What is the strongest established risk factor for bipolar disorder? Family History
Response Feedback: “The strongest established risk factor for BPD is
... [Show More] 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? Atomoxetine
NURS 6630 WEEK 6 MIDTERM EXAM SOLUTIONS
Response
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 15
It 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?
. Quetiapine
i. 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 he [Show Less]