MH701 exam 1 Exam Study Guide Questions And
Answers Verified 100% Correct
What is next steps after a treatment failure? - ANSWER Increase dose, try another
medication in same class, or if failure of #2 in same class - try a different class, add an
additional medication
Dysthymia (Persistent Depressive Disorder) - ANSWER A form of depression that is
not severe enough to be diagnosed as major depression.
Depressed mood for most of the day, for more days than not,
as indicated by either subjective account or observation by
others, for at least 2 years.
Note: In children and adolescents, mood can be irritable, and
duration must be at least 1 year.
Dysthymia treatment options - ANSWER (SSRIs) venlafaxine and bupropion are an
effective treatment for patients.
Individual insight-oriented psychotherapy is the most common treatment method for
dysthymia
Bupropion (Wellbutrin) MOA NDRI - ANSWER Blockade of norepinephrine and
dopamine reuptake increases the available pool of these amines in the synaptic cleft.
Contraindications: Hx of seizures
Anorexic or bulimic
Hx of substance abuse
Therapeutics: MDD
Seasonal affective disorder
Nicotine addiction
ADHD
Cocaine detox
Hypoactive sexual desire disorder.
Mirtazapine (Remeron) - ANSWER Boosts NE and serotonin (5HT) activity
Contradictions: Can cause fatal serotonin syndrome when combined with MAOIs
,May lower WBC
May increase cholesterol
Seizures
Causes weight gain
Causes sedation
Therapeutics: Can help patients who need to gain weight
Can help with anxiety and sleep-related to sedation
Can boost the efficacy of other antidepressants
Depression (especially patients with insomnia) Anxiety
Nightmare suppression
Helpful for sleep with children/adolescents.
MAOIs (monoamine oxidase inhibitors) - ANSWER Phenelzine (Nardil) is an example.
Hypertensive crisis may occur with tyramine food ingestion ( aged and fermented
foods), so care must be taken to avoid these substances.
Educate the client to avoid all medications until discussed with provider.
Many food/drug interactions
Therapeutics: Depression, panic disorder, Bulimia, and PTSD - if all other classes have
failed and pt appropriate.
ACTION is on NE, SE, Epinephrine, Dopamine, and tyramine
Trazodone (Desyrel) Nefazadone (Serzone) - ANSWER Enhances 5HT activity
Therapeutics: Depression, anxiety - off label sleep, these are best as augmenting
therapies and not monotherapy
Contraindications: Hepatic impairment, taking MAOI, carbamazepine can decrease
effects significantly, can lower the seizure threshold
with other antidepressants, can interfere w potency of HTN drugs, can interfere with
warfarin
Can cause priapism (TrazeBONE)
What is the significance of understanding about CYP 450 when prescribing various
medications that may
affect this? - ANSWER CYP450s are a family of enzymes that can determine how our
body metabolizes certain
, medications. By isolating these genotypes/phenotypes in appropriate patients, as
clinicians we can have a
foundation to prescribe medications related to whether the pt is an ultra-metabolizer or
poor metabolizer. This
aids in the determination of which drug and what dose. It can also help when you have a
patient on multiple
medications to attempt to predict any reaction. An UM may need a higher dose to start,
and a PM may need a
lower dose to start. CYP450 testing can also help to understand why one patient has
increased S/E as well as
which ethnic populations have shown poor efficacy or toxicity in regard to certain
medications. As PMHNPs,
numerous genotypes/phenotypes have been isolated for psychotropics,
antidepressants, neuroleptics and
opioids. There are even guidelines that have been established for specific TCAs and
SSRIs based on CYP450
testing. Of note, the utilization has not been perfected since CYP450 is not the only
factor in pharmacokinetics.
Lifestyle, substance abuse, polypharmacy, diet are only a few other factors that may
limit CYP450 genotypes/phenotypes from being the final determination in
prescribing.
Dopamine - ANSWER A neurotransmitter associated with movement, attention
and learning and the brain's pleasure and reward system. Called the pleasure
chemical
● Too much dopamine in area of the brain and too low in another area of the brain
has been
associated with schizophrenia
● Too little is associated with some forms of depression as well as the muscular
rigidity and tremors found in Parkinson's disease.
Serotonin (5-HT) - ANSWER Plays a role in mood, anxiety, emotions, appetite,
● sleep, appetite, and impulsive and aggressive behavior
● Too little serotonin is associated with depression
Norepinephrine - ANSWER ● Neurotransmitter associated with arousal and Fight or
flight
● Too much of this w/ no actual danger can leave a person anxious and hyperactive
● Too little norepinephrine has been associated with depression
Histamine - ANSWER *Histaminergic cell bodies are found in the
tuberomamillary neurons. The firing of these neurons has to do with the sleep-
wake cycle.
Answers Verified 100% Correct
What is next steps after a treatment failure? - ANSWER Increase dose, try another
medication in same class, or if failure of #2 in same class - try a different class, add an
additional medication
Dysthymia (Persistent Depressive Disorder) - ANSWER A form of depression that is
not severe enough to be diagnosed as major depression.
Depressed mood for most of the day, for more days than not,
as indicated by either subjective account or observation by
others, for at least 2 years.
Note: In children and adolescents, mood can be irritable, and
duration must be at least 1 year.
Dysthymia treatment options - ANSWER (SSRIs) venlafaxine and bupropion are an
effective treatment for patients.
Individual insight-oriented psychotherapy is the most common treatment method for
dysthymia
Bupropion (Wellbutrin) MOA NDRI - ANSWER Blockade of norepinephrine and
dopamine reuptake increases the available pool of these amines in the synaptic cleft.
Contraindications: Hx of seizures
Anorexic or bulimic
Hx of substance abuse
Therapeutics: MDD
Seasonal affective disorder
Nicotine addiction
ADHD
Cocaine detox
Hypoactive sexual desire disorder.
Mirtazapine (Remeron) - ANSWER Boosts NE and serotonin (5HT) activity
Contradictions: Can cause fatal serotonin syndrome when combined with MAOIs
,May lower WBC
May increase cholesterol
Seizures
Causes weight gain
Causes sedation
Therapeutics: Can help patients who need to gain weight
Can help with anxiety and sleep-related to sedation
Can boost the efficacy of other antidepressants
Depression (especially patients with insomnia) Anxiety
Nightmare suppression
Helpful for sleep with children/adolescents.
MAOIs (monoamine oxidase inhibitors) - ANSWER Phenelzine (Nardil) is an example.
Hypertensive crisis may occur with tyramine food ingestion ( aged and fermented
foods), so care must be taken to avoid these substances.
Educate the client to avoid all medications until discussed with provider.
Many food/drug interactions
Therapeutics: Depression, panic disorder, Bulimia, and PTSD - if all other classes have
failed and pt appropriate.
ACTION is on NE, SE, Epinephrine, Dopamine, and tyramine
Trazodone (Desyrel) Nefazadone (Serzone) - ANSWER Enhances 5HT activity
Therapeutics: Depression, anxiety - off label sleep, these are best as augmenting
therapies and not monotherapy
Contraindications: Hepatic impairment, taking MAOI, carbamazepine can decrease
effects significantly, can lower the seizure threshold
with other antidepressants, can interfere w potency of HTN drugs, can interfere with
warfarin
Can cause priapism (TrazeBONE)
What is the significance of understanding about CYP 450 when prescribing various
medications that may
affect this? - ANSWER CYP450s are a family of enzymes that can determine how our
body metabolizes certain
, medications. By isolating these genotypes/phenotypes in appropriate patients, as
clinicians we can have a
foundation to prescribe medications related to whether the pt is an ultra-metabolizer or
poor metabolizer. This
aids in the determination of which drug and what dose. It can also help when you have a
patient on multiple
medications to attempt to predict any reaction. An UM may need a higher dose to start,
and a PM may need a
lower dose to start. CYP450 testing can also help to understand why one patient has
increased S/E as well as
which ethnic populations have shown poor efficacy or toxicity in regard to certain
medications. As PMHNPs,
numerous genotypes/phenotypes have been isolated for psychotropics,
antidepressants, neuroleptics and
opioids. There are even guidelines that have been established for specific TCAs and
SSRIs based on CYP450
testing. Of note, the utilization has not been perfected since CYP450 is not the only
factor in pharmacokinetics.
Lifestyle, substance abuse, polypharmacy, diet are only a few other factors that may
limit CYP450 genotypes/phenotypes from being the final determination in
prescribing.
Dopamine - ANSWER A neurotransmitter associated with movement, attention
and learning and the brain's pleasure and reward system. Called the pleasure
chemical
● Too much dopamine in area of the brain and too low in another area of the brain
has been
associated with schizophrenia
● Too little is associated with some forms of depression as well as the muscular
rigidity and tremors found in Parkinson's disease.
Serotonin (5-HT) - ANSWER Plays a role in mood, anxiety, emotions, appetite,
● sleep, appetite, and impulsive and aggressive behavior
● Too little serotonin is associated with depression
Norepinephrine - ANSWER ● Neurotransmitter associated with arousal and Fight or
flight
● Too much of this w/ no actual danger can leave a person anxious and hyperactive
● Too little norepinephrine has been associated with depression
Histamine - ANSWER *Histaminergic cell bodies are found in the
tuberomamillary neurons. The firing of these neurons has to do with the sleep-
wake cycle.
