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2023-2024 NR546 Pharmacology Midterm Exam With Answers (298 Solved Questions)

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    NEWLY UPDATED NR 546 MIDTERM EXAM 2023 - 2024 WITH ANSWERS thalamus - - answer - involved in sensory organ and motor command processing striatum - - answer - involved in complex motor actions, also links cognition to motor actions limbic system - - answer - includes circuits that are associated w ith pleasure and reward basal ganglia - - answer - group of structures involved in voluntary motor movements amygdala - - answer - involved in emotional regulation and perception of odors corpus callosum - - answer - controls the communication between the two br ain hemispheres white matter - - answer - contains nerve fibers that connect neurons from different regions into functional circuits grey matter - - answer - contains nerve cells and dendrites brain tissue - - answer - made up of grey matter and white matter dorsal striatum - - answer - involved in complex motor actions and linkage of cognition to motor actions

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    - main input area for basal ganglia *activated when anticipating or engaging in pleasure The field of epigenetics is rapidly growing and can help explain how gene expression is: - - answer - influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness How does epigenetics impact a person's mental health? - - answer - internal or external factors activate portions of the genome that result in the manifestation of mental health symptoms - activation is often a result of a stressful event, which, when combined with the genetic risk, results in the disease - genes being on or off - occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes being "on" when they should be "off." What should the PMHNP consider when prescribing chemical restraints? - - answer -- allergy status - prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint - state regulations regarding chemical restrains must be reviewed 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? - - answer - No. The client has been court - ordered to take the prescribed medications and the standing order for chemical restraints

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    is approved. The PMHNP and other staff are not liable if the patient has an allergic reaction or adverse side effects. How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for clients? - - answer -- Genetic testing can assist by providing more information on how clients may respond to certain psychotropic medications - provides information on how a client may break down and metabolize med ications based on the cytochrome P450 system. Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link for schizophrenia and why one twin may develop schizophrenia when the other does not. When two people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia (Lemvigh et al., 2020). Why is there onl y half the risk? - - answer - Both environmental and psychosocial stressors can impact mental health. Although twins may have identical genes, their gene expression may be different. There may be an environmental exposure that turned a gene "on" that should have been "off" for one twin to develop schizophrenia and not the other. central sulcus - - answer - separates the frontal lobe from the parietal lobe

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    frontal lobe - - answer - associated with movement, intelligence, abstract thinking broca's area - - answer - s peech production temporal lobe - - answer - involves object identification and auditory signals cerebellum - - answer - coordination wernicke's area - - answer - speech comprehension occipital lobe - - answer - primary visual area parietal lobe - - answer - keeps us alert to what is going on around us sensory cortex - - answer - pain, heat, and other sensations motor cortex - - answer - movement hippocampus - - answer - involved in both memory and anxiety nucleus accumbens - - answer - involve d in the reward process Types of epigenetic changes: - - answer - DNA Methylation Histone modification Non - coding RNA The potential legal and ethical issues impacting mental health treatment must also be taken into account, including: - - answer -- informed consent

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    - competence to make healthcare decisions - off - label prescribing Informed consent - - answer - Clients have the right to receive enough information to make decisions about treatment. - mu st also be informed about potential risks associated with medications. - have the right to refuse treatment - cannot be forcibly medicated in non - emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed Compliance - - answer - A court order may be issued for a client to rec eive treatment against their wishes if they are considered a danger to themselves or others. - Examples: clients with schizophrenia or sex offenders - Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to mak e decisions - PMHNPs are responsible for being knowledgeable about their state laws and abiding by them. Off - Label Prescribing - - answer - Some clients may benefit from the unapproved use of a drug for symptom management. - Example: many SSRIs used to tx anx iety and OCD but are not FDA approved for use in this disorder. - potentially raises ethical and legal concerns - PMHNP must remain up to date with the latest recommendations for off - label prescribing.

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    Incidence of mental illness - what factors are increasin g the incidence - - answer - Psychological and sociological factors Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications Adherence - - answer - Persistence - taking med over intended time period Compliance - taking med as prescribed left hemisphere - - answer -- speech comprehension - word recognition - grammar - sequential processing - recognition of detail - conscious mental processin g right hemisphere - - answer -- prosody of speech - emotional modulation - visual - spatial skills - recognition of facial expression - music - abstract mathematical skills - holistic processing - unconscious mental processing Pharmacokinetics - - answer - the study of what happens to a drug from the time of administration until the parent drug and all metabolites leave the body

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    CYP450 - - answer - CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed p roduct in the bloodstream, responsible for degradating of a large # of psychotropic drugs - Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing *Most individuals have "normal" rates of drug metabolism from the majo r CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals. *genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers Five of the most important: CYP450 1A2, 2B6, 2D6, 2C9, 2 C19, and 3A4. ultra rapid metabolizers - - answer - elevated enzyme activity subtherapeutic drug levels poor efficacy with standard doses genotyping - - answer - the patient for pharmacogenomic use - genes for these CYP450 enzymes can now be readily measured an d used to predict which patients might need to have dosage adjustments - measurement of genes for drug metabolism most common targets of psychotropic drugs - - answer - G - protein receptors - Drug actions at these receptors occur in a spectrum, from full agonis t actions, to partial agonist actions, to antagonism, and even to inverse agonism.

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    Pharmacokinetics concepts - - answer - absorption distribution metabolism excretion Flockhart Table - - answer - drug interactions that are mediated by cytochrome P450 enzymes comprehensive list of drugs and the interactions related to the cytochrome P450 system Neurotransmitters - - answer - chemicals released by neurons to send communication across synaptic clefts to other neurons - impact human emotion and behavior Neurotransmi ssion: - - answer - the chemical transmission of information between neurons and their target cells - the chemicals, or neurotransmitters, are released from their transport vesicles to bind with receptor sites to perform their duties, which are excitatory or i nhibitory - neurotransmitter then either returned and stored for future use (reuptake) or inactivated and dissolved by enzymes - Types: Classic, Retrograde, Volume Classic neurotransmission - - answer - neurons send electrical impulses from one part of the cel l to another part of the same cell via their axons - one neuron hurling a chemical messenger, or neurotransmitter, at the receptors of a second neuron

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    - electrical impulse converted chemical signal at the synapse in a process known as excitation - secretion co upling, the first stage of chemical neurotransmission, then back into electrical impulse in second neuron - chemical information from the first neuron triggering a cascade of further chemical messages within the second neuron to change that neuron's molecul ar and genetic functioning Retrograde neurotransmission - - answer - postsynaptic neurons "talk back" to their presynaptic neurons - second neuron to the first at the synapse between them - Chemicals produced specifically as retrograde neurotransmitters at som e synapses include: endocannabinoids, gaseous neurotransmitter nitric oxide (NO), nerve growth factor (NGF). Volume neurotransmission - - answer - Neurotransmission without a synapse or nonsynaptic diffusion neurotransmission - Chemical messengers sent by one neuron to another can spill over to sites distant to the synapse by diffusion - neurotransmission can occur at any compatible receptor within the diffusion radius of the neurotransmitter - neurotransmission occurs in chemical "puffs" - sophisticated "chemical soup." - example: dopamine action in the prefrontal cortex, at the sites of autoreceptors on monoamine neurons Excitatory neurotransmitters: - - answer - increase the likelihood that the neuron will fire an action potential

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    inhibitor y neurotransmitters: - - answer - decrease the likelihood that a neuron will fire an action neurotransmitters that most impact mental health can be classified into four major categories: - - answer - cholinergics - acetylcholine monoamines - norepinephrine, dopa mine, serotonin, histamine amino acids - gamma - amino - butyric acid and glutamate neuropeptides Inhibitors: VISA CKGQ - - answer - Valproate Isoniazid Sulfonamides Amiodarone Chloramphenicol Ketoconazole Grapefruit Juice Quinidine - decrease medication metab olism Inducers: CRAP GPS - - answer - Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital

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    Sulfonylureas - increase medication metabolism neurotransmitters that may be responsible for a client's symptoms of depression - - answer - Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or glutamate can contribute to symptoms of depression client who is a poor metabolizer: - - answer - has a lower concentration of the necessary enzyme to metabolize a drug, which results in higher blood concentrations of the drug. - increase the risk of side effects and adverse reactions Why is trazodone not used as a front - line antidepressant - - answer - Its antidepressant that has a secondary effect of blocking histamine and adrenergic receptors - causes sedation and somnolence and as a result *often used as an adjunct in therapy when a depressed patient has difficulty sleeping effect on neurotrans mitters and side effects: Selective Serotonin Reuptake Inhibitors (SSRIs) - - answer - Inhibits the reuptake of serotonin, which can cause nausea, agitation, headache, and sexual dysfunction effect on neurotransmitters and side effects: Serotonin and Norepin ephrine Reuptake Inhibitors (SNRIs) - - answer - Inhibits the reuptake of serotonin and norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual dysfunction

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    effect on neurotransmitters and side effects: Tricyclic Antidepressants - - answer - - Inhibits the reuptake of serotonin and norepinephrine, which can cause sexual dysfunction - Blocks norepinephrine receptors, which can cause hypotension and tachycardia - Blocks histamine receptors, which can cause sedation and weight gain - Blocks acetylcho line receptors, which can cause dry mouth, constipation, blurred vision, and urinary retention effect on neurotransmitters and side effects: Monoamine Oxidase Inhibitors (MAOIs) - - answer - Increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it, which can cause sedation, dizziness, sexual dysfunction, and hypertensive cris is effect on neurotransmitters and side effects: Benzodiazepines - - answer - Increases the receptor affinity for GABA, which can cause dependence and confusion effect on neurotransmitters and side effects: Bupropion - - answer - Inhibits the reuptake of norep inephrine and dopamine, which can cause insomnia, dry mouth, tremors, and seizures antagonist - - answer - causes a conformational change that stabilizes the receptor in the baseline state and thus is "silent." - blocks the action of a neurotransmitter agoni sts - - answer - fully stimulate G - protein - linked receptors

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    partial agonists - - answer - stimulate receptors to a lesser degree than an agonist or natural neurotransmitter SSRIs, SNRIs, and tricyclic antidepressants increase ________ levels. ___________ do n ot impact serotonin levels. - - answer - increase serotonin levels. Benzodiazepines do not impact serotonin levels. Is nicotine an inducer or an inhibitor of the CYP 1A2 enzyme? - - answer - inducer Nicotine is an inducer of the CYP 1A2 enzyme. Does the PMHNP anticipate Joshua may need a higher or lower dose of olanzapine to achieve a therapeutic response? - - answer - Higher - Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers the concentration of drugs. Therefore, a higher dose of olanzapine may be nee ded to control his symptoms. Ernesto, a 60 - year - old, presents to the PMHNP with report of having anxiety, frequent occurrences of feeling frozen in place and like his heart is pounding out of his chest, as well as having difficulty sleeping. The PMHNP s uspects the client has an elevated level of which neurotransmitter? - - answer - Norepinephrine - responsible for the regulation of fight or flight responses and can impact mood and sleep. Which of the following is the best medication class for the PMHNP to p rescribe for Ernesto to address his elevated

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    norepinephrine levels? - - answer - selective serotonin reuptake inhibitor would block the reuptake of serotonin, leaving a larger amount of serotonin available. Increasing the amount of serotonin would help regul ate the feelings of fear and anxiety. Reducing the occurrence of fear would help reduce the release of norepinephrine. A serotonin and norepinephrine reuptake inhibitor would prevent the reuptake of norepinephrine, which would not reduce the level of nor epinephrine as needed. Benzodiazepines increase the levels of GABA and do not impact norepinephrine. A monoamine oxidase inhibitor would increase levels of norepinephrine. During a follow up appointment after 4 weeks, the PMHNP should assess for the need to add which medication to Ernesto's treatment plan? - - answer - The nurse should assess for sexual dysfunction and anticipate the potential need for a phosphodiesterase inhib itor such as sildenafil (Viagra). - After 4 to 6 weeks, the client should be experiencing full effects of the SSRI, so the need for a short - term medication like a benzodiazepine or a beta blocker are not anticipated. St. John's Wort is contraindicated with an SSRI and can cause serotonin syndrome. Glu - - answer - Glutamate - amino acid - excitatory neurotransmitter - "workhorse" of the brain - can affect almost every neuron in the brain - affects: energy, memory, learning, neural plasticity - relay sensory info. an d regulate spinal and motor reflexes - too much: schizophrenia, epilepsy, mania

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    - receptors: NMDA, AMPA GABA - - answer - inhibitory neurotransmitter - decrease neuroexcitability across the brain - "chill", take the edge off stress, help people calm down, relax , destress, sleep - to little: may experience anxiety or schizophrenia - slows down everything, even breathing - affect executive function and motor coordination, increase risk for accidents - Increased levels of gamma - aminobutyric acid have a calming effect. 5HT - - answer - Serotonin - help regulate mood - makes relaxed, comfortable, decreases stress, regulate sleep, arousal, libido, aggression, pain perception NE - - answer - norepinephrine - monoamine neurotransmitter - focus and productivity - too much due to stre ss, meds, caffein, stimulants can cause: nervous, antsy, affect focus DA - - answer - dopamine - monoamine neurotransmitter - regulate mood - associated with executive function, ability to perform well, be organized, emotional intelligence - movement and coordination - to little: lose pleasure, interest, alertness, self - confidence, parkinson's disease

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