APEA PMHNP 3P EXAM MANUAL 2025/2026 QUESTIONS
WITH ANSWERS GRADED A+
✔✔lamotrigine - ✔✔Stevens-johnson syndrome more common in child than adults.
Probably not a good idea to prescribe it to kids.
-blocks sodium channels
-may reduce folate levels so don't give in pregnancy
-valproate doubles the eliminate half-life of lamotrigine. Increases serum levels of
lamotrigine by inhibiting its metabolism
✔✔Latuda - ✔✔-good for bipolar depression
-take it with meals
✔✔Gabapentin - ✔✔-may increase Gaba synthesis.
-inhibits calcium influx at voltage-sensitive calcium channels
-negligible drug-drug interactions
-AVOID IN RENAL DISEASE
✔✔Isomer - ✔✔molecules with the same chemical formula but different chemical
structures. Same number of atoms but have different arrangement of atoms in space.
✔✔Lithium - ✔✔-propranolol for tremors
-do not administer if history of arrhythmia
-relatively slow onset of action so may have to temporarily take neuroleptic as well.
-monitor for hypercalcemia caused by hyperparathyroidism: may have to d/c lithium
-Lithium is known to affect renal concentrating abilities. monitor for polydispsia and
polyuria-->nephrogenic diabetes insipidus.
-start at 300 bid. can increase to 1800 mg
-check renal, thyroid, electrolytes twice in first 6 months.
-monitor lithium levels frequently until reaching stable dose.
✔✔IM injection - ✔✔-ventrogluteal up to 3ml of fluid
-1 inch to 1.5 inch needle. 25 gauge (18 for very viscous)
✔✔Omega 3 - ✔✔-polyunsaturated fatty acid
types of omega 3: EPA and DHA. EPA better for depression
-incorporated into the cell membrane. regulate dopaminergic and serotonin
transmission. Important in mood regulation by targeting the arachidonic cascade and
reducing synthesis of prostaglandin (high progtaglandin levels can cause somatic
symptoms of depression).
-will take up to four weeks before response is seen
✔✔Progesterone - ✔✔precursor to other steroid hormones.
Progesterone plus Estrogen-->inhibition of the gonadotropin axis-->inhibition of
androgen production in the ovaries and adrenal glands.
, -with estrogen, it will enhance sex hormone binding globulin and thus result in reduced
serum levels of free testosterone
✔✔autism pharmacology - ✔✔-greater sensitivity or idiosyncratic effects from
medication
-do not use anticonvusants
✔✔Sleep disorders - ✔✔-hypersomnia: excessive sleepiness
-parasomnias: strange behaviors during sleep
-nocturnal movement disorders: RLS
✔✔sleep apnea - ✔✔characterized by prolonged pauses in breathing during sleep.
-polysomnogram required for diagnosis
-obstructive: caused by a physical block in air flow despite respiratory effort
-central: is caused by lack of respiratory effort
✔✔bulimia Laboratory finding - ✔✔-induced vomiting may cause metabolic alkalosis:
elevated bicarbonate, hypochloremia, hypokalemia
-Increased BUN indicates dehydration
✔✔Eating disorder - ✔✔-fluoxetine found to be especially helpful in bulimia
-Consequences of anorexia: osteoporosis, cortical gray matter loss,
✔✔Nurse Practice Act - ✔✔the state guide that governs nursing practice. Defines scope
of practice, grounds for disciplinary action
✔✔HIPPA - ✔✔four guaranteed rights:
1. the right to be educated about HIPPA privacy
2. the right to access their protected health records
3. the right to request amendments to their PHR
4. the right to require their permission to disclose health records.
✔✔Drug clearance - ✔✔Consider genetic polymorphisms, concurrent diseases, age-
related changes, other drugs that are being administered
✔✔Paliperidone palmitate - ✔✔-half-life: 25 to 49 days.
-first dose is 234mg. 7 days later 156mg.
-maintenance dose: 39 to 234mg
-first two doses should be in the deltoid
✔✔olanzapine pamoate - ✔✔210-300mg every 2 weeks
-monitor for post-injection delirium. patient must be observed by healthcare professional
for at least 3 hours
WITH ANSWERS GRADED A+
✔✔lamotrigine - ✔✔Stevens-johnson syndrome more common in child than adults.
Probably not a good idea to prescribe it to kids.
-blocks sodium channels
-may reduce folate levels so don't give in pregnancy
-valproate doubles the eliminate half-life of lamotrigine. Increases serum levels of
lamotrigine by inhibiting its metabolism
✔✔Latuda - ✔✔-good for bipolar depression
-take it with meals
✔✔Gabapentin - ✔✔-may increase Gaba synthesis.
-inhibits calcium influx at voltage-sensitive calcium channels
-negligible drug-drug interactions
-AVOID IN RENAL DISEASE
✔✔Isomer - ✔✔molecules with the same chemical formula but different chemical
structures. Same number of atoms but have different arrangement of atoms in space.
✔✔Lithium - ✔✔-propranolol for tremors
-do not administer if history of arrhythmia
-relatively slow onset of action so may have to temporarily take neuroleptic as well.
-monitor for hypercalcemia caused by hyperparathyroidism: may have to d/c lithium
-Lithium is known to affect renal concentrating abilities. monitor for polydispsia and
polyuria-->nephrogenic diabetes insipidus.
-start at 300 bid. can increase to 1800 mg
-check renal, thyroid, electrolytes twice in first 6 months.
-monitor lithium levels frequently until reaching stable dose.
✔✔IM injection - ✔✔-ventrogluteal up to 3ml of fluid
-1 inch to 1.5 inch needle. 25 gauge (18 for very viscous)
✔✔Omega 3 - ✔✔-polyunsaturated fatty acid
types of omega 3: EPA and DHA. EPA better for depression
-incorporated into the cell membrane. regulate dopaminergic and serotonin
transmission. Important in mood regulation by targeting the arachidonic cascade and
reducing synthesis of prostaglandin (high progtaglandin levels can cause somatic
symptoms of depression).
-will take up to four weeks before response is seen
✔✔Progesterone - ✔✔precursor to other steroid hormones.
Progesterone plus Estrogen-->inhibition of the gonadotropin axis-->inhibition of
androgen production in the ovaries and adrenal glands.
, -with estrogen, it will enhance sex hormone binding globulin and thus result in reduced
serum levels of free testosterone
✔✔autism pharmacology - ✔✔-greater sensitivity or idiosyncratic effects from
medication
-do not use anticonvusants
✔✔Sleep disorders - ✔✔-hypersomnia: excessive sleepiness
-parasomnias: strange behaviors during sleep
-nocturnal movement disorders: RLS
✔✔sleep apnea - ✔✔characterized by prolonged pauses in breathing during sleep.
-polysomnogram required for diagnosis
-obstructive: caused by a physical block in air flow despite respiratory effort
-central: is caused by lack of respiratory effort
✔✔bulimia Laboratory finding - ✔✔-induced vomiting may cause metabolic alkalosis:
elevated bicarbonate, hypochloremia, hypokalemia
-Increased BUN indicates dehydration
✔✔Eating disorder - ✔✔-fluoxetine found to be especially helpful in bulimia
-Consequences of anorexia: osteoporosis, cortical gray matter loss,
✔✔Nurse Practice Act - ✔✔the state guide that governs nursing practice. Defines scope
of practice, grounds for disciplinary action
✔✔HIPPA - ✔✔four guaranteed rights:
1. the right to be educated about HIPPA privacy
2. the right to access their protected health records
3. the right to request amendments to their PHR
4. the right to require their permission to disclose health records.
✔✔Drug clearance - ✔✔Consider genetic polymorphisms, concurrent diseases, age-
related changes, other drugs that are being administered
✔✔Paliperidone palmitate - ✔✔-half-life: 25 to 49 days.
-first dose is 234mg. 7 days later 156mg.
-maintenance dose: 39 to 234mg
-first two doses should be in the deltoid
✔✔olanzapine pamoate - ✔✔210-300mg every 2 weeks
-monitor for post-injection delirium. patient must be observed by healthcare professional
for at least 3 hours
