PMHNP-BC Exam for ANCC PMHNP Board Certification

Document Content and Description Below

PMHNP-BC Exam for ANCC PMHNP Board Certification Risk of Schizophrenia in monozygotic twins is? - ANSWER 46-50% Family hx risk of schizophrenia - ANSWER 10x risk with 1st degree relative brain change... s in schizophrenia - ANSWER increase in ventricular volume (enlarged cerebral ventricles) Hippocampus volume decrease, 4% smaller Decreased electrical activity in frontal lobes Decrease glutamate and GABA release. Decreased total brain volume functional neuroimaging findings of schizophrenia - ANSWER Abnormal function of frontal cortical regions Including for solo lateral prefrontal and anterior cingulate cortices Maximum dose of Celexa - ANSWER 40mg/day as higher doses can cause abnormal electrical activity of the heart. Some experts still prescribe higher What class of medication is bupropion - ANSWER NDRI boosts norepinephrine, noradrenaline, and dopamine neurotransmitters What hematologic change is associated with lithium? - ANSWER Leukocytosis. Lithium raises WBC counts. Monitor CBC GABA in terms of anxiety disorders - ANSWER Most abundant inhibitory neurotransmitter. Decreasing GABA would increase anxiety. Benzos are used to bind with GABA to potentiate the anxiolytic effects of GABA What to avoid while on Disulfiram - ANSWER Anything containing alcohol (vinegar, mouthwash, aftershave, cough medicine). Avoid for 2 weeks after discontinuing disulfiram. Lab effected by disulfiram that requires monitoring - ANSWER Disulfiram can elevate liver function tests A medication that can induce mania - ANSWER Corticosteroids What finding would be associated with an acoustic neuroma? - ANSWER Unilateral ringing in the ear (tinnitus) may be the first symptom of an acoustic neuroma. What delay is expected in a 4 year old with Asperger's? - ANSWER Delay in social skills development. Unlike autistic disorder, no significant delays in language, cognitive development, or age appropriate self help skills are observed. Primary clinical features of Asperger's - ANSWER Qualitative social impairment Markedly abnormal nonverbal communicative gestures Failure to develop peer relationships Lack of social or emotional reciprocity Impaired ability to express pleasure in other persons' happiness. Chlorpromazine (Thorazine) and clozapine cause what troublesome side effect due to their alpha 1-adrenergic blockade? - ANSWER Orthostatic hypotension. Manage by raising dose of chlorpromazine and clozapine slowly. What medication is strictly prohibited when the patient is on an MAOI such as selegiline due to the risk of hypertensive crisis and death? - ANSWER Meperidine (Demerol) Dopamine pathways in relation to clinical symptoms of schizophrenia - ANSWER Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. Facial characteristics of child with fetal alcohol syndrome - ANSWER Small head Short eyelid opening Flat midface Smooth philtrum Underdeveloped jaw Thin upper lip Short nose (Can also have inner epicanthal folds, short palpebral fissure) Physical features of prayer willi syndrome - ANSWER Obesity Small stature Small hands and feet Hypotonia Hypogonadism Physical features of von recklinghausen's disease - ANSWER Café au lait spots Neurofibromas In what condition is the use of bupropion contraindicated? - ANSWER Bulimia. Do not use bupropion in past or present eating disorders due to increased risk of seizures. Predominant risk factor of antisocial personality disorder? - ANSWER Genetic predisposition of first-degree family member. Antisocial personality disorder is 5X more common among first-degree relative of men with the disorder than the general population. Risk of inhibition of platelet aggregation (risk of bleeding from SSRIs, NSAIDS, ASA) is an example of this - ANSWER Pharmacodynamics Rare but serious side effect of trazodone (Desyrel) - ANSWER Priapism arcus senilis (gray opaque band in the cornea) prior to age 40 is associated with what disorder? - ANSWER Hyperlipidemia Asians are poor metabolizers of which enzyme? (Will have exaggerated response to diazepam) - ANSWER CYP 2C19 Side effects of oxcarbazepine (Trileptal) - ANSWER Excessive urination and thirst (can be distinguished from possible DM II if blood sugar is up but HGBA1C is normal. Dopamine antagonism in the tuberoinfundibular pathway can cause what side effect? (Antipsychotic drugs) - ANSWER Galactorrhea Which part of the brain modulates pain and can help explain how transcranial magnetic stimulation can help decrease pain? - ANSWER Prefrontal cortex When administering clock drawing test, if patient is unable to correctly draw the face of the clock, what area of the brain likely has compromised functioning? - ANSWER Right hemisphere. The right hemisphere is involved with recognition of facial expressions, music, and visual images. When compromised, there are disturbances in drawing. Classic symptoms of NMS - ANSWER Acute mental status change, muscular rigidity, autonomic instability How do you calculate BMI? - ANSWER Weight (lbs) / height (inches) / height (inches) X 703 What labs are needed when anorexia is suspected? - ANSWER CBC with diff, electrolytes, thyroid panel, urinalysis Inverse agonist effect - ANSWER Causes the opposite effect of agonist, and causes the receptor to close the ion channel Acute dystonia in the eyes - ANSWER Oculogyric crisis. Eyes roll up. Treat by discontinuing offending agent. Administer IM Cogentin (benztropine). Not as common with atypicals as with first generation antipsychotics. Tardive dyskinesia (TD) onset - ANSWER Delayed onset. Involuntary movement disorder associated with antipsychotics. Insidious onset usually after 1-2 years of continuous exposure to antipsychotics. NMS Treatment - ANSWER Bromocriptine (Parlodel) dopamine receptor agonist to help decrease the dopamine blockade. Dantrolene (Dantrium) is a muscle relaxant. Anticholinergic drugs used for EPS - ANSWER Benztropine (cogentin) Trihexyphenidyl (Artane) Which CYP enzyme is implicated as a tobacco inducer? - ANSWER Smoking is a potent inducer of CYP1A2 enzyme activity, resulting in significant lower clozapine serum concentrations in smokers compared with non-smokers, upon a given dose. When on clozapine and a smoker, a higher dose may be needed. If they quit smoking, clozapine levels will rise, so dose reduction will be required. Lamotrigine - ANSWER Most associated with life threatening rash Where is Norepinephrine produced? - ANSWER locus coeruleus. Also in the medullary reticular formation. Which brain structure is activated in patients with severe anxiety? - ANSWER Amygdala. Important in mediation of fear, anxiety, and panic. Lithium causes what birth defect? - ANSWER Ebstein's anomaly (heart defect. Tricuspid valve isn't formed properly causing blood to leak back through into the right atrium). Neurodevelopment- what is most associated with risk taking behaviors in adolescent males? - ANSWER Maturation of the prefrontal cortex continues into mid-20's and early 30's. PFC acts to inhibit impulsive and motivational drives. Which serotonin receptors antagonism makes an antipsychotic [Show More]

Last updated: 2 years ago

Preview 1 out of 13 pages