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Psych

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Quiz on Psych, created by Maggie Throckmorton on 07/11/2017.
Maggie Throckmorton
Quiz by Maggie Throckmorton, updated more than 1 year ago
Maggie Throckmorton
Created by Maggie Throckmorton over 6 years ago
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Resource summary

Question 1

Question
In depression, remission is defined as:
Answer
  • 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

Question 2

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

Question 3

Question
T or F. Serotonin receptors are only in the brain.
Answer
  • True
  • False

Question 4

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

Question 5

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

Question 6

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

Question 7

Question
T or F. Zoloft is considered weight neutral
Answer
  • True
  • False

Question 8

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

Question 9

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

Question 10

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

Question 11

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

Question 12

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

Question 13

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

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

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

Question 19

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

Question 20

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

Question 21

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

Question 22

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

Question 23

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

Question 24

Question
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):
Answer
  • Tremors
  • Insomnia
  • Sedation
  • Urinary incontinence
  • Sweating
  • Urinary retention

Question 25

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

Question 26

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

Question 27

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

Question 28

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

Question 29

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

Question 30

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

Question 31

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

Question 32

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

Question 33

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

Question 34

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

Question 35

Question
T or F. True Serotonin Syndrome develops rapidly over 24 hours
Answer
  • True
  • False

Question 36

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

Question 37

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

Question 38

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

Question 39

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

Question 40

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

Question 41

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

Question 42

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

Question 43

Question
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.
Answer
  • True
  • False

Question 44

Question
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:
Answer
  • 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.

Question 45

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

Question 46

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

Question 47

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

Question 48

Question
A non-benzodiazipine option for treating anxiety is:
Answer
  • Effexor
  • Zoloft
  • Librium
  • BuSpar

Question 49

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

Question 50

Question
The provider knows the following is true about benzodiazipines:
Answer
  • 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.

Question 51

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

Question 52

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

Question 53

Question
T or F. There are no withdrawal symptoms from stopping benzos.
Answer
  • True
  • False

Question 54

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

Question 55

Question
T or F. Trazadone is good for early or middle insomnia.
Answer
  • True
  • False

Question 56

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

Question 57

Question
T or F. A rare side effect of trazadone is priapism.
Answer
  • True
  • False

Question 58

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

Question 59

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

Question 60

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

Question 61

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

Question 62

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

Question 63

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

Question 64

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

Question 65

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

Question 66

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

Question 67

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

Question 68

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

Question 69

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

Question 70

Question
Metabolic Syndrome is defined as:
Answer
  • 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)

Question 71

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

Question 72

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

Question 73

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

Question 74

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

Question 75

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

Question 76

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

Question 77

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

Question 78

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

Question 79

Question
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:
Answer
  • Elevated pulse and sweating
  • Insomnia
  • Decreased pulse and decreased blood pressure
  • Increased hunger

Question 80

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

Question 81

Question
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
Answer
  • True
  • False

Question 82

Question
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.
Answer
  • True
  • False

Question 83

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

Question 84

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

Question 85

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

Question 86

Question
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.
Answer
  • True
  • False

Question 87

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

Question 88

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

Question 89

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

Question 90

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