy
-Do not prescribe with benzodiazepines (BZOs) at the same time. Alprazolam is an anxiolytic
and ANS. BENZODIAZEPINE
GABA positive allosteric modulator
-Indication: Generalized anxiety disorder, other anxiety disorders, panic disorder, premenstrual
dysphoric disorder, irritable bowel syndrome, insomnia, acute mania, acute psychosis,
catatonia.
-Dosing:
• Anxiety: alprazolam IR: 1-4 mg/day (start at 0.75-1.5, 3 divided doses)
• Panic: alprazolam IR: 5-6 mg/day (start at 1.5, 3 divided doses)
• Panic: alprazolam XR: 3-6 mg/day (start at 0.5-1 QD AM)
Risks:
-Sedation, fatigue, depression
-Slurred speech, ataxia, and dizziness -Forgetfulness, confusion
- Hyperactivity and nervousness Pearls:
-not advised during pregnancy, particularly in the first trimester -Either a D/C drug or a bottle
feed was recommended. alprazolam IR (Xanax) - ANS-Short-acting
Use: GAD, panic disorder
Half-life: 12-15 hours
Equivalence: 0.5 mg
, Dosage:
-anxiety: 0.75-1.5mg/day in divided doses; max dose 4 mg/day
-panic: 1.5 mg/day in divided doses; the maximum daily dose may exceed 4 mg; gradually
increase -rapid onset, less sedating
-can cause sedation, fatigue, forgetfulness, hypersalivation
-useful adjunct to SSRI/SNRI
-recommended use: the smallest possible effective dose for the shortest possible time -risk for
respiratory depression, especially when taken with CNS depressants
-contraindicated in angle-closure glaucoma
-tapered dosing when discontinuing, risk of seizures with withdrawal
also known as "2 ligands" because they bind to the "2" subunit of presynaptic N and P/Q
VSCCs. These ligands prevent the release of excitatory neurotransmitters like glutamate when
neurotransmission is too high, as was thought to cause fear in the amygdala (Figure 8-17A) and
in CSTC circuits that cause worry, such as ANS-Gabapentin and pregabalin. amygdala -
ANS-involved in emotional regulation and perception of odors
The reciprocal connections that the amygdala shares with key areas of the prefrontal cortex
that regulate emotions, namely the orbitofrontal cortex and the anterior cingulate cortex, may
regulate fear - ANS-affect or feeling of fear. Amygdala-centered circuit - ANS-Fear
-panic
-phobia
Andrea, 65, comes to the doctor because "her nerves are a mess." Her husband has less than
a month to live after receiving the news this week that he has stage IV pancreatic cancer.
Andrea can not eat or sleep. She continually weeps and "her heart is broken." Andrea is on no
medications. Which is the best choice for the PMHNP to prescribe? - ANS-citalopram daily and
alprazolam #15 tabs PRN
Justification: The best options are alprazolam and citalopram. It is appropriate to begin an SSRI
with a PRN benzodiazepine to assist with coping while awaiting the full effects of citalopram.
Venlafaxine, an SNRI, contains norepinephrine which can increase anxiety. Trazadone may
help with sleep, but the dosing required for depression and anxiety would result in increased
sedation, which can increase fall risk in older adults. When the loss of appetite lasts less than a
week, mirtazapine is an option. Mirtazapine is associated with weight gain and is not a first-line
treatment for anxiety.
anhedonia - ANS-a diminished ability to experience pleasure
The antagonist, ANS, alters the conformation of the receptor, stabilizing it in its baseline state
and rendering it "silent." -blocks the action of a neurotransmitter
antipsychotic meds - ANS-primarily used for schizophrenia & psychotic disorders
-also used as adjunctive medications to treat depression and other conditions that resist
antidepressants. -not curative
-decrease/control symptoms/improve quality of life
Antipsychotics are prescribed based on their: - ANS--pharmacological properties
-side effect profiles
-adverse effects according to the unique symptoms and needs of individuals across the lifespan
Anxiety - ANS-response to situations that are perceived as stressful or dangerous
, -prepares the body to respond to perceived threatening environmental stimuli by increasing
alertness, heart rate, and respirations. *when symptoms of anxiety persist and become intense
or excessive, a diagnosis of an anxiety disorder may be warranted, and treatment is required
ANS is more prevalent in women than in men. -one of the most common mental health
concerns in the United States
-Pathological anxiety affects about 25% of people in their lifetime. -can be debilitating and
negatively impact the quality of life
Anxiety: Medication management - ANS-Antidepressants
-SSRIs
-SNRIs
Anxiolytics
-azrapirones
-benzodiazepines
Other
-alpha 2 delta ligands
-beta blockers
-histamine receptor agonists
any abnormal motor symptoms caused by D2 receptor blockers are lumped together and called
collectively: - ANS-extrapyramidal symptsom (EPS)
-motor side effects of D2 antagonists
appropriate first-line medication treatment information for anxiety disorder's: Generalized
anxiety disorder: - ANS-Generalized anxiety disorder:
SSRIs
SNRIs
buspirone
Drug Therapy at least 1 year
appropriate first-line medication treatment information for anxiety disorder's:
obsessive-compulsive disorder - ANS-Obsessive-compulsive disorder
fluoxetine
fluvoxamine
sertraline
paroxetine
clomipramine
Drug therapy for at least 1 year
appropriate first-line medication treatment information for anxiety disorder's: PTSD -
ANS-Post-traumatic stress disorder
paroxetine
sertraline
Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side
effects to the drugs used for chemical restraint? - ANS-No.
The client has been court-ordered to take the prescribed medications and the standing order for
chemical restraints is approved. If the patient experiences side effects or an allergic reaction,
neither the PMHNP nor any other staff members are responsible. One of the neuronal pathways
that is known to be affected here is the _____________ from the _____________ and the
