Question 1
Which drug below has an interaction with cigarette smoking and should be adjusted
based on patient’s tobacco
... [Show More] use/non-use?
Response
Feedback:
“Clozapine blood levels are significantly lowered by cigarette
smoking and by other hepatic enzyme-inducers.”
Question 2
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 3
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 4
Which of the following are NOT primary target(s) symptom for antipsychotic agents in
schizophrenia?
i. Depression, anxiety, demoralization, suicidality, excitability, and agitation
ii. Delusions, hallucinations, disorganized thoughts
iii. Affective flattening, alogia, avolition, anhedonia, social withdrawal
iv. Attention, memory, and executive functions
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 5
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
NURS 6630N MIDTERM EXAM EXPLAINED
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 6
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 7
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 8
Which anticonvulsant below induces its own metabolism over time?
Question 9
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 10
Which of the following medications are known as selective serotonin re-uptake inhibitors
(SSRIs)?
i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
Question 11
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?
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 12
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 13
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 14
Of 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 15
What is the therapeutic plasma level of carbamazepine?
Question 16
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 17
Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.
Response
Feedback:
under pharmacokinetics and pharmacod [Show Less]