PMHNP Study Set for ANCC Questions and Correct Answers, With Complete Solution. 338 Q&A. Updated 2024.
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PMHNP
PMHNP Study Set for ANCC Questions and Correct Answers, With Complete Solution. 338 Q&A. Updated 2024.
1. Review the MOA/DOSAGE for pharmacological therapy for a patient on a stimulant medication(s) for ADHD. (p. 747)
**Note: medication therapy not first line
**Beware of stimulant use for chil...
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PMHNP Study Set for ANCC Questions and Correct
Answers, With Complete Solution. 338 Q&A. Updated
2024.
1. Review the MOA/DOSAGE for pharmacological therapy for a patient on a
stimulant medication(s) for ADHD. (p. 747)
**Note: medication therapy not first line
**Beware of stimulant use for children with tics
**Rx'ing stimulants: ALWAYS assess cardiac risk because can lead to sudden cardiac
death
a. MOA: inhibit reuptake of dopamine and norepinephrine, thereby increasing
concentrations in the presynaptic cleft. Amphetamines directly stimulate the release of
dopamine and norepinephrine.
b. DOSAGE: Start low, titrate up. In adults, extended release preferred to maximize
compliance and minimize risk of abuse. In children, start with short acting to gauge
tolerability and response, then switch to a longer-acting.
Clozapine Chemical Structure
SDA - Serotonin 5HT2A Dopamine D2 antagonist.
Clozapine S/E
1. NO EPS, NO TD, NO Hyperprolactinemia
2. Life Threatening S/E agranulocytosis
3. Highest risk for MetX/Cardio Metabolic, greatest degree of weight gain
4. Increased risk seizures
5. Sedating, hyper salivation, risk of myocarditis
Clozapine Tx Benefits
1. Reduce risk of suicide in Schizo
2. Efficacy in treating aggression and violence
3. Reduce TD severity
"gold standard" on resistant symptoms but never first line of tx
Olanzapine Chemical Structure
Serotonin 5HT2A and D2 Dopamine antagonist
MORE POTENT THAN Clozapine
Olanzapine s/e
1. Lacks EPS, sedating d/t Antagonist of M1, H1, a1-adrenergic
2. Highest level of cardio-metabolic s/e - weight gain, insulin resistance, triglyceride
levels
Olanzapine Indications r/t mood
Improves mood not only in schizophrenia but also in Bipolar disorder and in treatment
resistant depression. Especially with addition of Fluoxetine
Quetiapine Chem Structure
Serotonin 5HT2A and D2 Dopamine antagonist
Not potent binding at D2 receptor
H1 biding - enhance sleep especially with M1 and A1 adrenergic
,Quetiapine Different Dosing Formulations
IR immediate vs. XR extended release
300mg IR- least effective dose for antipsychotic (it will occupy D2 at 60% but quickly
decreases due to hitting peak quickly (a few hours) requires multiple doses
XR - slowly hit its peak, yet rapid enough for the 60% D2 binding
Max Dose - 800mg IR form will only occupy D2 receptors for about 12 hours above the
60% threshold
Max Dose - 800mg XR maintains fully effective d2 occupancy x 24 hours, has less peak
dose sedation and not an ideal hypnotic due to delayed release
Quetiapine different doses different actions:
Papa Bear - 800mg XR = antipsychotic
Mama Bear - 300mg XR = antidepressant
Baby Bear - 50mg IR = sleeping
Quetiapine FDA Approved for
Bipolar depression and augmentation with SSRI/SNRI in unipolar depression
Neurotransmitters
Chemicals that transmit signals across a junction "synapse" from one neuron to another
'target' neuron
Where are neurotransmitters stored?
vesicles
Full Agonist
mimics the effect of the neurotransmitter
Partial Agonist
Mimic physiologic actions to a lesser degree
-Some affinity but only moderate intrinsic activity
-Also referred to as "agonist-antagonist"
Antagonist
blocks the effect a neurotransmitter
inverse agonist
chemical substance that produces effects opposite those of a particular
neurotransmitter
Serotonin Chemical Structure
5-HT - hydroxytriptamine
Has 7 5HT receptors
serotonergic drugs have a wide range of functions
DOMAINS
Serotonin effects much "DOMAINS"
D for depression -mood regulation
O is for Obsession serotonin regulates obsessive thoughts, behavior-requires higher
dosage than depression doses
M is for Migraines - serotonin receptors in brain abort a migraine
A is Anxiety -SSRIs treat
I is for Intestines - 90% of serotonin in the gut, it drives motility
N is Nausea - block serotonin effective at preventing nausea (zofran)
S is sexual side effects
Serotonin Syndrome
, Shits and SHIVERS
Shits is for diarrhea
S is for shivering - fairly unique symptom
H is for Hyperreflexia (overactive) and myoclonus (quick, involuntary muscle jerk)
Increased temperature
Vital sign instability - HR, BP, RR
Encephalopathy (decreased LOC)
Restlessness
Sweating is an autonomic response
a. Latuda FDA approved for
b. Off Label For
Schizophrenia age 13 and older, Bipolar Depression
b. Treatment resistant depression
b. mixed manic episode
1. Review the Contra/Adverse for pharmacological therapy for a patient on a
stimulant medication(s) for ADHD. (p. 747)
c. CONTRAINDICATIONS: Do not rx methylphenidate in patients with marked anxiety,
tension or agitation, glaucoma or hx of tics/Tourettes. Pre-existing cardiovascular
disease, moderate/severe HTN, hyperthyroidism, or hx of substance abuse.
d. ADVERSE REACTIONS:
a. Cardiovascular palpitations, tachycardia, HTN, arrhythmias
b. GI Change in appetite, N/V
c. Neurological HA, insomnia, seizure activity
d. Growth retardation
e. Stimulant Medications - One doesn't show efficacy over another.
a. Methylphenidate (Ritalin/Concerta)
b. Dextroamphetamine (Dexedrine)
c. Amphetamine/dextroamphetamine (Adderall)
Which dementia type has a relatively quick onset?
Delirium
Which following type of dementia is characterized by early changes in behaviors
vs. impairments in memory?
Fronto-temporal dementia
Which dementia is characterized by early persistent visual hallucinations, early
fluctuations in cognition and attention and EPS?
LBD
Which is the following dementias are characterized by Parkinson-like
movements?
LBD Lewey Body Dementia
Neurodegenerative disorder of cognition, related to Parkinsons, path by abnormal
aggregation of the Alpha-Synculien
Disease process of LBD
Neurdegenerative disorder of cognition related to Parkinsons Path by abnormal
aggregation of alpha synuclien
1. Progressive loss of memory, language, reasoning or higher mental functions like
calculating numbers, intense visual hallucinations - common to see people, animals,
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