NURS-6630N,Approaches to Treatment.2020

NURS-6630N,Approaches to Treatment.2020 Review Test Submission: Midterm Exam - Week 6 User Smiles Smiler Smillest Course NURS-6630N,Approaches to Treatment.2020 Winter Qtr 11/30-02/21 Test Midterm Exam - Week 6 Sta ...

NURS-6630N,Approaches to Treatment.2020 Review Test Submission: Midterm Exam - Week 6 User Smiles Smiler Smillest Course NURS-6630N,Approaches to Treatment.2020 Winter Qtr 11/30-02/21 Test Midterm Exam - Week 6 Started 1/8/21 Submitted 1/9/21 Due Date 1/11/21 Status Completed Attempt Score 64 out of 100 points Time Elapsed 2 hours, 29 minutes out of 2 hours and 30 minutes Results Displayed Feedback • Question 1 What is the strongest established risk factor for bipolar disorder? Family History Response Feedback: “The strongest established risk factor for BPD is a family history of BPD.” • Question 2 Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i. Nortriptyline ii. Citalopram iii. Duloxetine iv. Fluoxetine v. Venlafaxine vi. • Question 3 Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization as well as worse overall quality of life? Schizophrenia Response Feedback: “Moreover, non-adherent patients with schizophrenia are at greater risk for substance use, violence, and victimization as well as worse overall quality of life.” • Question 4 Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? AtomoxetineResponse Feedback: (Options C & D are both TCA antidepressants and, based on the patient’s age and comorbid conditions, a TCA would likely result in more side effects, such as increased fall risk due to potential for orthostatic hypotension and anticholinergic-related side effects. In addition, patient has a history for cardiac abnormalities due to A. fib diagnosis - TCAs result in electrocardiographic changes in susceptible individuals, therefore, would likely avoid. Choice B is used more for ADHD purposes than as an antidepressant) Page numbers used: Page 39 for TCA side-effect profile • Question 5 Which of the following is an appropriate strategy for managing treatment-resistant depression? Use both SSRI and SNRI • Question 6 Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? Response Feedback: “As noted previously, antidepressants may contribute to an increase in mood episode frequency.” • Question 7 With second-generation antipsychotics, what is the main side effect that requires frequent monitoring? Response Feedback: table 7-6 & page 80, table 7-7; Page 78: “However, attention over the past decade has focused on effect of second-generation antipsychotics on glucose metabolism and lipids and associated metabolic syndrome.” • Question 8 Which amino acid is involved in the synthesis of both norepinephrine and dopamine? • Question 9 An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects? Response Feedback: Only TCA is listed with most anticholinergic effects; Page 39 for TCA side effect profile: “dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia, memory difficulties, and ejaculatory difficulties” • Question 10 Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder?Response Feedback: “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may have reduced the alcohol use as well” • Question 11 M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.? I. Duloxetine II. Quetiapine III. Diazepam IV. Escitalopram V. Response Feedback: “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally considered first-line agents for the treatment of GAD because of their favorable side effect profile….” • Question 12 The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized? Response Feedback: under serotonin subheading and figure 1-18 on page 16: Locus Coeruleus: Norepinephrine Nucleus basalis: cholinergic neurons Substantia Nigra: dopamine Ventral Tegmental area: dopamine • Question 13 Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder? Response Feedback: “Psychosis is not represented in the diagnostic features for BPD.” - “Psychosis typically resolves along with the mood symptoms, though diagnostic criteria acknowledge that psychotic symptoms may linger beyond the end of the episode.” • Question 14 A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend? Response Feedback: under selective serotonin re-uptake inhibitors discontinuation syndrome subtitle: “The risk of such adverse events occurring seems to be inversely related to the half-life of the SSRI, with fluoxetine reported as having a significantly lower risk than paroxetine in two studies. For more severe discontinuation-related adverse events, re-institution of the SSRI and slow taper may be necessary to alleviate these symptoms.” • Question 15It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder. Response Feedback: “Lamotrigine has also been extensively studied in bipolar depression as well….” • Question 16 Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder? . Depakote i. Lamotrigine ii. Topiramate iii. Carbamazepine iv. Gabapentin v. Response Feedback: All the others listed except for lamotrigine are not used in treatment of bipolar disorder. • Question 17 A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning? Response Feedback: “In 2004, the FDA asked manufacturers of almost all the new antidepressant drugs to include in their labeling a warning statement that recommends close observation of adult and pediatric patients treated with these drugs for worsening depression or the emergence of suicidality." • Question 18 Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotoninnorepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? Response Feedback: “Because the SSRI/SNRIs have the potential to cause initial restlessness, insomnia, and increased anxiety, and because the patients are commonly sensitive to somatic sensations, the starting doses should be low, typically half (or less) of the usual starting dose….” • Question 19 Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression? Response Feedback: “Combination of an SSRI OR an SNRI with a norepinephrine-dopamine re-uptake inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or mianserin) is a commonly used combination” • Question 20 Which atypical antipsychotic(s) require a meal for better absorption? . Quetiapinei. Ziprasidone ii. Asenapine iii. Olanzapine iv. Lurasidone v. Response Feedback: - Ziprasidone – best with a fatty meal - Lurasidone – best with a meal of at least 350 calories (no effect of fat composition) • Question 21 Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY. Response Feedback: under pharmacokinetics and pharmacodynamics subtitle - “NSAIDs or other COX-2 inhibitors may decrease renal blood flow and thereby increase lithium levels by up to 25%.” - “Therefore, thiazide diuretics, which act distally, will tend to increase lithium levels by up to 50% while those that act more proximally generally have less of an effect on lithium levels.” • Question 22 Which of the following are NOT primary target(s) symptom for antipsychotic agents in schizophrenia? . Depression, anxiety, demoralization, suicidality, excitability, and agitation i. Delusions, hallucinations, disorganized thoughts ii. Affective flattening, alogia, avolition, anhedonia, social withdrawal iii. Attention, memory, and executive functions iv. Response Feedback: “For schizophrenia, the primary target symptoms for antipsychotic agents fall into three categories: psychotic symptoms (e.g., hallucinations, delusions, disorganization); agitation (e.g., distractibility, affective lability, tension, increased motor activity); and negative symptoms (e.g. apathy, diminished affect, social withdrawal, poverty of speech.” AND “Although cognitive deficits are an important contributor to disability in schizophrenia, cognitive deficits usually are not considered a target for antipsychotic agents because they are not very responsible to current agents.” • Question 23 Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure, agranulocytosis, and seizures? Response Feedback: Box 7-5 * indicated clozapine-specific black box warnings • Question 24 Which neurotransmitter is considered the major inhibitory neurotransmitter? • Question 25 A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to her whole body. She has a past medical history significant for type 2 diabetes,hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash? • Question 26 Glia cells play a supportive role in the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia or macroglia. Of the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered? • Question 27 Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia? Response Feedback: “Notably, pharmacovigilance studies suggest that atypical antipsychotics may increase stroke risk among older patients, particularly those with dementia, so use of SGA requires more caution in this group.” • Question 28 Which of the following receptors below would likely result in extra-pyramidal symptoms, tardive dyskinesia, and hyperprolactinemia? Response Feedback: first generation antipsychotics all share the common property of D2 blockade, which can produce EPS, TD, and hyperprolactinemia • Question 29 Which anticonvulsant below induces its own metabolism over time? • Question 30 K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response? Response Feedback: “It has been consistently observed and reported that remission of depression often requires 4 weeks of treatment or more;” Page 33: “Use of antidepressant for at least 6– 12 weeks to determine whether it is helping or not” • Question 31 Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations.Response Feedback: Which drug below has an interaction with cigarette smoking and should be adjusted based on patient’s tobacco use/non-use? • Question 32 K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy? Response Feedback: “Therefore, in treatment-responders, most experts favor a continuation of antidepressant therapy for a minimum of 6 months following the achievement of remission.” • Question 33 Close-ended questions will help identify when patients are taking medications incorrectly. • Question 34 K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.? Response Feedback: “The regular use of benzodiazepines for more than 2 to 3 weeks may be associated with physiological dependence and the potential for significant withdrawal symptoms with discontinuation. Discontinuation of benzodiazepines is best done with a gradual taper to minimize withdrawal symptoms.” - Answer choice A: Honor the patient’s request of discontinuing the medication. - Answer Choice C: An abrupt stop of a benzodiazepine will likely send the patient into having withdrawal symptoms. - Answer D: Patient will likely experience withdrawal symptoms due to how often the patient uses it OR patient will experience withdrawal symptoms after missing one dose, thus the therapy wouldn’t have changed at all from how she has been taking it. • Question 35 Which answer choice includes all the components of patient-focused interventions to enhance adherence? . Education I. Motivation II. Skills III. Logistics IV. • Question 36 Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)? . LithiumI. Fluoxetine II. Aripiprazole III. Risperidone IV. Ziprasidone V. Venlafaxine VI. Quetiapine VII. Valproate VIII. • Question 37 Which drug below has an interaction with cigarette smoking and should be adjusted based on patient’s tobacco use/non-use? Response Feedback: “Clozapine blood levels are significantly lowered by cigarette smoking and by other hepatic enzyme-inducers.” • Question 38 In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor? • Question 39 When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium? • Question 40 Choose the appropriate pair regarding acetylcholine receptors. Response Feedback: “There are two classes of ACh receptors: muscarinic and nicotinic. While muscarinic receptors are G-protein-coupled, nicotinic receptors are ion channels, which allows for rapid influx of NA+ and Ca2+ into the post-synaptic neuron.” • Question 41 Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient? Response Feedback: “Other bothersome adverse effects” Patient is likely experiencing lithium toxicity and labs should be verified first before continuing with other treatments for the tremor. • Question 42 Choose the appropriate statement regarding lamotrigine dosing.Response Feedback: Carbamazepine induced metabolism of lamotrigine – increase dose of lamotrigine; Valproate may inhibit clearance of lamotrigine, so dose reduction of lamotrigine is needed • Question 43 Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway Response Feedback: “GABAB receptors, akin to the metabotropic glutamate receptors, are G-protein-coupled receptors rather than ion channels. Activation of GABAB causes downstream changes in potassium (K+) and Ca+2 channels, largely via G-protein-mediated inhiation of cAMP.” • Question 44 A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient? Response Feedback: “Valproic acid may produce teratogenic effects.” • Question 45 How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic? • Question 46 The following patient case is considered an example of treatment-resistant depression. B. B. is a 26-year old-female at your clinic today with the diagnosis, “treatment-resistant depression.” She is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in depressive symptoms. She has trialed the following medications in the past with treatment duration listed: - Paroxetine 40 mg daily for 4 weeks - Citalopram 20 mg daily for 2 weeks Response Feedback: “At least one trial with an antidepressant with established efficacy in MDD (with sufficient duration and doses) is considered to be adequate antidepressant treatment.” • Question 47 What is the therapeutic plasma level of carbamazepine? • Question 48Of the following medications used in the treatment of social anxiety disorder, which one would you AVOID in a patient who has uncontrolled hypertension? Response Feedback: Phenelzine reported to have hypertensive reactions as a limitation/primary side effect • Question 49 M. M. is 27-year-old female student pharmacist who presents to the ER after experiencing extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms? Response Feedback: “The use of beta-blockers may be associated with orthostatic hypotension, lightheadedness, bradycardia, and nausea.” • Question 50 Which drug below differs from other atypical antipsychotics in causing persistent hyperprolactinemia? Response Feedback: “Risperidone differs from other second-generation antipsychotics in causing persistent hyperprolactinemia.” • Question 51 When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?My answers to some of the questions – Some Right some wrong What is the strongest established risk factor for bipolar disorder? A. Female > Male B. Family history of bipolar disorder C. Male > female D. Being diagnosed with Major Depressive Disorder Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i. Nortriptyline ii. Citalopram iii. Duloxetine iv. Fluoxetine v. Venlafaxine A. i, iii, and v only B. iii and v only C. i only D. ii and iv only E. i, ii, iii, iv, and v Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization as well as worse overall quality of life? a. Parkinson’s Disease b. Multiple Sclerosis c. Schizophrenia d. Major depressive disorder Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? A. FluoxetineB. Atomoxetine C. Nortriptyline D. Imipramine With second-generation antipsychotics, what is the main side effect that requires frequent monitoring? A. Metabolic Syndrome B. Extra-pyramidal symptoms C. Parkinsonism D. Dystonia Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? A. Valproate, because it is only used in the treatment of acute manic episodes. B. Lithium, because it is only used in the treatment of acute manic episodes. C. Venlafaxine, because it can possibly increase frequency of mood episodes. D. Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance. Which of the following is an appropriate strategy for managing treatment-resistant depression? A. Switch from one SSRI to another SSRI B. Switch from one SSRI to a SNRI C. Combine two antidepressants with different mechanisms of action D. Augment with lithium E. Any of the above would be an appropriate strategy Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? A. FluoxetineB. Atomoxetine C. Nortriptyline D. Imipramine Which amino acid is involved in the synthesis of both norepinephrine and dopamine? a. Tyrosine b. Glutamic acid c. Tryptophan d. Phenylalanine An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects? A. Escitalopram B. Duloxetine C. Bupropion D. Nortriptylin Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder? A. Citalopram B. Paroxetine C. Sertraline D. Sertraline The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?a. Locus Coeruleus b. Raphe Nuclei c. Nucleus Basalis d. Substantia Nigra e. Ventral Tegmental Area Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder? i. Depakote ii. Lamotrigine iii. Topiramate iv. Carbamazepine v. Gabapentin A. i and ii B. ii and iv C. i and iv D. iii and v Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotoninnorepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? A. Symptom remission is expected within 1 week. B. Symptoms may worsen initially with SSRI treatment. C. They are considered second-line therapy. D. Start at the usual starting dose that is consistent with depression treatment. A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning? A. Myocarditis B. Sexual dysfunction C. Decreased seizure threshold D. Suicidal thinking and behaviorWhich of the following statements below is NOT considered an appropriate treatment strategy for treatmentresistant depression? A. Sertraline + Bupropion B. Fluoxetine + Venlafaxine C. Desvenlafaxine + Bupropion D. Fluoxetine + Mirtazapine Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotoninnorepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? A. Symptom remission is expected within 1 week. B. Symptoms may worsen initially with SSRI treatment. C. They are considered second-line therapy. D. Start at the usual starting dose that is consistent with depression treatment. Which atypical antipsychotic(s) require a meal for better absorption? i. Quetiapine ii. Ziprasidone iii. Asenapine iv. Olanzapine v. Lurasidone A. I and V B. II and V C. III and V D. V only Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY. A. Ibuprofen – decrease lithium levels B. Hydrochlorothiazide – decrease lithium levels C. Naproxen – increase lithium levels D. Chlorthalidone – increase lithium levelsOf the following antipsychotic medications listed below, which one has a Black Box Warning for seizure, agranulocytosis, and seizures? A. Quetiapine B. Clozapine C. Olanzapine D. Lurasidone Which neurotransmitter is considered the major inhibitory neurotransmitter? a. Glutamate b. Glycine c. GABA d. Acetylcholine A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to her whole body. She has a past medical history significant for type 2 diabetes, hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash? A. Ziprasidone B. Quetiapine C. Risperidone D. Lamotrigine Glia cells play a supportive role in the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia or macroglia. Of the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered?a. Astrocytes b. Oligodendrocytes c. Schwann cells d. Ependymal cells Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia? A. Carbamazepine B. Lithium C. Bupropion D. Olanzapine K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response? A. 2–4 weeks B. 4–12 weeks C. ≥ 6 months D. ≤ 1 week Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations. A. True B. False K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy? A. ≥ 12 months B. 3 months C. ≥ 6 monthsD. 4–12 weeks Close-ended questions will help identify when patients are taking medications incorrectly. a. True b. False K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.? A. Inform her that the therapy is working and there is no need to discontinue. B. Begin a slow taper of clonazepam and talk about alternative medications to help with her new diagnosis. C. Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily. D. Change her scheduled dosing to as needed to help with anxiety symptoms. Which answer choice includes all the components of patient-focused interventions to enhance adherence? I. Education II. Motivation III. Skills IV. Logistics a. I, II, and III only b. I, II, III, and IV c. II and III only d. I and IV only When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium? A. 5 days; 0.6 to 0.8 mEq/L B. 4–6 weeks; 0.6 to 0.8 mEq/L C. 3 days; 0.8 – 1.2 mEq/L D. No need to check until patient experiences symptoms of lithium toxicityWhich of the following receptors below would likely result in extra-pyramidal symptoms, tardive dyskinesia, and hyperprolactinemia? A. 5-HT2 agonism B. D2 agonism C. D2 antagonism D. 5-HT2 antagonism Hello, I have identified the correct answers in bold. Kindly look at them, I hope they will be of help to you Explanation: Which of the following is an appropriate strategy for managing treatment-resistant depression? A.Switch from one SSRI to another SSRI B.Switch from one SSRI to a SNRI C.Combine two antidepressants with different mechanisms of action D.Augment with lithium E.Any of the above would be an appropriate strategy Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? A.Valproate, because it is only used in the treatment of acute manic episodes. B.Lithium, because it is only used in the treatment of acute manic episodes. C.Venlafaxine, because it can possibly increase frequency of mood episodes. D.Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance. With second-generation antipsychotics, what is the main side effect that requires frequent monitoring? A.Metabolic Syndrome B.Extra-pyramidal symptoms C.Parkinsonism D.Dystonia Which amino acid is involved in the synthesis of both norepinephrine and dopamine? a.Tyrosine b.Glutamic acid c.Tryptophan d.PhenylalanineWhich drug below differs from other atypical antipsychotics in causing persistent hyperprolactinemia? A.Clozapine B.Risperidone C.Aripiprazole D.Olanzapine M. M. is a 27-year-old female student pharmacist who presents to the ER after experiencing extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms? A.Tranylcypromine B.Clonazepam C.Propranolol D.Fluoxetine Of the following medications used in the treatment of social anxiety disorder, which one would you AVOID in a patient who has uncontrolled hypertension? A.Citalopram B.Lorazepam C.Phenelzine D.Atenolol What is the therapeutic plasma level of carbamazepine? A.4 to 12 µg/mL B.4 to 12 mg/mL C.0.8-1.2 mEq/mL D.0.6 to 0.8 mEq/L The following patient case is considered an example of treatment-resistant depression. B. B. is a 26-year old-female at your clinic today with the diagnosis, "treatment-resistant depression." She is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in depressive symptoms. She has trialed the following medications in the past with treatment duration listed: - Paroxetine 40 mg daily for 4 weeks - Citalopram 20 mg daily for 2 weeks A.True B.False How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic? A.Stop offending agent B.Initiate Dantrolene C.Both A & B D.None of the aboveA 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient? A.The drug causes weight gain, therefore, I would likely not want patient on it for her disease state. B.This drug is safe to use by this patient. C.This drug is used more for seizures than bipolar disorder, therefore, I would want to look at other options first. D.This drug is a teratogen, therefore, I would need to counsel on avoidance of this medication while trying for a baby, and to follow-up with the doctor who prescribed it. Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway a.GABAA - ionotropic - calcium and potassium b.GABAB - ionotropic - chloride c.GABAB - metabotropic - Calcium and potassium d.GABAA - metabotropic - chloride Choose the appropriate statement regarding lamotrigine dosing. A.If adding carbamazepine decrease lamotrigine dose B.If adding valproic acid decrease lamotrigine dose C.If adding carbamazepine no dose change is needed D.If adding valproic acid no dose change is neeed Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient? A.Start propranolol for the tremor. B.Tell patient to cut dose in half to stop the tremor. C.Verify labs to determine appropriate lithium level. D.Tell patient to discontinue the medication all together due to lithium toxicity. Choose the appropriate pair regarding acetylcholine receptors. a.Nicotinic - ion; muscarinic - ion b.Nicotinic - G-protein; muscarinic - ion c.Nicotinic - G-protein; muscarinic - G-protein d.Nicotinic - ion; muscarinic - G-protein e.None of the above is correct When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium?A.5 days; 0.6 to 0.8 mEq/L B.4-6 weeks; 0.6 to 0.8 mEq/L C.3 days; 0.8 - 1.2 mEq/L D.No need to check until patient experiences symptoms of lithiu In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor? a.Sodium - ionotropic b.Sodium - metabotropic c.Magnesium - metabotropic d.Magnesium - ionotropic Which drug below has an interaction with cigarette smoking and should be adjusted based on patient's tobacco use/non-use? A.Risperidone B.Haloperidol C.Aripiprazole D.Clozapine Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)? 1. Lithium 2. Fluoxetine 3. Aripiprazole 4. Risperidone 5. Ziprasidone 6. Venlafaxine 7. Quetiapine 8. Valproate A.II, III, and VIII only B.I, III, IV, V, VII, and VIII only C.II, III, and VI only D.I only E.All that are listed are appropriate in treating the acute episode. Which answer choice includes all the components of patient-focused interventions to enhance adherence? 1. Education 2. Motivation 3. Skills 4. Logistics a.I, II, and III onlyb.I, II, III, and IV c.II and III only d.I and IV only K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.? A.Inform her that the therapy is working and there is no need to discontinue. B.Begin a slow taper of clonazepam and talk about alternative medications to help with her new diagnosis. C.Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily. D.Change her scheduled dosing to as needed to help with anxiety symptoms. Close-ended questions will help identify when patients are taking medications incorrectly. a.True b.False K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling "great" and that his relationship with his girlfriend is "better than ever now." Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy? A.≥ 12 months B.3 months C.≥ 6 months D.4-12 weeks Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations. A.True B.False Answer:1:- Initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium? A).5 days; 0.6 to 0.8 mEq/L. Answer:2:- In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion. a). Sodium - ionotropicAnswer:3:- drug below has an interaction with cigarette smoking and should be adjusted based on patient's tobacco use/non-use. d). Clozapine. Answer:4:- ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy. B). I, III, IV, V, VII, and VIII only Answer:5:- choice includes all the components of patient-focused interventions to enhance adherence. d). I and IV only Answer:6:- Discontinue the medication. What is the appropriate next step to help K. T. B). Begin a slow taper of clonazepam and talk about alternative medications to help with her new diagnosis. Answer:7:- Close-ended questions will help identify when patients are taking medications incorrectly. a.True. Answer:8:- How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy: A). ≥ 12 months Answer:9:- Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations.