Pregunta 1
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In depression, remission is defined as:
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A period of >3 weeks and <3 months with no clinically depressive symptoms
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A period of more than 1 year with no clinically depressive symptoms
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A period of >2 weeks and <2 months with no clinically depressive symptoms
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A period of 5 months with no clinically depressive symptoms
Pregunta 2
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T or F. Recovery from depression is considered an asymptomatic period of more than 2 months.
Pregunta 3
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T or F. Serotonin receptors are only in the brain.
Pregunta 4
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Thinking of the MOA, the goal of treating depression with SSRI's is:
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Induce more sound sleep
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Increase the amount of circulating dopamine
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Increase the amount circulating serotonin
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To increase the amount of serotonin in the re-uptake pump
Pregunta 5
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Prozac has all of the following qualities except (select all that apply):
Pregunta 6
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T or F. Data supports that weight gain with anti-depressant use is only a side effect of the med.
Pregunta 7
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T or F. Zoloft is considered weight neutral
Pregunta 8
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FDA warning indicates this dose of Celexa may prolong QT interval.
Pregunta 9
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Celexa is less attractive option due to:
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Poor efficacy
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Narrow dosage range
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Cost
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Availability
Pregunta 10
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T or F. Escitalopram was designed to have less sexual side effects.
Pregunta 11
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Paxil is not used commonly in primary care because (select all that apply):
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Difficult to titrate off of
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Major weight gain
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Pregnancy D category
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Patient is uncomfortable if a dose is missed
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Patient's do not like it
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No longer on the market in US
Pregunta 12
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T or F. The sexual side effects of SSRI's will eventually go away.
Pregunta 13
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SSRI's can cause:
Pregunta 14
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T or F. If SSRI's are combined with MAOI's there is an increased risk for serotonin syndrome.
Pregunta 15
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T or F. SSRI's and NSAID's can never be taken together
Pregunta 16
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The NP should ensure the patient knows the following about SSRI's (select all that apply):
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There is an increased risk for suicide in young adults when meds are initiated
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Symptoms will not improve all at once
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Energy could come back, however mood can remain the same until medicine has more time to work
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May initially have more thoughts of SI
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Will always make you less anxious
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Work immediately
Pregunta 17
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T or F. By week 4 of a dose, the patient will see the most benefit they will ever see of that dose.
Pregunta 18
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What is a good way to assess the effectiveness of the patient's current dose of their anti-depressants?
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Ask the patient "Do you feel like there's room for you to feel better?"
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Ask the patient's family if it seems like the patient is better
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Check a Vitamin D level
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Ask the patient, "how is your sleep?"
Pregunta 19
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T or F. The stopping point for titration is based on how the patient feels.
Pregunta 20
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The principles of titration include (select all that apply):
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The goal is recovery
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The goal is remission
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Maximize dose of a single drug before switching
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Try low doses of several agents
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Effectiveness of a med has more to do with how a patient metabolizes the med
Pregunta 21
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The following are characteristics of cymbalta (select all that apply):
Pregunta 22
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T or F. Venlafaxine is a commonly used in primary care because of its wide dosing range and low cost.
Pregunta 23
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To work around patients who have an antidepressant medication bias the provider can:
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Prescribe a less common anti-depressant like Pristiq
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Prescribe the patient whatever drug they request
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Prescribe a common anti-depressant like Lexapro
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Tell the patient they will take what you prescribe them
Pregunta 24
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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):
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Tremors
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Insomnia
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Sedation
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Urinary incontinence
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Sweating
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Urinary retention
Pregunta 25
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The provider knows that Effexor has:
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The strongest effect on norepinephrine
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The strongest effect on dopamine
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The weakest effect on norepinephrine
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Little effect on BP
Pregunta 26
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T or F. Patient's can experience withdrawal by even missing a single dose of an SNRI.
Pregunta 27
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T or F. There are no renal or hepatic dosing adjustments with SNRI's.
Pregunta 28
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T or F. Antidepressant naive patients should be started on an SSRI.
Pregunta 29
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The following is true of the NDRI, buproprion (select all that apply):
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Boosts several neurotransmitters
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Is C/I in seizure disorders
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Can cause weight loss
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Has more sexual side effects
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Can interfere with sleep if taken too close to bedtime
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Can cause tinnitus
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May help patient's quit smoking
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Requires patient to reduce consumption of alcohol
Pregunta 30
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T or F. Viibryd's partial agonist action was designed to limit some of the side effects of SSRI's.
Pregunta 31
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Brintellix while having some good emerging efficacy, is not commonly prescribed in primary care due to:
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high cost and significant GI effects, that can go away after two weeks
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High rate of sexual side effects
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Does not work in people for whom SSRI and SNRI's failed
Pregunta 32
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TCA's are not a mainstay of treatment due to what following side effects and cautions (select all that apply)
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Risk for overdose
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Blurred vision
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Excessive thirst
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Weight gain
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Diarrhea
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Constipation
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Sedation and dizziness
Pregunta 33
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T or F. MAOI's are not commonly prescribed as they have interact with several drugs.
Pregunta 34
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It is important for patient's to understand this about taking anti-depressant to increase adherence:
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These meds are not "Tylenol or Advil", they will take time to work
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You can stop and start the meds if you like
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They will work immediately
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They can expect few if any side effects.
Pregunta 35
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T or F. True Serotonin Syndrome develops rapidly over 24 hours
Pregunta 36
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The following are signs and symptoms of serotonin syndrome (select all that apply):
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Mental status changes (anxiety, agitation, delirium, restlessness, disorientation
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Autonomic hyperactivity (diaphoresis, tachycardia, hyperthermia, hypertension, vomiting and diarrhea)
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Neuromuscular abnormalities (tremor, muscle rigidity, myoclonus, hyperreflexia, and bi-lateral Babinski sign)
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Sleep disturbances
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Polyphagia
Pregunta 37
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T or F. The provider should maximize the dose of drug before changing or adding drugs.
Pregunta 38
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For these patients, you might consider starting them at lower doses of antidepressants (select all that apply):
Pregunta 39
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The rule of thumb for when to switch a patient to another anti-depressant is:
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No symptom improvement after 2 dose adjustments AND patient is still safe (no S/I)
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The first time the patient tells you the med is not working
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When a friend tells them about one that will work better
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After one dose adjustment AND patient is still safe (no S/I)
Pregunta 40
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The provider can consider adding Wellbutrin to an SSRI/SNRI if:
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If the patient requests it
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If the dose of the first agent is at its max, and patient has residual symptoms and sexual side effects are bothersome
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Can only add to an SNRI
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Can only add to an SSRI
Pregunta 41
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T or F. If a patient has a full resolution of depressive symptoms the provider should keep their medication at the same dose.
Pregunta 42
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With a partial resolution of depressive symptoms the provider should first:
Pregunta 43
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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.
Pregunta 44
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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:
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The medication unmasked bipolar disorder with a first episode of hypomania or mania.
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Not concerned. The patient is just adjusting to the meds.
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The patient is developing Serotonin Syndrome.
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The patient is just not on the right anti-depressant and needs a medication change.
Pregunta 45
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T or F. After a 1st lifetime depressive episode, it is reasonable to trial off agent after 6 months to a year.
Pregunta 46
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T or F. SSRI's and SNRI's are FDA approved for anxiety, but usually require lower doses.
Pregunta 47
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The provider knows that when prescribing an SNRI or SSRI to a patient for the first time with anxiety, the medication can cause:
Pregunta 48
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A non-benzodiazipine option for treating anxiety is:
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Effexor
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Zoloft
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Librium
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BuSpar
Pregunta 49
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T or F. It can take 1-2 weeks for a patient to feel a therapeutic effect from BuSpar.
Pregunta 50
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The provider knows the following is true about benzodiazipines:
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Xanax has the shortest half-life and Valium has the longest half-life
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Klonopin has a shorter half-life than Ativan
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The patient can discontinue them on their own
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Ativan has a shorter half-life than Xanax.
Pregunta 51
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Which benzo is used commonly used for alcohol detox due to its long half-life?
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Valium
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Klonopin
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Ativan
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Xanax
Pregunta 52
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T or F. Benzodiazipines should not be used for more than 12 weeks.
Pregunta 53
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T or F. There are no withdrawal symptoms from stopping benzos.
Pregunta 54
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A anti-depressant that is known to be effective for sleep in lower doses is:
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Viibyrd
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Trazadone
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Celexa
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Zoloft
Pregunta 55
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T or F. Trazadone is good for early or middle insomnia.
Pregunta 56
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T or F. If a patient has a history of using benzo's they will probably find trazadone very effective for sleep.
Pregunta 57
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T or F. A rare side effect of trazadone is priapism.
Pregunta 58
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This medication is an attractive choice for older women who have insomnia and diminished appetite:
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Remeron
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Melatonin
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Ambien
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Trazadone
Pregunta 59
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The provider knows that lower doses of Remeron can cause:
Pregunta 60
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T or F. Ambien has the potential for causing amnesia and odd behaviors.
Pregunta 61
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A controlled substance used for sleep, that may become habit forming and should be prescribed for short term use is:
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Zolpidem
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Remeron
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Trazadone
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Zoloft
Pregunta 62
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T or F. There is a risk of developing hyponatremia with the use of Trileptal.
Pregunta 63
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For patients on Depakote, the PMHNP knows they should monitor their patients LFT's, platelets and plasma levels:
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every 6-12 months
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at baseline, 1 month and q6months
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baseline and then annually thereafter
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They only need to monitor platelets.
Pregunta 64
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T or F. There is a risk for Stevens-Johnson Syndrome in patient's taking Lamictal.
Pregunta 65
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With Lithium the following is true (select all that apply):
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Electrolytes should be monitored (Na+, K+, Mg and P levels)
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Can be nephrotoxic
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Patient should have a thyroid panel every 6 months
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Is teratogenic in the 1st trimester
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NSAIDS, ACEI, diuretics and CCB may cause increased plasma levels,
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Elderly people require lower dose for therapeutic response
Pregunta 66
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T or F. Atypical anti-psychotics can and should be prescribed by PCP's
Pregunta 67
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T or F. One dose of olanzapine (Zyprexa) can raise blood sugar.
Pregunta 68
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If a patient is taking an atypical anti-psychotic, the provider should monitor for and counsel patient on:
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Potential for metabolic syndrome and weight gain
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Potential for weight loss
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The cost and availability of the meds
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Risk for hypoglycemia
Pregunta 69
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The following atypical anti-psychotics have the biggest risk for metabolic adverse reactions (select all that apply):
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Olanzapine (Zyprexa)
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Quetapine (Seroquel)
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Risperidone (Risperdal)
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Aripiprazole (Abilify)
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Ziprasidone (Geodon)
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Lurasidone (Latuda)
Pregunta 70
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Metabolic Syndrome is defined as:
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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
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Abdominal obesity and elevated BP only
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High triglycerides, low HDL and high fast blood glucose
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Abdominal obesity only (greater than 35 inches in women and 40 inches in men)
Pregunta 71
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T or F. The PMHNP should get a baseline ECG before initiating Geodon due to risk for prolonged QT interval.
Pregunta 72
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T or F. Before prescribing meds for migraines, the NP should advise the patient to maintain a migraine diary.
Pregunta 73
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The following is true for migraine rescue agents (select all that apply):
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Are taken to abort a migraine
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A single larger dose is more helpful than smaller doses
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Most helpful when taken soon after symptom onset
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More helpful in smaller doses than a single large dose
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Probably won't help
Pregunta 74
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T or F. Excedrin migraine has about the same amount of caffeine as two diet cokes or 1 cup of coffee.
Pregunta 75
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T or F. Triptans are vasoconstrictors and block pain pathways in the brainstem.
Pregunta 76
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The following is true in the use of triptans like Imitrex (select all that apply):
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Cannot exceed 200 mg in 24 hours
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Can take one dose of any strength followed by a second dose, typically of the same strength of the 1st dose, 2 hours later
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Should consider upping to max dose for next migraine event if 2nd dose was ineffective
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If there is no relief, even after changing meds, refer to neurologist
Pregunta 77
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In the use of triptans for migraines the provider should teach the patient to:
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Take at the first sign of headache pain
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Take an hour after symptoms have started
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Take before the symptoms start
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Are indicated in patients with a history of ischemic stroke
Pregunta 78
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T or F. Uncontrolled HTN, Prinzmetal's Angina and Pregnancy are all contraindications in the use of Triptans for migraines.
Pregunta 79
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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:
Pregunta 80
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T or F. Triptans should not be taken with MAOI's and and within 24 hours of Ergots
Pregunta 81
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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
Pregunta 82
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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.
Pregunta 83
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The following are common migraine prophylaxis agents (select all that apply):
Pregunta 84
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T or F. Mostly common anti-seizure medications are protein bound and require monitoring to ensure therapeutic levels.
Pregunta 85
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Along with providing seizure protection, which two medications also help with mood stabilization:
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Lamictal and Depakote
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Dilantin and Keppra
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Topamax and Depakote
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Dilantin and Trileptal
Pregunta 86
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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.
Pregunta 87
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The most common side effects with Cholinesterase Inhibitors are:
Pregunta 88
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T or F. With Namenda common side effects include constipation, headache, dizziness and pain.
Pregunta 89
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Because Levadopa compete with amino acids for absorption, it is best to take them:
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Without food, especially protein
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With food, especially protein
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With dairy products
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Not with dairy products
Pregunta 90
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T or F. The dykinesias a Parkinson's patient can have are more commonly associated with their use of levodopa and not their disease.