Psychiatric Nurse Practitioner |\ |\ |\
Assessment questions with answers |\ |\ |\
Explain the clinical signifcance of the Stystematic Treatment
|\ |\ |\ |\ |\ |\ |\ |\
Enhancement Program for Bipolar Disorder: STEP-BD) |\ |\ |\ |\ |\
As more contempts are tried with SSRIs to relieve depressive
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
symptoms, the client becomes more treatment resistant leading
|\ |\ |\ |\ |\ |\ |\ |\
to poor outcomes.
|\ |\
Explain the clinical significance of the Sequenced Treatment
|\ |\ |\ |\ |\ |\ |\ |\
Alternative to Relieve Depression STAR D |\ |\ |\ |\ |\
Strong behavioral therapy combined with medications lead to
|\ |\ |\ |\ |\ |\ |\ |\
30% better outcomes as compared to monotherapy or
|\ |\ |\ |\ |\ |\ |\ |\
medication or therapy alone. |\ |\ |\
Describe the mechanism of action of Typical Antipsychotics
|\ |\ |\ |\ |\ |\ |\
Blocking D2 receptors in the mesolimbic and mesocortical
|\ |\ |\ |\ |\ |\ |\
The Blocking D2 receptors in the mesolimbic and mesocortical
|\ |\ |\ |\ |\ |\ |\ |\ |\
tract
tract reducing positive symptoms of psychosis, does effect the
|\ |\ |\ |\ |\ |\ |\ |\ |\
negative symptoms of the disorder, can create EPS symptoms in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the nigro-striatal tract,
|\ |\
Nigrostriatal
involved with muscular movement
|\ |\ |\
Mesolimbic
source of visual hallucinations and auditory hallucinations,
|\ |\ |\ |\ |\ |\
Mesocortical
mesocortical area holds affective symptoms, |\ |\ |\ |\
,Blocking Alpha 1 adrenergic receptors through down regulation
|\ |\ |\ |\ |\ |\ |\ |\
causing orthostatic hypotention |\ |\
Pharmacological strategies in addressing EPS symptoms |\ |\ |\ |\ |\
Change medication |\
Lower the dose |\ |\
Prescribe cogentin |\
Second generation antipsychotics are pharmacology directed to
|\ |\ |\ |\ |\ |\
blocking both D2 and 5HT receptors in the brain and also relieve
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the negative symptoms of psychosi
|\ |\ |\ |\
down regulation blocking Alpha ! receptors
|\ |\ |\ |\ |\
Orthostatic hypotension and dizziness which comes |\ |\ |\ |\ |\
down regulation of blocking Muscarinic and Histamine receptors
|\ |\ |\ |\ |\ |\ |\
Weight gain, dizziness |\ |\
serontin down regulation in the gut |\ |\ |\ |\ |\
constipation
Neuroleptic malignant syndrome |\ |\
cause by increased medication changes or treatment naive
|\ |\ |\ |\ |\ |\ |\ |\
patients
What are notable side effects of Clozapine
|\ |\ |\ |\ |\ |\
Induced by cigarette smoking which is through the 1A2 pathway
|\ |\ |\ |\ |\ |\ |\ |\ |\
Recommended dosing schedule for clozapine |\ |\ |\ |\
Start at 12.5 first day,
|\ |\ |\ |\
then in divide doses of 25-50 mg/day up to 300-400 mg per day.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Clozapine maxes |\
Maximum dose is 900 mg per day. |\ |\ |\ |\ |\ |\
No single dose should exceed 450 mg
|\ |\ |\ |\ |\ |\
,Clozapine monitoring |\
Need to register at the clozapine website as a provider
|\ |\ |\ |\ |\ |\ |\ |\ |\
Normal levels of WBCs > 3500 |\ |\ |\ |\ |\
Normal levels of ANC > 2000 |\ |\ |\ |\ |\
wbc
WBC with differentials, Absolute Neutrophil Count
|\ |\ |\ |\ |\
Blood draws are done weekly for the first 6 months, then every
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
other week for 6 months, then monthly
|\ |\ |\ |\ |\ |\
Notable side effects of Risperidone |\ |\ |\ |\
Increase risk of seizure |\ |\ |\
Contraindicated for pregnancy |\ |\
Increased prolactin |\
Metabolic syndrome diagnostic criteria |\ |\ |\
Combination of any three of the following |\ |\ |\ |\ |\ |\
Abdominal circumference > 37 in males > 31.5 in femaies |\ |\ |\ |\ |\ |\ |\ |\ |\
Plus any two of the following:
|\ |\ |\ |\ |\
Elevated Triglycerides > 150 mg/dl |\ |\ |\ |\
HDL less than 40 mg/dl in men, 50 mg/dl in women
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Blood pressure >130/85, or receiving treatment for hypertension
|\ |\ |\ |\ |\ |\ |\
Fasting blood sugar >110 mg/dl or prior type of DM diagnosis
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A weight increase of 7% should prompt the provider
|\ |\ |\ |\ |\ |\ |\ |\
to consider a different medication.
|\ |\ |\ |\
Neuroleptic Malignant Syndrome criteria |\ |\ |\
Within 2 weeks of beginning the medication or a significant
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
medication increase / or present with abrupt withdrawal of |\ |\ |\ |\ |\ |\ |\ |\ |\
levodopa or exposure to a dopamine agonist |\ |\ |\ |\ |\ |\
Classic triad: |\
, Hot, Stiff, and Out of it: includes extreme mental status
|\ |\ |\ |\ |\ |\ |\ |\ |\
change/confusion, extreme muscle rigidity, and extremem
|\ |\ |\ |\ |\ |\ |\
autonomic instability/hyperthermia: |\
What is the appropriate treatment for Neuroleptic Malignant
|\ |\ |\ |\ |\ |\ |\ |\
Syndrome
Dantrolene bromocriptine to relieve rigidity |\ |\ |\ |\
How are TCA metabolized
|\ |\ |\
the 2D6 pathway
|\ |\
The importance of TCA to be aware of:
|\ |\ |\ |\ |\ |\ |\
Toxicity causes heart block, torsade de pointes arrythmia or
|\ |\ |\ |\ |\ |\ |\ |\ |\
sudden death |\
Monoamine Oxidase Inhibitor (MAOIs) concern for treatment |\ |\ |\ |\ |\ |\
Low tyramine diet including red wine, cheese, processed foods,
|\ |\ |\ |\ |\ |\ |\ |\ |\
causes a hypertensive crisis (high blood pressure)
|\ |\ |\ |\ |\ |\
Buproprion
Can lower the seizure threshold, should avoid in children and the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
elderly, NDRI class |\ |\
Fluoxetine (Prozac) |\
Longer half life 36-40 hours
|\ |\ |\ |\
Paroxetine (Paxil) |\
known for withdrawl symptoms if not taken regular, short half-
|\ |\ |\ |\ |\ |\ |\ |\ |\
life, good for anxiety disorders
|\ |\ |\ |\
Citalopram (Celexa) |\
cardiac effect may require decreased doses (QT prolongation) do
|\ |\ |\ |\ |\ |\ |\ |\ |\
not go over 40 mg/day
|\ |\ |\ |\
Trazodone
Can cause priaprism
|\ |\
Assessment questions with answers |\ |\ |\
Explain the clinical signifcance of the Stystematic Treatment
|\ |\ |\ |\ |\ |\ |\ |\
Enhancement Program for Bipolar Disorder: STEP-BD) |\ |\ |\ |\ |\
As more contempts are tried with SSRIs to relieve depressive
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
symptoms, the client becomes more treatment resistant leading
|\ |\ |\ |\ |\ |\ |\ |\
to poor outcomes.
|\ |\
Explain the clinical significance of the Sequenced Treatment
|\ |\ |\ |\ |\ |\ |\ |\
Alternative to Relieve Depression STAR D |\ |\ |\ |\ |\
Strong behavioral therapy combined with medications lead to
|\ |\ |\ |\ |\ |\ |\ |\
30% better outcomes as compared to monotherapy or
|\ |\ |\ |\ |\ |\ |\ |\
medication or therapy alone. |\ |\ |\
Describe the mechanism of action of Typical Antipsychotics
|\ |\ |\ |\ |\ |\ |\
Blocking D2 receptors in the mesolimbic and mesocortical
|\ |\ |\ |\ |\ |\ |\
The Blocking D2 receptors in the mesolimbic and mesocortical
|\ |\ |\ |\ |\ |\ |\ |\ |\
tract
tract reducing positive symptoms of psychosis, does effect the
|\ |\ |\ |\ |\ |\ |\ |\ |\
negative symptoms of the disorder, can create EPS symptoms in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the nigro-striatal tract,
|\ |\
Nigrostriatal
involved with muscular movement
|\ |\ |\
Mesolimbic
source of visual hallucinations and auditory hallucinations,
|\ |\ |\ |\ |\ |\
Mesocortical
mesocortical area holds affective symptoms, |\ |\ |\ |\
,Blocking Alpha 1 adrenergic receptors through down regulation
|\ |\ |\ |\ |\ |\ |\ |\
causing orthostatic hypotention |\ |\
Pharmacological strategies in addressing EPS symptoms |\ |\ |\ |\ |\
Change medication |\
Lower the dose |\ |\
Prescribe cogentin |\
Second generation antipsychotics are pharmacology directed to
|\ |\ |\ |\ |\ |\
blocking both D2 and 5HT receptors in the brain and also relieve
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the negative symptoms of psychosi
|\ |\ |\ |\
down regulation blocking Alpha ! receptors
|\ |\ |\ |\ |\
Orthostatic hypotension and dizziness which comes |\ |\ |\ |\ |\
down regulation of blocking Muscarinic and Histamine receptors
|\ |\ |\ |\ |\ |\ |\
Weight gain, dizziness |\ |\
serontin down regulation in the gut |\ |\ |\ |\ |\
constipation
Neuroleptic malignant syndrome |\ |\
cause by increased medication changes or treatment naive
|\ |\ |\ |\ |\ |\ |\ |\
patients
What are notable side effects of Clozapine
|\ |\ |\ |\ |\ |\
Induced by cigarette smoking which is through the 1A2 pathway
|\ |\ |\ |\ |\ |\ |\ |\ |\
Recommended dosing schedule for clozapine |\ |\ |\ |\
Start at 12.5 first day,
|\ |\ |\ |\
then in divide doses of 25-50 mg/day up to 300-400 mg per day.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Clozapine maxes |\
Maximum dose is 900 mg per day. |\ |\ |\ |\ |\ |\
No single dose should exceed 450 mg
|\ |\ |\ |\ |\ |\
,Clozapine monitoring |\
Need to register at the clozapine website as a provider
|\ |\ |\ |\ |\ |\ |\ |\ |\
Normal levels of WBCs > 3500 |\ |\ |\ |\ |\
Normal levels of ANC > 2000 |\ |\ |\ |\ |\
wbc
WBC with differentials, Absolute Neutrophil Count
|\ |\ |\ |\ |\
Blood draws are done weekly for the first 6 months, then every
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
other week for 6 months, then monthly
|\ |\ |\ |\ |\ |\
Notable side effects of Risperidone |\ |\ |\ |\
Increase risk of seizure |\ |\ |\
Contraindicated for pregnancy |\ |\
Increased prolactin |\
Metabolic syndrome diagnostic criteria |\ |\ |\
Combination of any three of the following |\ |\ |\ |\ |\ |\
Abdominal circumference > 37 in males > 31.5 in femaies |\ |\ |\ |\ |\ |\ |\ |\ |\
Plus any two of the following:
|\ |\ |\ |\ |\
Elevated Triglycerides > 150 mg/dl |\ |\ |\ |\
HDL less than 40 mg/dl in men, 50 mg/dl in women
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Blood pressure >130/85, or receiving treatment for hypertension
|\ |\ |\ |\ |\ |\ |\
Fasting blood sugar >110 mg/dl or prior type of DM diagnosis
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A weight increase of 7% should prompt the provider
|\ |\ |\ |\ |\ |\ |\ |\
to consider a different medication.
|\ |\ |\ |\
Neuroleptic Malignant Syndrome criteria |\ |\ |\
Within 2 weeks of beginning the medication or a significant
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
medication increase / or present with abrupt withdrawal of |\ |\ |\ |\ |\ |\ |\ |\ |\
levodopa or exposure to a dopamine agonist |\ |\ |\ |\ |\ |\
Classic triad: |\
, Hot, Stiff, and Out of it: includes extreme mental status
|\ |\ |\ |\ |\ |\ |\ |\ |\
change/confusion, extreme muscle rigidity, and extremem
|\ |\ |\ |\ |\ |\ |\
autonomic instability/hyperthermia: |\
What is the appropriate treatment for Neuroleptic Malignant
|\ |\ |\ |\ |\ |\ |\ |\
Syndrome
Dantrolene bromocriptine to relieve rigidity |\ |\ |\ |\
How are TCA metabolized
|\ |\ |\
the 2D6 pathway
|\ |\
The importance of TCA to be aware of:
|\ |\ |\ |\ |\ |\ |\
Toxicity causes heart block, torsade de pointes arrythmia or
|\ |\ |\ |\ |\ |\ |\ |\ |\
sudden death |\
Monoamine Oxidase Inhibitor (MAOIs) concern for treatment |\ |\ |\ |\ |\ |\
Low tyramine diet including red wine, cheese, processed foods,
|\ |\ |\ |\ |\ |\ |\ |\ |\
causes a hypertensive crisis (high blood pressure)
|\ |\ |\ |\ |\ |\
Buproprion
Can lower the seizure threshold, should avoid in children and the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
elderly, NDRI class |\ |\
Fluoxetine (Prozac) |\
Longer half life 36-40 hours
|\ |\ |\ |\
Paroxetine (Paxil) |\
known for withdrawl symptoms if not taken regular, short half-
|\ |\ |\ |\ |\ |\ |\ |\ |\
life, good for anxiety disorders
|\ |\ |\ |\
Citalopram (Celexa) |\
cardiac effect may require decreased doses (QT prolongation) do
|\ |\ |\ |\ |\ |\ |\ |\ |\
not go over 40 mg/day
|\ |\ |\ |\
Trazodone
Can cause priaprism
|\ |\
