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Psych

Beschreibung

Quiz am Psych, erstellt von Maggie Throckmorton am 07/11/2017.
Maggie Throckmorton
Erzeugt von Maggie Throckmorton
Maggie Throckmorton
Erstellt von Maggie Throckmorton vor fast 9 Jahre
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Zusammenfassung der Ressource

Frage 1

Frage
In depression, remission is defined as:
Antworten
  • A period of >3 weeks and <3 months with no clinically depressive symptoms
  • A period of more than 1 year with no clinically depressive symptoms
  • A period of >2 weeks and <2 months with no clinically depressive symptoms
  • A period of 5 months with no clinically depressive symptoms

Frage 2

Frage
T or F. Recovery from depression is considered an asymptomatic period of more than 2 months.
Antworten
  • True
  • False

Frage 3

Frage
T or F. Serotonin receptors are only in the brain.
Antworten
  • True
  • False

Frage 4

Frage
Thinking of the MOA, the goal of treating depression with SSRI's is:
Antworten
  • Induce more sound sleep
  • Increase the amount of circulating dopamine
  • Increase the amount circulating serotonin
  • To increase the amount of serotonin in the re-uptake pump

Frage 5

Frage
Prozac has all of the following qualities except (select all that apply):
Antworten
  • Most activating
  • Decreases energy
  • Causes less weight gain
  • Wide dosing range
  • Have no effect on panic or anxiety

Frage 6

Frage
T or F. Data supports that weight gain with anti-depressant use is only a side effect of the med.
Antworten
  • True
  • False

Frage 7

Frage
T or F. Zoloft is considered weight neutral
Antworten
  • True
  • False

Frage 8

Frage
FDA warning indicates this dose of Celexa may prolong QT interval.
Antworten
  • 40 mg
  • 20 mg
  • 50 mg
  • 30 mg

Frage 9

Frage
Celexa is less attractive option due to:
Antworten
  • Poor efficacy
  • Narrow dosage range
  • Cost
  • Availability

Frage 10

Frage
T or F. Escitalopram was designed to have less sexual side effects.
Antworten
  • True
  • False

Frage 11

Frage
Paxil is not used commonly in primary care because (select all that apply):
Antworten
  • Difficult to titrate off of
  • Major weight gain
  • Pregnancy D category
  • Patient is uncomfortable if a dose is missed
  • Patient's do not like it
  • No longer on the market in US

Frage 12

Frage
T or F. The sexual side effects of SSRI's will eventually go away.
Antworten
  • True
  • False

Frage 13

Frage
SSRI's can cause:
Antworten
  • Bothersome GI side effects early on
  • Decreased seizure threshold
  • Akathesia
  • Increased libido

Frage 14

Frage
T or F. If SSRI's are combined with MAOI's there is an increased risk for serotonin syndrome.
Antworten
  • True
  • False

Frage 15

Frage
T or F. SSRI's and NSAID's can never be taken together
Antworten
  • True
  • False

Frage 16

Frage
The NP should ensure the patient knows the following about SSRI's (select all that apply):
Antworten
  • There is an increased risk for suicide in young adults when meds are initiated
  • Symptoms will not improve all at once
  • Energy could come back, however mood can remain the same until medicine has more time to work
  • May initially have more thoughts of SI
  • Will always make you less anxious
  • Work immediately

Frage 17

Frage
T or F. By week 4 of a dose, the patient will see the most benefit they will ever see of that dose.
Antworten
  • True
  • False

Frage 18

Frage
What is a good way to assess the effectiveness of the patient's current dose of their anti-depressants?
Antworten
  • Ask the patient "Do you feel like there's room for you to feel better?"
  • Ask the patient's family if it seems like the patient is better
  • Check a Vitamin D level
  • Ask the patient, "how is your sleep?"

Frage 19

Frage
T or F. The stopping point for titration is based on how the patient feels.
Antworten
  • True
  • False

Frage 20

Frage
The principles of titration include (select all that apply):
Antworten
  • The goal is recovery
  • The goal is remission
  • Maximize dose of a single drug before switching
  • Try low doses of several agents
  • Effectiveness of a med has more to do with how a patient metabolizes the med

Frage 21

Frage
The following are characteristics of cymbalta (select all that apply):
Antworten
  • The generic is very expensive
  • Is an SSRI
  • Has an indication for pain
  • Is an SNRI

Frage 22

Frage
T or F. Venlafaxine is a commonly used in primary care because of its wide dosing range and low cost.
Antworten
  • True
  • False

Frage 23

Frage
To work around patients who have an antidepressant medication bias the provider can:
Antworten
  • Prescribe a less common anti-depressant like Pristiq
  • Prescribe the patient whatever drug they request
  • Prescribe a common anti-depressant like Lexapro
  • Tell the patient they will take what you prescribe them

Frage 24

Frage
SNRI's have the same side effects of SSRI's (weight gain, loss of libido) but also have these additional side effects (select all that apply):
Antworten
  • Tremors
  • Insomnia
  • Sedation
  • Urinary incontinence
  • Sweating
  • Urinary retention

Frage 25

Frage
The provider knows that Effexor has:
Antworten
  • The strongest effect on norepinephrine
  • The strongest effect on dopamine
  • The weakest effect on norepinephrine
  • Little effect on BP

Frage 26

Frage
T or F. Patient's can experience withdrawal by even missing a single dose of an SNRI.
Antworten
  • True
  • False

Frage 27

Frage
T or F. There are no renal or hepatic dosing adjustments with SNRI's.
Antworten
  • True
  • False

Frage 28

Frage
T or F. Antidepressant naive patients should be started on an SSRI.
Antworten
  • True
  • False

Frage 29

Frage
The following is true of the NDRI, buproprion (select all that apply):
Antworten
  • Boosts several neurotransmitters
  • Is C/I in seizure disorders
  • Can cause weight loss
  • Has more sexual side effects
  • Can interfere with sleep if taken too close to bedtime
  • Can cause tinnitus
  • May help patient's quit smoking
  • Requires patient to reduce consumption of alcohol

Frage 30

Frage
T or F. Viibryd's partial agonist action was designed to limit some of the side effects of SSRI's.
Antworten
  • True
  • False

Frage 31

Frage
Brintellix while having some good emerging efficacy, is not commonly prescribed in primary care due to:
Antworten
  • high cost and significant GI effects, that can go away after two weeks
  • High rate of sexual side effects
  • Does not work in people for whom SSRI and SNRI's failed

Frage 32

Frage
TCA's are not a mainstay of treatment due to what following side effects and cautions (select all that apply)
Antworten
  • Risk for overdose
  • Blurred vision
  • Excessive thirst
  • Weight gain
  • Diarrhea
  • Constipation
  • Sedation and dizziness

Frage 33

Frage
T or F. MAOI's are not commonly prescribed as they have interact with several drugs.
Antworten
  • True
  • False

Frage 34

Frage
It is important for patient's to understand this about taking anti-depressant to increase adherence:
Antworten
  • These meds are not "Tylenol or Advil", they will take time to work
  • You can stop and start the meds if you like
  • They will work immediately
  • They can expect few if any side effects.

Frage 35

Frage
T or F. True Serotonin Syndrome develops rapidly over 24 hours
Antworten
  • True
  • False

Frage 36

Frage
The following are signs and symptoms of serotonin syndrome (select all that apply):
Antworten
  • Mental status changes (anxiety, agitation, delirium, restlessness, disorientation
  • Autonomic hyperactivity (diaphoresis, tachycardia, hyperthermia, hypertension, vomiting and diarrhea)
  • Neuromuscular abnormalities (tremor, muscle rigidity, myoclonus, hyperreflexia, and bi-lateral Babinski sign)
  • Sleep disturbances
  • Polyphagia

Frage 37

Frage
T or F. The provider should maximize the dose of drug before changing or adding drugs.
Antworten
  • True
  • False

Frage 38

Frage
For these patients, you might consider starting them at lower doses of antidepressants (select all that apply):
Antworten
  • Older adults
  • Frail or underweight adults
  • Women
  • Adolescents
  • Patient or provider med anxiety

Frage 39

Frage
The rule of thumb for when to switch a patient to another anti-depressant is:
Antworten
  • No symptom improvement after 2 dose adjustments AND patient is still safe (no S/I)
  • The first time the patient tells you the med is not working
  • When a friend tells them about one that will work better
  • After one dose adjustment AND patient is still safe (no S/I)

Frage 40

Frage
The provider can consider adding Wellbutrin to an SSRI/SNRI if:
Antworten
  • If the patient requests it
  • If the dose of the first agent is at its max, and patient has residual symptoms and sexual side effects are bothersome
  • Can only add to an SNRI
  • Can only add to an SSRI

Frage 41

Frage
T or F. If a patient has a full resolution of depressive symptoms the provider should keep their medication at the same dose.
Antworten
  • True
  • False

Frage 42

Frage
With a partial resolution of depressive symptoms the provider should first:
Antworten
  • Increase the dose
  • Keep the same dose, but give it more time to work
  • Change medications
  • Add Wellbutrin

Frage 43

Frage
T or F. if a patient's depressive symptoms are not better, but not worse either, the provider should keep the patient's dose the same.
Antworten
  • True
  • False

Frage 44

Frage
If a patient is started on an anti-depressant and returns to your office and tells you they have been up for days and they just bought two (2) new Corvette's, the provider is concerned:
Antworten
  • The medication unmasked bipolar disorder with a first episode of hypomania or mania.
  • Not concerned. The patient is just adjusting to the meds.
  • The patient is developing Serotonin Syndrome.
  • The patient is just not on the right anti-depressant and needs a medication change.

Frage 45

Frage
T or F. After a 1st lifetime depressive episode, it is reasonable to trial off agent after 6 months to a year.
Antworten
  • True
  • False

Frage 46

Frage
T or F. SSRI's and SNRI's are FDA approved for anxiety, but usually require lower doses.
Antworten
  • True
  • False

Frage 47

Frage
The provider knows that when prescribing an SNRI or SSRI to a patient for the first time with anxiety, the medication can cause:
Antworten
  • A paradoxical antidepressant effect and make them feel worse
  • Insomnia
  • Increased hunger
  • Episodic tinnitus

Frage 48

Frage
A non-benzodiazipine option for treating anxiety is:
Antworten
  • Effexor
  • Zoloft
  • Librium
  • BuSpar

Frage 49

Frage
T or F. It can take 1-2 weeks for a patient to feel a therapeutic effect from BuSpar.
Antworten
  • True
  • False

Frage 50

Frage
The provider knows the following is true about benzodiazipines:
Antworten
  • Xanax has the shortest half-life and Valium has the longest half-life
  • Klonopin has a shorter half-life than Ativan
  • The patient can discontinue them on their own
  • Ativan has a shorter half-life than Xanax.

Frage 51

Frage
Which benzo is used commonly used for alcohol detox due to its long half-life?
Antworten
  • Valium
  • Klonopin
  • Ativan
  • Xanax

Frage 52

Frage
T or F. Benzodiazipines should not be used for more than 12 weeks.
Antworten
  • True
  • False

Frage 53

Frage
T or F. There are no withdrawal symptoms from stopping benzos.
Antworten
  • True
  • False

Frage 54

Frage
A anti-depressant that is known to be effective for sleep in lower doses is:
Antworten
  • Viibyrd
  • Trazadone
  • Celexa
  • Zoloft

Frage 55

Frage
T or F. Trazadone is good for early or middle insomnia.
Antworten
  • True
  • False

Frage 56

Frage
T or F. If a patient has a history of using benzo's they will probably find trazadone very effective for sleep.
Antworten
  • True
  • False

Frage 57

Frage
T or F. A rare side effect of trazadone is priapism.
Antworten
  • True
  • False

Frage 58

Frage
This medication is an attractive choice for older women who have insomnia and diminished appetite:
Antworten
  • Remeron
  • Melatonin
  • Ambien
  • Trazadone

Frage 59

Frage
The provider knows that lower doses of Remeron can cause:
Antworten
  • Significant weight gain
  • Are weight neutral
  • Cause significant weight loss
  • Are ineffective for sleep

Frage 60

Frage
T or F. Ambien has the potential for causing amnesia and odd behaviors.
Antworten
  • True
  • False

Frage 61

Frage
A controlled substance used for sleep, that may become habit forming and should be prescribed for short term use is:
Antworten
  • Zolpidem
  • Remeron
  • Trazadone
  • Zoloft

Frage 62

Frage
T or F. There is a risk of developing hyponatremia with the use of Trileptal.
Antworten
  • True
  • False

Frage 63

Frage
For patients on Depakote, the PMHNP knows they should monitor their patients LFT's, platelets and plasma levels:
Antworten
  • every 6-12 months
  • at baseline, 1 month and q6months
  • baseline and then annually thereafter
  • They only need to monitor platelets.

Frage 64

Frage
T or F. There is a risk for Stevens-Johnson Syndrome in patient's taking Lamictal.
Antworten
  • True
  • False

Frage 65

Frage
With Lithium the following is true (select all that apply):
Antworten
  • Electrolytes should be monitored (Na+, K+, Mg and P levels)
  • Can be nephrotoxic
  • Patient should have a thyroid panel every 6 months
  • Is teratogenic in the 1st trimester
  • NSAIDS, ACEI, diuretics and CCB may cause increased plasma levels,
  • Elderly people require lower dose for therapeutic response

Frage 66

Frage
T or F. Atypical anti-psychotics can and should be prescribed by PCP's
Antworten
  • True
  • False

Frage 67

Frage
T or F. One dose of olanzapine (Zyprexa) can raise blood sugar.
Antworten
  • True
  • False

Frage 68

Frage
If a patient is taking an atypical anti-psychotic, the provider should monitor for and counsel patient on:
Antworten
  • Potential for metabolic syndrome and weight gain
  • Potential for weight loss
  • The cost and availability of the meds
  • Risk for hypoglycemia

Frage 69

Frage
The following atypical anti-psychotics have the biggest risk for metabolic adverse reactions (select all that apply):
Antworten
  • Olanzapine (Zyprexa)
  • Quetapine (Seroquel)
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Lurasidone (Latuda)

Frage 70

Frage
Metabolic Syndrome is defined as:
Antworten
  • A constellation of symptoms, abdominal obesity with 2 of 4 of the following symptoms: elevated triglycerides, reduced HDL, elevated BP and elevated fasting blood glucose
  • Abdominal obesity and elevated BP only
  • High triglycerides, low HDL and high fast blood glucose
  • Abdominal obesity only (greater than 35 inches in women and 40 inches in men)

Frage 71

Frage
T or F. The PMHNP should get a baseline ECG before initiating Geodon due to risk for prolonged QT interval.
Antworten
  • True
  • False

Frage 72

Frage
T or F. Before prescribing meds for migraines, the NP should advise the patient to maintain a migraine diary.
Antworten
  • True
  • False

Frage 73

Frage
The following is true for migraine rescue agents (select all that apply):
Antworten
  • Are taken to abort a migraine
  • A single larger dose is more helpful than smaller doses
  • Most helpful when taken soon after symptom onset
  • More helpful in smaller doses than a single large dose
  • Probably won't help

Frage 74

Frage
T or F. Excedrin migraine has about the same amount of caffeine as two diet cokes or 1 cup of coffee.
Antworten
  • True
  • False

Frage 75

Frage
T or F. Triptans are vasoconstrictors and block pain pathways in the brainstem.
Antworten
  • True
  • False

Frage 76

Frage
The following is true in the use of triptans like Imitrex (select all that apply):
Antworten
  • Cannot exceed 200 mg in 24 hours
  • Can take one dose of any strength followed by a second dose, typically of the same strength of the 1st dose, 2 hours later
  • Should consider upping to max dose for next migraine event if 2nd dose was ineffective
  • If there is no relief, even after changing meds, refer to neurologist

Frage 77

Frage
In the use of triptans for migraines the provider should teach the patient to:
Antworten
  • Take at the first sign of headache pain
  • Take an hour after symptoms have started
  • Take before the symptoms start
  • Are indicated in patients with a history of ischemic stroke

Frage 78

Frage
T or F. Uncontrolled HTN, Prinzmetal's Angina and Pregnancy are all contraindications in the use of Triptans for migraines.
Antworten
  • True
  • False

Frage 79

Frage
While it is probably safe to take Triptans with SSRI's, SNRI's and anti-psychotics the NP should tell the patient to watch for:
Antworten
  • Elevated pulse and sweating
  • Insomnia
  • Decreased pulse and decreased blood pressure
  • Increased hunger

Frage 80

Frage
T or F. Triptans should not be taken with MAOI's and and within 24 hours of Ergots
Antworten
  • True
  • False

Frage 81

Frage
T or F. Rescue migraine agents for any class should not be used for more than 10 days per month due to risk for rebound headache
Antworten
  • True
  • False

Frage 82

Frage
T or F. Migraine prophylaxis is neurologist driven and should be considered in patients who frequent, long lasting and who have significant impairment from their migraines.
Antworten
  • True
  • False

Frage 83

Frage
The following are common migraine prophylaxis agents (select all that apply):
Antworten
  • Beta blockers
  • CCB
  • TCAS/SSRI's/SNRI's
  • Anticonvulsants (valprote, gabapentin, and topiramate)
  • NSAIDS
  • ASA

Frage 84

Frage
T or F. Mostly common anti-seizure medications are protein bound and require monitoring to ensure therapeutic levels.
Antworten
  • True
  • False

Frage 85

Frage
Along with providing seizure protection, which two medications also help with mood stabilization:
Antworten
  • Lamictal and Depakote
  • Dilantin and Keppra
  • Topamax and Depakote
  • Dilantin and Trileptal

Frage 86

Frage
T or F. Cholinesterase Inhibitors like Aricept, Exelon and Razadyne are indicated for mild-severe dementia and reduce the amount of acetylcholine breakdown in the brain.
Antworten
  • True
  • False

Frage 87

Frage
The most common side effects with Cholinesterase Inhibitors are:
Antworten
  • GI, may present as dyspepsia or as anorexia and weight loss
  • Headache and blurry vision
  • Puritis and urticaria
  • Numbness in extremities

Frage 88

Frage
T or F. With Namenda common side effects include constipation, headache, dizziness and pain.
Antworten
  • True
  • False

Frage 89

Frage
Because Levadopa compete with amino acids for absorption, it is best to take them:
Antworten
  • Without food, especially protein
  • With food, especially protein
  • With dairy products
  • Not with dairy products

Frage 90

Frage
T or F. The dykinesias a Parkinson's patient can have are more commonly associated with their use of levodopa and not their disease.
Antworten
  • True
  • False
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