NR546 WEEK 6 2024 ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS
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Substance Use Disorder - ANSWEROccurs when the recurrent use of a substance, such
as alcohol or drugs, causes clinically significant impairment, including health problems,
disability, or failure to meet responsibilities at home, work, or school.
When does drug use typically begin? - ANSWERAdolescence
Common Comorbidities of substance use disorder - ANSWERAnxiety disorders
depression
bipolar disorder
psychotic illness
borderline personality disorder
antisocial personality disorder
Neurological basis: Genetic factors of SUD - ANSWER40-60% of a client's vulnerability to
substance use disorders may be attributed to genetic factors
Vulnerability involves complex interactions between multiple genetic factors/.
Genetic involvement may impact an individual's experience of a drug as pleasurable or
not or how long a drug remains in the body.
Epigenetic factors in SUD` - ANSWERinfluence whether genes associated with substance
use disorder are activated
Neurological Basis: Neuroanatomy in SUD - ANSWERBrain circuits that mediate reward,
impulse control, decision making, learning, and emotions play a role in substance use
disorder.
,Mesolimbic Dopamine pathway in SUD - ANSWERhas been identified as the key pathway
that mediates reward.
Connects the ventral tegmental area of the midbrain to the ventral striatum of the basal
ganglia.
The pathway begins in the ventral tegmental area (VTA) and connects to the ventral
striatum/nucleus
Neurobiological Basis: Neural Networks - ANSWERMesolimbic pathway is most
associated with reward. Drugs and alcohol act directly on brain receptors leading to a
release of dopamine.
As substance use increases, brain circuits adapt by reducing sensitivity to dopamine,
leading to tolerance and the need to increase use of a substance to achieve the same
high.
Neurological Basis: Neural Signaling - ANSWERDopamine is responsible for regulating
the brain's motivation, pleasure, and reward center.
Dopamine is release in response to natural pleasurable activities or situations such as
achieving an accomplishment, enjoying a good meal. or participating in an athletic
activity. Addictive drugs cause a surge of dopamine in the ventral striatum or nucleus
accumbens.
Repeated use can lead to changes in brain circuitry leading to craving, addiction,
dependence, withdrawal.
What neurotransmitter is the target when treating SUD? - ANSWERDopamine.
Tolerance - ANSWERWith repeated ingestion of a drug, the drug shows decreased effect.
Increasing doses are required to achieve the effects noted with the original
administration
,Dependence - ANSWERState of adaption produced with repeated administration of
certain drugs so that physical symptoms occur when the drug is discontinued abruptly.
Addiction - ANSWERA change in behavior caused by biochemical changes in the brain
after continued substance use characterized by preoccupation with and repeated use of
a substance despite negative outcomes.
Withdrawal - ANSWERPhysiological and psychological reactions that occur when the
use of a substance is stopped abruptly.
Intoxication - ANSWERCondition following the ingestion of a substance resulting in
changes in level of consciousness, cognition, perception, judgement, and behavior.
Treatment - ANSWERThe PMHNP must ascertain what substance the client is using, how
much and how often the substance is used, and when the substance was last ingested to
determine the most appropriate course of treatment.
Treatment is different when a client is actively using vs during withdrawal, following
detoxification, and abstinence.
Tolerance and dependence impact treatment decisions, sometimes necessitating
increased medication dosing.
Medication Assisted Therapy (MAT) - ANSWERclients use prescription medications as
part of a treatment plan for SUD. Substitutes the drug of abuse for the prescribed
medication that targets the same receptor as the preferred substance.
Can reduce cravings, improve relapse rates, reduce mortality from overdose, and
increase the likelihood of abstinence either alone or in combination with with
psychosocial interventions. Most prescribed for opioid use disorder but may also be
used for clients with alcohol or tobacco use disorder.
Goals of MAT - ANSWERImproved Survival
Improved treatment retention
, Decreased illegal activity
Increased Quality of Life
Improved birth outcomes in people who use substance while pregnant
Reduced HIV and Hep B&C infections
Impulsive/Compulsive Disorders - ANSWEROther mental health disorders shar similar
neurobiological characteristics with substance use disorders.
Pharmacological management for Obesity - ANSWERPhentermine or
phentermine/topiramate
Bupropion or bupropion/naltrexone
lorcaserin
zonisamide
Pharmacological management for Anorexia Nervosa - ANSWEROlanzapine may lead to
modest weight gain
Pharmacological management for Bulimia Nervosa - ANSWERHigh dose fluoxetine
Pharmacological Management for Binges Eating Disorders - ANSWERLisdexamfetamine
Topiramate
Bupropion
What medication do you avoid in individuals with anorexia nervosa and bulimia nervosa
and why? - ANSWERAvoid bupropion as it lowers the seizure threshold in these patients
putting them at risk for new onset seizures.
Opioid Use Disorder - ANSWERChronic Use of opioids that causes clinically significant
distress or impairment
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