NSG 552 EXAM 2 Wilkes University ACTUAL EXAM QUESTION AND VERIFIED ANSWERS WITH RATIONALES GRADED A+100% What is agoraphobia and how can it be treated? - ✔✔ANSW✔✔intense fear of being in public pleases where escape or obtaining help may be difficult Treat with CBT and SSRI What is narcolepsy? - ✔✔ANSW✔✔excessive daytime sleepiness and falling asleep in inappropriate places; cataplexy, hallucinations and/or sleep paralysis at the beginning or end of sleep episodes What is catplexy? - ✔✔ANSW✔✔brief episodes of su dden bilateral loss of muscle tone what is the etiology of narcolepsy? - ✔✔ANSW✔✔loss of hypothalamic neurons that produce hypocretin How is narcolepsy managed? - ✔✔ANSW✔✔sleep hygiene, scheduled daytime naps, avoid shift work Amphetamines (D -amphetamine , methamphetamine) Modafinil (Provigil) - first line pharmacologic treatment - CNS stimulant which promotes wakefullness What is the drug of choice for cataplexy? - ✔✔ANSW✔✔Sodium oxalate - avoid use with alcohol or other CNS depressants TCA - imipramine ( Tofranil), desipramine (Norpramin), clomipramine (Anafranil) What are REM suppression drugs? - ✔✔ANSW✔✔SSNI - fluoxetine (Prozac), SNRI - duloxetine (Cymbalta), atomoxetine (Strattara), venlafaxine (Effexor) Do non -benzo hypnotics affect REM sleep - ✔✔ANSW✔✔Non-benzo hypnotics DO NOT affect REM sleep What is a problem found with OTC sedative/hypnotics? - ✔✔ANSW✔✔tolerance to sedating effects can develop rapidly Describe Ramelteon (Rozerem) - ✔✔ANSW✔✔Selective melatonin (MT1 and MT2) agonist that is effective and safe sleep aid due to no tolerance or dependance It DOES NOT act on benzo receptors What are non -pharmacological interventions for sleep apnea - ✔✔ANSW✔✔weight loss, avoidance of alcohol, CPAP, uvulopalatopharyngoplasty What are the characteristics of restless leg syndrome (RLS)? - ✔✔ANSW✔✔urge to move legs accompanied by unpleasant sensations in the legs relief with movement, aggravation with inactivity worse in the evening 1.5-2 times more likely in males What are the risk factors for RLS? - ✔✔ANSW✔✔age, iron deficiency, antidepressants (activating type - Effexor), antipsychotics, dopamine blocking antiemetic, antihistamines, strong familial component What is the treatment for RLS? - ✔✔ANSW✔✔remove offending agent, replace iron What are first -line medications for RLS? - ✔✔ANSW✔✔Dopamine agonists - pramipexole (Mirapex) and ropinirole (requip) Benzodiazepines Gabapentin (Neurontin) - anticonvulsant pregabalin (Lyrica) - antiepileptic Low potency opioids for treatment refractory patients What treatment is used for generalized anxiety disorder - ✔✔ANSW✔✔First line - SSRI Second line - Buspar (anxiolytic), SNRI Can consider short term course of benzos or augmentation with buspirone (Buspar) SSRI - escitalopram (Lexapro), paroxetine (Paxil), SNRI - duloxetine (Cymbalta), venlafaxine (Effexor) What is used to treat panic at tacks? - ✔✔ANSW✔✔initially use benzos short term What is used to treat panic disorder? - ✔✔ANSW✔✔First line - SSRI, SRNA Second line - TCAs, though limited use Adjunct - benzo with caution, short -term until SSRIs reach therapeutic efficacy Alprazolam (Xanax ) is FDA approved SSRI - Fluoxetine (Prozac), Paxil (paroxetine), Zoloft (sertraline), SNRI - Effexor (venlafaxine) TCA - clomipramine (Anafranil), imipramine (Tofranil) What is social phobia and how is it treated? - ✔✔ANSW✔✔fear of scrutiny by others or fear of acting in humiliating or embarrassing way CBT
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