Maggie Throckmorton
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Quiz on Psych, created by Maggie Throckmorton on 07/11/2017.

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Maggie Throckmorton
Created by Maggie Throckmorton over 6 years ago
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Psych

Question 1 of 90

1

In depression, remission is defined as:

Select one of the following:

  • 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

Explanation

Question 2 of 90

1

T or F. Recovery from depression is considered an asymptomatic period of more than 2 months.

Select one of the following:

  • True
  • False

Explanation

Question 3 of 90

1

T or F. Serotonin receptors are only in the brain.

Select one of the following:

  • True
  • False

Explanation

Question 4 of 90

1

Thinking of the MOA, the goal of treating depression with SSRI's is:

Select one of the following:

  • 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

Explanation

Question 5 of 90

1

Prozac has all of the following qualities except (select all that apply):

Select one or more of the following:

  • Most activating

  • Decreases energy

  • Causes less weight gain

  • Wide dosing range

  • Have no effect on panic or anxiety

Explanation

Question 6 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 7 of 90

1

T or F. Zoloft is considered weight neutral

Select one of the following:

  • True
  • False

Explanation

Question 8 of 90

1

FDA warning indicates this dose of Celexa may prolong QT interval.

Select one of the following:

  • 40 mg

  • 20 mg

  • 50 mg

  • 30 mg

Explanation

Question 9 of 90

1

Celexa is less attractive option due to:

Select one of the following:

  • Poor efficacy

  • Narrow dosage range

  • Cost

  • Availability

Explanation

Question 10 of 90

1

T or F. Escitalopram was designed to have less sexual side effects.

Select one of the following:

  • True
  • False

Explanation

Question 11 of 90

1

Paxil is not used commonly in primary care because (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 12 of 90

1

T or F. The sexual side effects of SSRI's will eventually go away.

Select one of the following:

  • True
  • False

Explanation

Question 13 of 90

1

SSRI's can cause:

Select one of the following:

  • Bothersome GI side effects early on

  • Decreased seizure threshold

  • Akathesia

  • Increased libido

Explanation

Question 14 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 15 of 90

1

T or F. SSRI's and NSAID's can never be taken together

Select one of the following:

  • True
  • False

Explanation

Question 16 of 90

1

The NP should ensure the patient knows the following about SSRI's (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 17 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 18 of 90

1

What is a good way to assess the effectiveness of the patient's current dose of their anti-depressants?

Select one of the following:

  • 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?"

Explanation

Question 19 of 90

1

T or F. The stopping point for titration is based on how the patient feels.

Select one of the following:

  • True
  • False

Explanation

Question 20 of 90

1

The principles of titration include (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 21 of 90

1

The following are characteristics of cymbalta (select all that apply):

Select one or more of the following:

  • The generic is very expensive

  • Is an SSRI

  • Has an indication for pain

  • Is an SNRI

Explanation

Question 22 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 23 of 90

1

To work around patients who have an antidepressant medication bias the provider can:

Select one of the following:

  • 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

Explanation

Question 24 of 90

1

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):

Select one or more of the following:

  • Tremors

  • Insomnia

  • Sedation

  • Urinary incontinence

  • Sweating

  • Urinary retention

Explanation

Question 25 of 90

1

The provider knows that Effexor has:

Select one of the following:

  • The strongest effect on norepinephrine

  • The strongest effect on dopamine

  • The weakest effect on norepinephrine

  • Little effect on BP

Explanation

Question 26 of 90

1

T or F. Patient's can experience withdrawal by even missing a single dose of an SNRI.

Select one of the following:

  • True
  • False

Explanation

Question 27 of 90

1

T or F. There are no renal or hepatic dosing adjustments with SNRI's.

Select one of the following:

  • True
  • False

Explanation

Question 28 of 90

1

T or F. Antidepressant naive patients should be started on an SSRI.

Select one of the following:

  • True
  • False

Explanation

Question 29 of 90

1

The following is true of the NDRI, buproprion (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 30 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 31 of 90

1

Brintellix while having some good emerging efficacy, is not commonly prescribed in primary care due to:

Select one of the following:

  • 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

Explanation

Question 32 of 90

1

TCA's are not a mainstay of treatment due to what following side effects and cautions (select all that apply)

Select one or more of the following:

  • Risk for overdose

  • Blurred vision

  • Excessive thirst

  • Weight gain

  • Diarrhea

  • Constipation

  • Sedation and dizziness

Explanation

Question 33 of 90

1

T or F. MAOI's are not commonly prescribed as they have interact with several drugs.

Select one of the following:

  • True
  • False

Explanation

Question 34 of 90

1

It is important for patient's to understand this about taking anti-depressant to increase adherence:

Select one of the following:

  • 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.

Explanation

Question 35 of 90

1

T or F. True Serotonin Syndrome develops rapidly over 24 hours

Select one of the following:

  • True
  • False

Explanation

Question 36 of 90

1

The following are signs and symptoms of serotonin syndrome (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 37 of 90

1

T or F. The provider should maximize the dose of drug before changing or adding drugs.

Select one of the following:

  • True
  • False

Explanation

Question 38 of 90

1

For these patients, you might consider starting them at lower doses of antidepressants (select all that apply):

Select one or more of the following:

  • Older adults

  • Frail or underweight adults

  • Women

  • Adolescents

  • Patient or provider med anxiety

Explanation

Question 39 of 90

1

The rule of thumb for when to switch a patient to another anti-depressant is:

Select one of the following:

  • 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)

Explanation

Question 40 of 90

1

The provider can consider adding Wellbutrin to an SSRI/SNRI if:

Select one of the following:

  • 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

Explanation

Question 41 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 42 of 90

1

With a partial resolution of depressive symptoms the provider should first:

Select one of the following:

  • Increase the dose

  • Keep the same dose, but give it more time to work

  • Change medications

  • Add Wellbutrin

Explanation

Question 43 of 90

1

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.

Select one of the following:

  • True
  • False

Explanation

Question 44 of 90

1

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:

Select one of the following:

  • 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.

Explanation

Question 45 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 46 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 47 of 90

1

The provider knows that when prescribing an SNRI or SSRI to a patient for the first time with anxiety, the medication can cause:

Select one of the following:

  • A paradoxical antidepressant effect and make them feel worse

  • Insomnia

  • Increased hunger

  • Episodic tinnitus

Explanation

Question 48 of 90

1

A non-benzodiazipine option for treating anxiety is:

Select one of the following:

  • Effexor

  • Zoloft

  • Librium

  • BuSpar

Explanation

Question 49 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 50 of 90

1

The provider knows the following is true about benzodiazipines:

Select one of the following:

  • 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.

Explanation

Question 51 of 90

1

Which benzo is used commonly used for alcohol detox due to its long half-life?

Select one of the following:

  • Valium

  • Klonopin

  • Ativan

  • Xanax

Explanation

Question 52 of 90

1

T or F. Benzodiazipines should not be used for more than 12 weeks.

Select one of the following:

  • True
  • False

Explanation

Question 53 of 90

1

T or F. There are no withdrawal symptoms from stopping benzos.

Select one of the following:

  • True
  • False

Explanation

Question 54 of 90

1

A anti-depressant that is known to be effective for sleep in lower doses is:

Select one of the following:

  • Viibyrd

  • Trazadone

  • Celexa

  • Zoloft

Explanation

Question 55 of 90

1

T or F. Trazadone is good for early or middle insomnia.

Select one of the following:

  • True
  • False

Explanation

Question 56 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 57 of 90

1

T or F. A rare side effect of trazadone is priapism.

Select one of the following:

  • True
  • False

Explanation

Question 58 of 90

1

This medication is an attractive choice for older women who have insomnia and diminished appetite:

Select one of the following:

  • Remeron

  • Melatonin

  • Ambien

  • Trazadone

Explanation

Question 59 of 90

1

The provider knows that lower doses of Remeron can cause:

Select one of the following:

  • Significant weight gain

  • Are weight neutral

  • Cause significant weight loss

  • Are ineffective for sleep

Explanation

Question 60 of 90

1

T or F. Ambien has the potential for causing amnesia and odd behaviors.

Select one of the following:

  • True
  • False

Explanation

Question 61 of 90

1

A controlled substance used for sleep, that may become habit forming and should be prescribed for short term use is:

Select one of the following:

  • Zolpidem

  • Remeron

  • Trazadone

  • Zoloft

Explanation

Question 62 of 90

1

T or F. There is a risk of developing hyponatremia with the use of Trileptal.

Select one of the following:

  • True
  • False

Explanation

Question 63 of 90

1

For patients on Depakote, the PMHNP knows they should monitor their patients LFT's, platelets and plasma levels:

Select one of the following:

  • every 6-12 months

  • at baseline, 1 month and q6months

  • baseline and then annually thereafter

  • They only need to monitor platelets.

Explanation

Question 64 of 90

1

T or F. There is a risk for Stevens-Johnson Syndrome in patient's taking Lamictal.

Select one of the following:

  • True
  • False

Explanation

Question 65 of 90

1

With Lithium the following is true (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 66 of 90

1

T or F. Atypical anti-psychotics can and should be prescribed by PCP's

Select one of the following:

  • True
  • False

Explanation

Question 67 of 90

1

T or F. One dose of olanzapine (Zyprexa) can raise blood sugar.

Select one of the following:

  • True
  • False

Explanation

Question 68 of 90

1

If a patient is taking an atypical anti-psychotic, the provider should monitor for and counsel patient on:

Select one of the following:

  • Potential for metabolic syndrome and weight gain

  • Potential for weight loss

  • The cost and availability of the meds

  • Risk for hypoglycemia

Explanation

Question 69 of 90

1

The following atypical anti-psychotics have the biggest risk for metabolic adverse reactions (select all that apply):

Select one or more of the following:

  • Olanzapine (Zyprexa)

  • Quetapine (Seroquel)

  • Risperidone (Risperdal)

  • Aripiprazole (Abilify)

  • Ziprasidone (Geodon)

  • Lurasidone (Latuda)

Explanation

Question 70 of 90

1

Metabolic Syndrome is defined as:

Select one of the following:

  • 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)

Explanation

Question 71 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 72 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 73 of 90

1

The following is true for migraine rescue agents (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 74 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 75 of 90

1

T or F. Triptans are vasoconstrictors and block pain pathways in the brainstem.

Select one of the following:

  • True
  • False

Explanation

Question 76 of 90

1

The following is true in the use of triptans like Imitrex (select all that apply):

Select one or more of the following:

  • 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

Explanation

Question 77 of 90

1

In the use of triptans for migraines the provider should teach the patient to:

Select one of the following:

  • 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

Explanation

Question 78 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 79 of 90

1

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:

Select one of the following:

  • Elevated pulse and sweating

  • Insomnia

  • Decreased pulse and decreased blood pressure

  • Increased hunger

Explanation

Question 80 of 90

1

T or F. Triptans should not be taken with MAOI's and and within 24 hours of Ergots

Select one of the following:

  • True
  • False

Explanation

Question 81 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 82 of 90

1

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.

Select one of the following:

  • True
  • False

Explanation

Question 83 of 90

1

The following are common migraine prophylaxis agents (select all that apply):

Select one or more of the following:

  • Beta blockers

  • CCB

  • TCAS/SSRI's/SNRI's

  • Anticonvulsants (valprote, gabapentin, and topiramate)

  • NSAIDS

  • ASA

Explanation

Question 84 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

Question 85 of 90

1

Along with providing seizure protection, which two medications also help with mood stabilization:

Select one of the following:

  • Lamictal and Depakote

  • Dilantin and Keppra

  • Topamax and Depakote

  • Dilantin and Trileptal

Explanation

Question 86 of 90

1

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.

Select one of the following:

  • True
  • False

Explanation

Question 87 of 90

1

The most common side effects with Cholinesterase Inhibitors are:

Select one of the following:

  • GI, may present as dyspepsia or as anorexia and weight loss

  • Headache and blurry vision

  • Puritis and urticaria

  • Numbness in extremities

Explanation

Question 88 of 90

1

T or F. With Namenda common side effects include constipation, headache, dizziness and pain.

Select one of the following:

  • True
  • False

Explanation

Question 89 of 90

1

Because Levadopa compete with amino acids for absorption, it is best to take them:

Select one of the following:

  • Without food, especially protein

  • With food, especially protein

  • With dairy products

  • Not with dairy products

Explanation

Question 90 of 90

1

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

Select one of the following:

  • True
  • False

Explanation

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