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NR 566 Final Exam NR 566 / NR566 Chamberlain College Of Nursing – Questions With Complete Solutions 1st generation antipsychotics black box warning Correct Answers When used off-label to treat older adult patients with dementia-related psychosis, all antipsychotics (FGAs and SGAs) approximately double the rate of mortality. Most deaths result from heart-related events (e.g., heart failure, sudden death) or from infection (mainly pneumonia). Because antipsychotics are not approved for treating dementia-related psychosis, and because doing so increases the risk for death, such use is not recommended. 2nd generation antipsychotic-Clozapine BLACK BOX WARNING Correct Answers Clozapine can cause life- threatening agranulocytosis. Its use should be reserved for patients who have not responded to safer alternatives. antidepressants Correct Answers Because antidepressant drugs can be used to commit suicide, prescriptions should be written for the smallest number of doses consistent with good patient management. What should be done if suicidal thoughts emerge during drug therapy, or if depression is persistently worse while taking drugs? One option is to switch to another antidepressant. However, as noted, the risk for suicidality appears equal with all antidepressants. Another option is to stop antidepressants entirely. However, this option is probably unwise because the long-term risk for suicide from untreated depression is much greater than the long-term risk associated with antidepressant drugs. If the risk for suicide appears high, temporary hospitalization may be the best protection.
Are all intranasal glucocorticoids equally effective? Correct Answers Yes, all appear equally effective. Are beta-adrenergic blockers suitable for initial therapy or maintenance therapy in glaucoma? Correct Answers They are suitable for both initial therapy and maintenance therapy. Are MAOIs selective or nonselective? Correct Answers Nonselective; they inhibit both MAO-A and MAO-B at therapeutic doses Are nonstimulants regulated as controlled substances? Correct Answers No, unlike stimulants, nonstimulants are not regulated as controlled substances. Are routine ECGs necessary before starting a child on stimulant therapy without evidence of heart disease? Correct Answers No, routine ECGs are unnecessary in that case. Are SGAs approved for treating dementia-related psychosis in older adults? Correct Answers No, SGAs are not approved for this use. Are systemic effects common with intranasal glucocorticoids? Correct Answers Systemic effects are possible but are rare at recommended doses. Are TCAs recommended for the treatment of BPD? Correct Answers No, they are not recommended.
Can nonstimulants be used alone for ADHD treatment? Correct Answers Yes, they may be employed as monotherapy. Can nonstimulants be used in combination with stimulants for ADHD treatment? Correct Answers Yes, they can be used as add-on therapy with a stimulant. Can tardive dyskinesia be reversible? Correct Answers For some patients, symptoms of TD may decline after dosage reduction or drug withdrawal, but for others, it can be irreversible. Can β-adrenergic blockers be used in combination with other drugs? Correct Answers Yes, they are employed for emergency management of acute angle-closure glaucoma. Diphenhydramine (Benadryl) and Doxylamine (Unisom) Correct Answers Two most common H1 antagonist sleep aids Do adrenergic agonists in ocular decongestants typically cause adverse effects? Correct Answers Rarely, when applied in the low concentrations found in decongestant products. Do all first-generation antipsychotic agents have the same effectiveness? Correct Answers Yes, all FGA agents are equally effective, although individual patients may respond better to one FGA than another. Do antipsychotic drugs alter the underlying pathology of schizophrenia? Correct Answers No, antipsychotic drugs do
not alter the underlying pathology of schizophrenia; they only offer symptomatic relief. Do glucocorticoids typically induce significant sodium retention? Correct Answers No, they do not usually induce significant sodium retention. Do stimulants create positive behavior in children with ADHD? Correct Answers No, they only reduce negative behavior. Does benzoyl peroxide promote the emergence of resistant P. acnes? Correct Answers No, unlike other topical antimicrobials, benzoyl peroxide does not promote emergence of resistant P. acnes. Does bupropion affect serotonergic, cholinergic, or histaminergic transmission? Correct Answers No, it does not affect these transmissions. Does bupropion inhibit MAO? Correct Answers No, it does not inhibit MAO. Does buspirone bind to GABA or benzodiazepine receptors? Correct Answers No, it does not bind to GABA or benzodiazepine receptors. Does buspirone display cross-dependence with benzodiazepines? Correct Answers No, it does not display cross-dependence.
anxiety or psychotic agitation, increasing antipsychotic dosage may worsen akathisia. How can antipsychotic agents be used in long-term maintenance for bipolar disorder? Correct Answers As monotherapy or in combination with a mood stabilizer. How can daytime sedation be minimized for patients on 1st generation antipsychotics? Correct Answers By giving the entire daily dose at bedtime. How can discomfort from glucocorticoid withdrawal be minimized? Correct Answers By gradual dosage reduction. How can glucocorticoids affect growth in children? Correct Answers They can suppress growth, leading to growth delay How can glucocorticoids mask the presence of an infection? Correct Answers By suppressing the immune system and neutrophils, reducing inflammation. How can insomnia caused by stimulant medications be minimized? Correct Answers By reducing the size of the afternoon dose and taking it no later than 4:00 PM. How can lithium-induced tremor be reduced? Correct Answers With a beta blocker (e.g., propranolol) and by reducing peak levels of lithium. How can mild acne be managed? Correct Answers With topical antibiotics and topical retinoids
How can rebound congestion be minimized? Correct Answers By limiting topical application to 3 to 5 days. How can the risk of renal injury from lithium be reduced? Correct Answers By keeping the dosage low and avoiding long- term lithium therapy. How can withdrawal symptoms from SNRI be minimized? Correct Answers By tapering the dosage over 2 to 4 weeks. How developed is the blood-brain barrier at birth? Correct Answers The blood-brain barrier is not fully developed at birth. How do 1st generation antipsychotics affect seizure threshold? Correct Answers They can reduce seizure threshold, increasing the risk for seizure activity. How do amphetamines help with narcolepsy? Correct Answers By stimulating the CNS, amphetamines promote arousal and alleviate symptoms. How do certain H1 antagonists help with motion sickness? Correct Answers They inhibit muscarinic receptors. How do glucocorticoids affect blood sugar levels? Correct Answers Glucocorticoids promote hyperglycemia. How do glucocorticoids affect calcium levels in the body? Correct Answers They reduce intestinal absorption of calcium, causing hypocalcemia.
How do high doses of glucocorticoids affect protein synthesis? Correct Answers Protein synthesis is suppressed. How do low-potency antipsychotics compare to high-potency antipsychotics regarding early EPS reactions? Correct Answers Early reactions occur less frequently with low-potency agents than with high-potency agents. How do lymphocytes intensify inflammation? Correct Answers By causing direct cell injury and promoting antibody formation. How do MAOIs exert their antidepressant effects? Correct Answers By inhibiting MAO-A in nerve terminals, increasing the amount of NE and 5-HT available for release How do nonstimulants compare to stimulants in terms of effectiveness for ADHD? Correct Answers Nonstimulants are less effective than stimulants. How do prostaglandin analogs like latanoprost reduce intraocular pressure (IOP)? Correct Answers By increasing aqueous humor outflow. How do prostaglandins and histamine contribute to inflammation? Correct Answers They cause vasodilation and increase capillary permeability. How do stimulant drugs affect cognitive function in children with ADHD? Correct Answers Tests of cognitive function (memory, reading, arithmetic) often improve significantly.
How do stimulants reduce impulsiveness and hyperactivity in children with ADHD? Correct Answers They improve attention and focus, allowing the child to concentrate on the task at hand. How do sympathomimetics reduce nasal congestion? Correct Answers By activating α1-adrenergic receptors on nasal blood vessels, causing vasoconstriction. How do the mechanisms of 1st and 2nd generation H antagonists differ? Correct Answers First-generation affects both H1 and muscarinic receptors; second-generation primarily targets H1 receptors. How do the pharmacologic effects of SNRIs compare to SSRIs? Correct Answers SNRIs have similar effects to SSRIs, but SSRIs may be better tolerated. How does alternate-day therapy help decrease adrenal insufficiency? Correct Answers It allows plasma glucocorticoids to decline to a level that permits some production of ACTH, promoting cortisol synthesis by the adrenal glands. How does azelaic acid work? Correct Answers Azelaic acid suppresses the growth of P. acnes and decreases the proliferation of keratinocytes. How does blocking histamine action affect wakefulness? Correct Answers Blocking histamine action can lead to sedation and help induce sleep.
How does travoprost's effectiveness vary among different populations? Correct Answers It is more effective in blacks than in nonblacks. How does venlafaxine compare to SSRIs in clinical trials? Correct Answers They are about equally effective, but SSRIs are probably safer. How effective is intranasal cromolyn sodium compared to intranasal glucocorticoids? Correct Answers Moderately effective; benefits are much less than those of intranasal glucocorticoids How frequently should an eye exam be conducted for patients on glucocorticoids? Correct Answers An eye exam should be done every 6 months. How frequently should pediatric height be assessed for patients on glucocorticoids? Correct Answers Check pediatric height every 6 months. How is drug selection determined for long-term therapy in bipolar disorder? Correct Answers It is based on what worked acutely. How is ipratropium administered for allergic rhinitis? Correct Answers As a nasal spray (0.03% and 0.06%) How is montelukast administered? Correct Answers Orally
How long do the effects of irreversible MAOIs persist after drug withdrawal? Correct Answers About 2 weeks How long does it take for bupropion's antidepressant effects to begin? Correct Answers 1 to 3 weeks. How long does it take for mast cell stabilizers to become maximally effective? Correct Answers Benefits take several days to develop and 2 or more weeks to become maximally effective. How long does it typically take for responses to mood stabilizers to develop maximally? Correct Answers 2 or more weeks How long does it typically take for responses to mood stabilizers to develop maximally? Correct Answers 2 or more weeks How long does it typically take for the clinical response to MAOIs to develop? Correct Answers Slowly How long does it usually take for substantial improvement from antipsychotic drugs? Correct Answers Substantial improvement usually takes 2 to 4 weeks. How long may it take for maximal effects of intranasal glucocorticoids to develop in patients with seasonal allergic rhinitis? Correct Answers Maximal effects may require a week or more to develop. How long may it take for maximal responses to develop in patients with perennial rhinitis using intranasal glucocorticoids?
How long should treatment continue after symptoms are in remission? Correct Answers At least 4 to 9 months How many second-generation antipsychotic medications are approved for the management of acute manic or mixed episodes in bipolar disorder? Correct Answers Seven How many second-generation antipsychotic medications are approved for the management of acute manic or mixed episodes in bipolar disorder? Correct Answers Seven How often must WBC count and ANC be monitored after the first 6 months of clozapine treatment? Correct Answers Every 2 weeks for an additional 6 months. How often must WBC count and ANC be monitored during the first 6 months of clozapine treatment? Correct Answers Weekly. How often should blood pressure (BP) and body mass index (BMI) be checked for patients on glucocorticoids? Correct Answers Check BP and BMI at every visit. How often should bone mineral density (BMD) be checked for patients on glucocorticoids? Correct Answers Check BMD in 1 year, and if stable compared with baseline, every 2 to 3 years thereafter. If BMD decreased from baseline, assess annually. How often should CBC, glucose, electrolytes, and lipids be assessed for patients on glucocorticoids? Correct Answers
Assess CBC, glucose, electrolytes, and lipids in 1 month, then every 6 to 12 months if the condition is stable. How often should patients meet with their prescriber during the first 4 weeks of antidepressant treatment? Correct Answers At least weekly. How quickly can an initial response to intranasal glucocorticoids be seen in patients with seasonal allergic rhinitis? Correct Answers An initial response can be seen within hours. How quickly can improvement be seen with benzoyl peroxide treatment? Correct Answers Improvement can be seen within days of starting treatment. How quickly can initial effects of antipsychotic drugs be seen? Correct Answers Initial effects may be seen in 1 to 2 days. How quickly can ocular hypertension develop after starting glucocorticoids? Correct Answers Rapidly How quickly does recovery from reversible MAO inhibition occur? Correct Answers In 3 to 5 days How quickly does the biochemical action of MAOIs occur? Correct Answers Rapidly How sedating are second generation H1 antagonists? Correct Answers Less sedating as they do not cross the blood-brain barrier effectively.
If a patient responded to acute therapy with lithium alone, what should be tried for long-term therapy? Correct Answers Lithium alone. In addition to allergic rhinitis, what other conditions can sympathomimetics help with? Correct Answers They can reduce congestion associated with sinusitis and colds. In what situations is it best to reserve montelukast for use? Correct Answers For patients who do not respond to or cannot tolerate intranasal glucocorticoids or antihistamines. In which cases should systemic therapy be prescribed for AOE? Correct Answers For patients with diabetes, immune deficiencies, difficulty with topical administration, or if the infection has spread beyond the EAC. In which patient populations should glucocorticoids be used with caution? Correct Answers Glucocorticoids must be used with caution in pediatric patients and in women who are pregnant or breastfeeding. In which patients are beta adrenergic blockers contraindicated? Correct Answers Patients with AV heart block, sinus bradycardia, and cardiogenic shock. In which patients is heightened pigmentation of the iris most noticeable when using latanoprost? Correct Answers Patients with green-brown, yellow-brown, or blue/gray-brown irides.
In which populations are H1 antagonists contraindicated? Correct Answers Newborns, children under the age of 2, and women who are breastfeeding. Is buspirone suitable for PRN use? Correct Answers No, it is not suitable for PRN use or for patients who need immediate relief. Is the risk for tardive dyskinesia (TD) different among all first- generation antipsychotics? Correct Answers No, the risk for TD is equal with all FGAs. Is there data showing that limiting stimulant use in children with heart defects protects them from sudden death? Correct Answers No, there are no data showing that. Is there data showing that screening for heart disease with an ECG before starting stimulants is beneficial? Correct Answers No, there are no data showing that it is beneficial. Is there data to support the use of one stimulant over another for ADHD? Correct Answers No, there are no data to support use of one stimulant over another. Name a few stimulant drugs with proven efficacy for ADHD. Correct Answers Methylphenidate (Ritalin, Concerta), dexmethylphenidate (Focalin), dextroamphetamine- amphetamine mixture (Adderall), lisdexamfetamine (Vyvanse) Name a fixed-dose combination of clindamycin and benzoyl peroxide. Correct Answers Acanya, BenzaClin, or Clindoxyl.
