ANCC PMHNP Study Set Latest -

ANCC PMHNP Study Set (Latest - Actual Questions and Answers 100% Correct

• Review the MOA/DOSAGE for pharmacological therapy for a patient on a

stimulant medication(s) for ADHD. (p. 747)

Answer:

**Note: medication therapy not first line

**Beware of stimulant use for children with tics

**Rx'ing stimulants: ALWAYS assess cardiac risk because can lead to sudden

cardiac death

• MOA: inhibit reuptake of dopamine and norepinephrine, thereby increasing con-

centrations in the presynaptic cleft. Amphetamines directly stimulate the release of dopamine and norepinephrine.

• DOSAGE: Start low, titrate up. In adults, extended release preferred to maximize

compliance and minimize risk of abuse. In children, start with short acting to gauge tolerability and response, then switch to a longer-acting.

• Clozapine Chemical Structure

Answer: SDA - Serotonin 5HT2A Dopamine D2 antagonist.

• Clozapine S/E

Answer:

• NO EPS, NO TD, NO Hyperprolactinemia
• Life Threatening S/E agranulocytosis
• Highest risk for MetX/Cardio Metabolic, greatest degree of weight gain
• Increased risk seizures
• Sedating, hyper salivation, risk of myocarditis

• Clozapine Tx Benefits

Answer:

• Reduce risk of suicide in Schizo
• Efficacy in treating aggression and violence
• Reduce TD severity

"gold standard" on resistant symptoms but never first line of tx

• Olanzapine Chemical Structure

Answer: Serotonin 5HT2A and D2 Dopamine antago nist

MORE POTENT THAN Clozapine

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• Olanzapine s/e

Answer:

• Lacks EPS, sedating d/t Antagonist of M1, H1, a1-adrenergic
• Highest level of cardio-metabolic s/e - weight gain, insulin resistance, triglyceride

levels

• Olanzapine Indications r/t mood

Answer: Improves mood not only in schizophrenia but also in Bipolar disorder and in treatment resistant depression. Especially with addition of Fluoxetine

• Quetiapine Chem Structure

Answer:

Serotonin 5HT2A and D2 Dopamine antagonist Not potent binding at D2 receptor H1 biding - enhance sleep especially with M1 and A1 adrenergic

• Quetiapine Different Dosing Formulations

Answer:

IR immediate vs. XR extended release 300mg IR- least effective dose for antipsychotic (it will occupy D2 at 60% but quickly decreases due to hitting peak quickly (a few hours) requires multiple doses XR - slowly hit its peak, yet rapid enough for the 60% D2 binding Max Dose - 800mg IR form will only occupy D2 receptors for about 12 hours above the 60% threshold Max Dose - 800mg XR maintains fully effective d2 occupancy x 24 hours, has less peak dose sedation and not an ideal hypnotic due to delayed release

10. Quetiapine different doses different actions:

Answer:

Papa Bear - 800mg XR = antipsychotic Mama Bear - 300mg XR = antidepressant Baby Bear - 50mg IR = sleeping

• Quetiapine FDA Approved for

Answer: Bipolar depression and augmentation with SSRI/SNRI in unipolar

depression

• Neurotransmitters

Answer: Chemicals that transmit signals across a junction "synapse" from one neuron to another 'target' neuron

• Where are neurotransmitters stored?

Answer: vesicles 2 / 4

• Full Agonist

Answer: mimics the effect of the neurotransmitter

• Partial Agonist

Answer: Mimic physiologic actions to a lesser degree

-Some affinity but only moderate intrinsic activity -Also referred to as "agonist-antagonist"

• Antagonist

Answer: blocks the effect a neurotransmitter

• inverse agonist

Answer: chemical substance that produces effects opposite those of a particular

neurotransmitter

• Serotonin Chemical Structure

Answer:

5-HT - hydroxytriptamine Has 7 5HT receptors

• serotonergic drugs have a wide range of functions

Answer: DOMAINS

• Serotonin effects much "DOMAINS"

Answer:

D for depression -mood regulation O is for Obsession serotonin regulates obsessive thoughts, behavior-requires higher dosage than depression doses M is for Migraines - serotonin receptors in brain abort a migraine A is Anxiety - SSRIs treat I is for Intestines - 90% of serotonin in the gut, it drives motility N is Nausea - block serotonin effective at preventing nausea (zofran) S is sexual side effects

• Serotonin Syndrome

Answer:

Shits and SHIVERS Shits is for diarrhea S is for shivering - fairly unique symptom H is for Hyperreflexia (overactive) and myoclonus (quick, involuntary muscle jerk) Increased temperature 3 / 4

Vital sign instability - HR, BP, RR Encephalopathy (decreased LOC) Restlessness Sweating is an autonomic response

• a. Latuda FDA approved for
• Off Label For

Answer: Schizophrenia age 13 and older, Bipolar Depression

• Treatment resistant depression
• mixed manic episode

• 1. Review the Contra/Adverse for pharmacological therapy for a patient on a

stimulant medication(s) for ADHD. (p. 747) Answer: c. CONTRAINDICATIONS: Do not rx methylphenidate in patients with marked anxiety, tension or agitation, glaucoma or hx of tics/Tourettes. Pre-existing cardiovascular disease, moderate/severe HTN, hyperthyroidism, or hx of substance abuse.

d. ADVERSE REACTIONS:

• Cardiovascular palpitations, tachycardia, HTN, arrhythmias
• GI Change in appetite, N/V
• Neurological HA, insomnia, seizure activity
• Growth retardation
• Stimulant Medications - One doesn't show efficacy over another.
• Methylphenidate (Ritalin/Concerta)
• Dextroamphetamine (Dexedrine)
• Amphetamine/dextroamphetamine (Adderall)

• Which dementia type has a relatively quick onset?

Answer: Delirium

• Which following type of dementia is characterized by early changes in

behaviors vs. impairments in memory?

Answer: Fronto-temporal dementia

• Which dementia is characterized by early persistent visual hallucinations, early

fluctuations in cognition and attention and EPS?

Answer: LBD

• Which is the following dementias are characterized by Parkinson-like

movements?

Answer: LBD Lewey Body Dementia

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