Exam (elaborations)

Midterm Exam NR546 / NR 546 Advanced Pharmacology Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner Exam (Latest 2024 / 2025 Updates STUDY BUNDLE WITH COMPLETE SOLUTIONS) | 100% Correct | Grade A – Chamberlain

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Midterm Exam NR546 / NR 546 Advanced Pharmacology
Psychopharmacology for the Psychiatric-Mental Health
Nurse Practitioner Exam (Latest Updates
STUDY BUNDLE WITH COMPLETE SOLUTIONS) |
100% Correct | Grade A – Chamberlain

Tanrıkulu and Erbaş (2020) investigated identical twins to determine the
presence of an inherited link for schizophrenia and why one twin may
develop schizophrenia when the other does not. When two people have
100% identical DNA, why don't both persons develop the exact illnesse s?
Studies of identical Danish twins found that if one twin had schizophrenia,
the other twin had a 50% lifetime risk of developing schizophrenia (Lemvigh
et al., 2020). Why is there only half the risk?
- ans -Both environmental and psychosocial stressors can impact mental
health. Although twins may have identical genes, their gene expression
may be different.

There may be an environmental exposure that turned a gene "on" that
should have been "off" for one twin to develop schizophrenia and not the
other.

dorsal striatum
- ans -involved in complex motor actions and linkage of cognition to motor
actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure

The field of epigenetics is rapidly growing and can help explain how gene
expression is: - ans -influenced by environmental factors and how
epigenetics contributes to the manifestation of mental illness

How does epigenetics impact a person's mental health?
- ans -internal or external factors activate portions of the genome that
result in the manifestation of mental health symptoms
-activation is often a result of a stressful event, which, when combined with
the genetic risk, results in the disease
-genes being on or off

,-occurrence of symptoms may be the result of inheritance of an abnormal
gene or of normal genes being "on" when they should be "off."

Types of epigenetic changes:
- ans -DNA Methylation
Histone modification
Non-coding RNA

The potential legal and ethical issues impacting mental health treatment
must also be taken into account, including:
- ans --informed consent
-competence to make healthcare decisions
-off-label prescribing

Informed consent
- ans -Clients have the right to receive enough information to make
decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be
forcibly medicated if they are violent toward themselves or others and when
less restrictive methods have failed

Compliance
- ans -A court order may be issued for a client to receive treatment against
their wishes if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive
capabilities or are incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws
and abiding by them.

Off-Label Prescribing
- ans -Some clients may benefit from the unapproved use of a drug for
symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA
approved for use in this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-
label prescribing.

,Incidence of mental illness-what factors are increasing the incidence
- ans -Psychological and sociological factors

Lifestyle factors such as a client's smoking status, diet, exercise, history of
medication adherence, or history of addiction should be considered when
prescribing psychotropic medications

Adherence
- ans -Persistence
-taking med over intended time period
Compliance
-taking med as prescribed

left hemisphere
- ans --speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing

right hemisphere
- ans --prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing

Pharmacokinetics - ans -the study of what happens to a drug from the time
of administration until the parent drug and all metabolites leave the body

CYP450
- ans -CYP450 enzymes in the gut wall or liver convert drug substrate into
a biotransformed product in the bloodstream, responsible for degradating of
a large # of psychotropic drugs

, -Not all ind. have same genetic form of CYP450 enzymes, determined with
pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major
CYP450 enzymes and are said to be "extensive metabolizers", most drug
doses are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra
rapid metabolizers

Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.

ultra rapid metabolizers
- ans -elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses

genotyping
- ans -the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used
to predict which patients might need to have dosage adjustments
-measurement of genes for drug metabolism

most common targets of psychotropic drugs
- ans -G-protein receptors
-Drug actions at these receptors occur in a spectrum, from full agonist
actions, to partial agonist actions, to antagonism, and even to inverse
agonism.

Pharmacokinetics concepts
- ans -absorption
distribution
metabolism
excretion

Flockhart Table - ans -drug interactions that are mediated by cytochrome
P450 enzymes

comprehensive list of drugs and the interactions related to the cytochrome
P450 system

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Exam (elaborations)

Midterm Exam NR546 / NR 546 Advanced Pharmacology Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner Exam (Latest 2024 / 2025 Updates STUDY BUNDLE WITH COMPLETE SOLUTIONS) | 100% Correct | Grade A – Chamberlain

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