NR 547 Midterm Exam Questions with Verified Answers (Correct
Update)
Question 1: "atypical" en at night for secause dating side effect Paroxetine medications tak-
Answer: antipsychotics like quetiapine (Seroquel) or olanzapine (Zyprexa), can significant drowsiness
taken once at bedtime
Question 2: en with food Enuresis
Answer: metformin (reduce GI ettects ) Lurasidone with at least 350 calories for medication
ettectiveness Lithium and valproic acid (Depakote) often cause gastrointestinal upset, which can be
mitigated by taking them with food, and sometimes a split dose
Question 3: Erectile
Answer: DSM-5-TR Criteria (key points): 2eepisodes/week for 3emonths OR significant
distress/impairment; age 5eyears; not due to substance/medical condition. Types: Nocturnal: Only at
night (most common). Diurnal: Only during day. Mixed: Both. Primary: Never achieved control.
Secondary: Lost control after 6emonths of dryness. Common Treatment: Behavioral (alarms, fluid
restriction) & Pharmacological (Desmopressin, Imipramine).
Question 4: dysfunction...statistics, causes and treatments · Obtaining a sex-
Answer: Around 40% of men are attected by age 40. Around 70% of men report ED by age 70 Vascular
Issues: Insuflcient blood flow into the penis High prolactin levels Antidepressants (especially SSRIs)
Antihypertensives (e.g., beta-blockers, diuretics) Antihistamines Opioids Sedatives Oral Medications
(Phosphodiesterase-5 (PDE5) Inhibitors - First-line pharmacologic): eg Sildenafil (Viagra) ""fils"
Important Note: Contraindicated with nitrates Alprostadil: Can be administered as a penile injection
Question 5: Principles: ual history. Female Sex-
Answer: Privacy, non-judgmental, routine, open-ended questions, permission-seeking, clear language.
Components (The "5 Ps"): Partners: Number, gender, new/established. Practices: Types of sexual
activity (vaginal, oral, anal). Protection from STIs: Condom use, STI testing, vaccinations (HPV, Hep
B). Past History of STIs: Any previous STIs, treatment. Prevention of Pregnancy: Contraception use,
pregnancy intentions. Purpose: Assess sexual health, identify risks (STIs, pregnancy), address
dysfunction, build rapport, inform care.
Question 6: ual Interest/Arousal Disorder (FSIAD) Female Orgasmic
Answer: Lack of sexual thoughts/fantasies. Decreased initiation of sexual activity. Reduced
excitement/pleasure during sexual activity. Absent/reduced response to internal or external sexual cues.
Reduced genital or non-genital sensations during sexual activity. Diagnosis: Requires at least 3 of the
above symptoms for at least 6 months, causing significant distres
Page 1
,Question 7: Symptoms: Disorder Genito-Pelvic
Answer: Marked diflculty, delay in, or absence of achieving orgasm despite adequate sexual arousal and
stimulation. Diagnosis: Requires persistent or recurrent diflculty achieving orgasm in almost all
(75-100%) sexual encounters, lasting at least 6 months, and causing significant distress.
Question 8: Pain/Penetration Disorder (GPPPD): causes of female
Answer: Symptoms: Persistent or recurrent diflculties with one or more of the following: 1. Vaginal
penetration during intercourse. 2. Marked vulvovaginal or pelvic pain during vaginal intercourse or
penetration attempts. 3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of,
during, or as a result of vaginal penetration. 4. Marked tensing or tightening of the pelvic floor muscles
during attempted vaginal penetration. Diagnosis: Requires at least one of these symptoms for at least 6
months, causing significant distress.
Question 9: sexual dysfunction treatments for
Answer: Physical: Hormonal (menopause, pregnancy), medical conditions (diabetes, heart disease),
medications (antidepressants), gynecological issues. Psychological: Depression, anxiety, stress, trauma.
Relationship: Communication, partner dysfunction. Sociocultural: Beliefs, lack of education.
Question 10: female sexual dysfunction Flibanserin
Answer: Flibanserin (Addyi): Oral medication taken daily at bedtime. Acts on serotonin receptors.
(Note: Interactions with alcohol and certain antifungals). Bremelanotide (Vyleesi): Self-administered
injection taken prior to sexual activity. Activates melanocortin receptors. Other Medications (sometimes
used ott-label or for specific issues): Bupropion (Wellbutrin) for desire (especially if
antidepressant-induced FSD). Ospemifene (Osphena): Oral medication for painful sex due to
Genitourinary Syndrome of Menopause (GSM). GSM. Prasterone (Intrarosa): Vaginal insert for painful
sex due to Genitourinary Syndrome of Menopause (GSM).
Page 2
, Question 11: What are the
A. It's sometimes called a "norepinephrine-dopamine disinhibitor" (NDDI) due to its
downstream ettects on increasing dopamine and norepinephrine and decreasing serotonin in
certain brain areas.'' FDA-approved specifically for: Acquired, generalized hypoactive sexual
desire disorder (HSD
D. in premenopausal women. It is NOT a "female Viagra" because it doesn't directly attect blood
flow to the genitals; it acts on the brain. Indication: Acquired, generalized HSDD in
premenopausal women only. Acts on brain neurotransmitters (serotonin, dopamine,
norepinephrine). Dosing: 100 mg once daily at bedtime. Takes 4e-8 weeks for ettect. Key Side
Ettects: Severe hypotension & syncope (fainting), dizziness, somnolence, nausea. CRUCIAL
Interactions/Contraindications (Boxed Warning): Alcohol: Increased risk of severe
hypotension/syncope. Moderate/Strong CYP3A4 Inhibitors (e.g., grapefruit juice): Increased
drug levels, severe hypotension/syncope. Hepatic Impairment: Contraindicated due to increased
drug exposure. Patient Teaching: Take at bedtime only; strictly avoid alcohol; avoid grapefruit;
report dizziness/fainting; do not drive until ettects known; not for immediate ettect.
Answer: Serotonin 1A receptor agonist and serotonin 2A receptor antagonist (often described as a
"multifunctional serotonin agonist and antagonist" or MSAA). It's sometimes called a
"norepinephrine-dopamine disinhibitor" (NDDI) due to its downstream ettects on increasing dopamine
and norepinephrine and decreasing serotonin in certain brain areas.'' FDA-approved specifically for:
Acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. It is NOT a
"female Viagra" because it doesn't directly attect blood flow to the genitals; it acts on the brain.
Indication: Acquired, generalized HSDD in premenopausal women only. Acts on brain
neurotransmitters (serotonin, dopamine, norepinephrine). Dosing: 100 mg once daily at bedtime. Takes
4e-8 weeks for ettect. Key Side Ettects: Severe hypotension & syncope (fainting), dizziness,
somnolence, nausea. CRUCIAL Interactions/Contraindications (Boxed Warning): Alcohol: Increased
risk of severe hypotension/syncope. Moderate/Strong CYP3A4 Inhibitors (e.g., grapefruit juice):
Increased drug levels, severe hypotension/syncope. Hepatic Impairment: Contraindicated due to
increased drug exposure. Patient Teaching: Take at bedtime only; strictly avoid alcohol; avoid
grapefruit; report dizziness/fainting; do not drive until ettects known; not for immediate ettect.
Question 12: main treatment approaches for Circadian Rhythm Sleep-Wake Disorders (CR-
SWDs)? Ramelteon (Roz-
Answer: Non-Pharm (First-line): Chronotherapy (shifting sleep-wake cycle), sleep hygiene (consistent
schedule, light exposure), light therapy (morning for Delayed Sleep Phase Disorder, evening for
Advanced Sleep Phase Disorder), dark therapy. Pharm (Adjuncts): Melatonin (timing crucial),
Tasimelteon (for Non-24), Ramelteon (less ettective), Stimulants (for wakefulness in Shift Work/Jet
Lag), Hypnotics (short-term for jet lag-related insomnia, not generally recommended). Key Principle:
Realignment of the sleep-wake schedule with the circadian rhythm. Treatment depends on the specific
CRSWD.
Question 13: erem) Modafinil
Answer: Drug Class: Melatonin Receptor Agonist. 8 mg once daily, within 30 minutes of going to bed.
Do not use with fluvoxamine (Luvox): Fluvoxamine is a strong CYP1A2 inhibitor
Page 3
Update)
Question 1: "atypical" en at night for secause dating side effect Paroxetine medications tak-
Answer: antipsychotics like quetiapine (Seroquel) or olanzapine (Zyprexa), can significant drowsiness
taken once at bedtime
Question 2: en with food Enuresis
Answer: metformin (reduce GI ettects ) Lurasidone with at least 350 calories for medication
ettectiveness Lithium and valproic acid (Depakote) often cause gastrointestinal upset, which can be
mitigated by taking them with food, and sometimes a split dose
Question 3: Erectile
Answer: DSM-5-TR Criteria (key points): 2eepisodes/week for 3emonths OR significant
distress/impairment; age 5eyears; not due to substance/medical condition. Types: Nocturnal: Only at
night (most common). Diurnal: Only during day. Mixed: Both. Primary: Never achieved control.
Secondary: Lost control after 6emonths of dryness. Common Treatment: Behavioral (alarms, fluid
restriction) & Pharmacological (Desmopressin, Imipramine).
Question 4: dysfunction...statistics, causes and treatments · Obtaining a sex-
Answer: Around 40% of men are attected by age 40. Around 70% of men report ED by age 70 Vascular
Issues: Insuflcient blood flow into the penis High prolactin levels Antidepressants (especially SSRIs)
Antihypertensives (e.g., beta-blockers, diuretics) Antihistamines Opioids Sedatives Oral Medications
(Phosphodiesterase-5 (PDE5) Inhibitors - First-line pharmacologic): eg Sildenafil (Viagra) ""fils"
Important Note: Contraindicated with nitrates Alprostadil: Can be administered as a penile injection
Question 5: Principles: ual history. Female Sex-
Answer: Privacy, non-judgmental, routine, open-ended questions, permission-seeking, clear language.
Components (The "5 Ps"): Partners: Number, gender, new/established. Practices: Types of sexual
activity (vaginal, oral, anal). Protection from STIs: Condom use, STI testing, vaccinations (HPV, Hep
B). Past History of STIs: Any previous STIs, treatment. Prevention of Pregnancy: Contraception use,
pregnancy intentions. Purpose: Assess sexual health, identify risks (STIs, pregnancy), address
dysfunction, build rapport, inform care.
Question 6: ual Interest/Arousal Disorder (FSIAD) Female Orgasmic
Answer: Lack of sexual thoughts/fantasies. Decreased initiation of sexual activity. Reduced
excitement/pleasure during sexual activity. Absent/reduced response to internal or external sexual cues.
Reduced genital or non-genital sensations during sexual activity. Diagnosis: Requires at least 3 of the
above symptoms for at least 6 months, causing significant distres
Page 1
,Question 7: Symptoms: Disorder Genito-Pelvic
Answer: Marked diflculty, delay in, or absence of achieving orgasm despite adequate sexual arousal and
stimulation. Diagnosis: Requires persistent or recurrent diflculty achieving orgasm in almost all
(75-100%) sexual encounters, lasting at least 6 months, and causing significant distress.
Question 8: Pain/Penetration Disorder (GPPPD): causes of female
Answer: Symptoms: Persistent or recurrent diflculties with one or more of the following: 1. Vaginal
penetration during intercourse. 2. Marked vulvovaginal or pelvic pain during vaginal intercourse or
penetration attempts. 3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of,
during, or as a result of vaginal penetration. 4. Marked tensing or tightening of the pelvic floor muscles
during attempted vaginal penetration. Diagnosis: Requires at least one of these symptoms for at least 6
months, causing significant distress.
Question 9: sexual dysfunction treatments for
Answer: Physical: Hormonal (menopause, pregnancy), medical conditions (diabetes, heart disease),
medications (antidepressants), gynecological issues. Psychological: Depression, anxiety, stress, trauma.
Relationship: Communication, partner dysfunction. Sociocultural: Beliefs, lack of education.
Question 10: female sexual dysfunction Flibanserin
Answer: Flibanserin (Addyi): Oral medication taken daily at bedtime. Acts on serotonin receptors.
(Note: Interactions with alcohol and certain antifungals). Bremelanotide (Vyleesi): Self-administered
injection taken prior to sexual activity. Activates melanocortin receptors. Other Medications (sometimes
used ott-label or for specific issues): Bupropion (Wellbutrin) for desire (especially if
antidepressant-induced FSD). Ospemifene (Osphena): Oral medication for painful sex due to
Genitourinary Syndrome of Menopause (GSM). GSM. Prasterone (Intrarosa): Vaginal insert for painful
sex due to Genitourinary Syndrome of Menopause (GSM).
Page 2
, Question 11: What are the
A. It's sometimes called a "norepinephrine-dopamine disinhibitor" (NDDI) due to its
downstream ettects on increasing dopamine and norepinephrine and decreasing serotonin in
certain brain areas.'' FDA-approved specifically for: Acquired, generalized hypoactive sexual
desire disorder (HSD
D. in premenopausal women. It is NOT a "female Viagra" because it doesn't directly attect blood
flow to the genitals; it acts on the brain. Indication: Acquired, generalized HSDD in
premenopausal women only. Acts on brain neurotransmitters (serotonin, dopamine,
norepinephrine). Dosing: 100 mg once daily at bedtime. Takes 4e-8 weeks for ettect. Key Side
Ettects: Severe hypotension & syncope (fainting), dizziness, somnolence, nausea. CRUCIAL
Interactions/Contraindications (Boxed Warning): Alcohol: Increased risk of severe
hypotension/syncope. Moderate/Strong CYP3A4 Inhibitors (e.g., grapefruit juice): Increased
drug levels, severe hypotension/syncope. Hepatic Impairment: Contraindicated due to increased
drug exposure. Patient Teaching: Take at bedtime only; strictly avoid alcohol; avoid grapefruit;
report dizziness/fainting; do not drive until ettects known; not for immediate ettect.
Answer: Serotonin 1A receptor agonist and serotonin 2A receptor antagonist (often described as a
"multifunctional serotonin agonist and antagonist" or MSAA). It's sometimes called a
"norepinephrine-dopamine disinhibitor" (NDDI) due to its downstream ettects on increasing dopamine
and norepinephrine and decreasing serotonin in certain brain areas.'' FDA-approved specifically for:
Acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. It is NOT a
"female Viagra" because it doesn't directly attect blood flow to the genitals; it acts on the brain.
Indication: Acquired, generalized HSDD in premenopausal women only. Acts on brain
neurotransmitters (serotonin, dopamine, norepinephrine). Dosing: 100 mg once daily at bedtime. Takes
4e-8 weeks for ettect. Key Side Ettects: Severe hypotension & syncope (fainting), dizziness,
somnolence, nausea. CRUCIAL Interactions/Contraindications (Boxed Warning): Alcohol: Increased
risk of severe hypotension/syncope. Moderate/Strong CYP3A4 Inhibitors (e.g., grapefruit juice):
Increased drug levels, severe hypotension/syncope. Hepatic Impairment: Contraindicated due to
increased drug exposure. Patient Teaching: Take at bedtime only; strictly avoid alcohol; avoid
grapefruit; report dizziness/fainting; do not drive until ettects known; not for immediate ettect.
Question 12: main treatment approaches for Circadian Rhythm Sleep-Wake Disorders (CR-
SWDs)? Ramelteon (Roz-
Answer: Non-Pharm (First-line): Chronotherapy (shifting sleep-wake cycle), sleep hygiene (consistent
schedule, light exposure), light therapy (morning for Delayed Sleep Phase Disorder, evening for
Advanced Sleep Phase Disorder), dark therapy. Pharm (Adjuncts): Melatonin (timing crucial),
Tasimelteon (for Non-24), Ramelteon (less ettective), Stimulants (for wakefulness in Shift Work/Jet
Lag), Hypnotics (short-term for jet lag-related insomnia, not generally recommended). Key Principle:
Realignment of the sleep-wake schedule with the circadian rhythm. Treatment depends on the specific
CRSWD.
Question 13: erem) Modafinil
Answer: Drug Class: Melatonin Receptor Agonist. 8 mg once daily, within 30 minutes of going to bed.
Do not use with fluvoxamine (Luvox): Fluvoxamine is a strong CYP1A2 inhibitor
Page 3
