FINAL EXAM TEST QUESTIONS LATEST UPDATE
Question 18:
Christine is a 9-year-old female who presents for care after having been placed in the local foster care system. She has been in and out of foster care for the last 4 years after her parents were killed in an automobile accident. Christine ...
Question 18:
Christine is a 9-year-old female who presents for care after having been placed in
the local foster care system. She has been in and out of foster care for the last 4
years after her parents were killed in an automobile accident. Christine has been
placed in a variety of homes and residential care facilities. The PMHNP
recognizes that Christine is at high risk for:
A. Dissociative disorders
B. Post-traumatic stress disorder
C. Impulse-control disorder
D. Attachment disorder
Question 7:
Caylee is a 5-year-old girl who is referred for evaluation by child protective
services. She was recently removed from her biological family and placed in
foster care, as her home environment was reportedly unsafe due to conditions of
extreme neglect. Her foster mother reports that Caylee is very quiet and
withdrawn and always appears sad and disinterested in her surroundings;
however, she becomes very irritable when anything unexpected or unplanned
occurs. The foster mother became very concerned when it appeared that Caylee
was hallucinating. The PMHNP considers that:
A. Caylee is at high risk for suicide and precautions should be taken
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
C. The history and reported symptoms are typical of depressive disorder in young
children
D. This is a common situation when prepubertal children are removed from the
biological parents regardless of how dysfunctional they are
,Question 2:
Debi is a 15-year-old girl who is currently being treated for depression. Her
parents have been very proactive and involved in her care, and Debi has achieved
remission 2 months after beginning treatment with a combination of
pharmacotherapy and cognitive behavioral therapy. While counseling Debi's
parents about important issues in management, the PMHNP advises that:
A. There is a > 50% likelihood that Debi's younger sibling will develop depressive
symptoms
B. The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically need long-term pharmacologic management
to prevent relapses
Agomelatine
Brand: Valdoxan
-Melatonin multimodal (Mel-MM)
-Agonist at melatonergic 1 and melatonergic 2 receptors
-Antagonist at 5HT2C receptors
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
Amitriptyline (Elavil)
Tricyclic antidepressant.
Aripiprazole (Abilify)
Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine
receptor antagonist in high concentration and also stimulates increase of dopamine in
low concentrations. Side effects: insomnia, akathisia.
Brexpiprazole (Rexulti)
Treatment for depression. Atypical antipsychotic
Bupropion (Wellbutrin)
Antidepressant and smoking cessation aid, It can treat depression and help people quit
smoking. It can also prevent depression caused by seasonal affective disorder (SAD).
,Citalopram (Celexa)
Antidepressant, SSRI: 20-40 mg qd.
Clomipramine (Anafranil)
-Serotonin reuptake inhibitor (S-RI)
-Tricyclic antidepressant (TCA)
-Parent drug is a potent serotonin reuptake inhibitor
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
-Increases serotonergic neurotransmission by blocking the serotonin reuptake pump
(transporter), -Desensitization of serotonin receptors, especially serotonin 1A receptors
-Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
pump (transporter), -Desensitization of beta adrenergic receptors
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
-Lacks dopamine transporters
-Increases dopamine neurotransmission in this part of the brain
**FDA Approved for Pediatrics in tx Obsessive-compulsive disorder (OCD) (ages 10
and older)
*Off-Label for Pediatric Use: Depression, Severe and treatment-resistant, depression,
Cataplexy syndrome, Anxiety, Insomnia,
Neuropathic pain/chronic pain
-Full therapeutic benefits may take 2-8 weeks
-Dosing: in Peds/Adolescents/Adults:
100-250mg/day
Cyamemazine (Tercian)
Treatment for depression.
-Known as cyamepromazine
-Typical antipsychotic drug of the phenothiazine class.
-Treatment for schizophrenia
and psychosis-associated
anxiety
-Behaves like an atypical
antipsychotic, due to its
, potent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-HT2A).
-Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist,
serotonin dopamine antagonist)
-Commonly Prescribed for (not FDA approved):
-Schizophrenia
-Anxiety associated with psychosis (short-term)
-Anxiety associated with nonpsychotic disorders, including mood disorders and
personality disorders (short-term)
-Severe depression
-Bipolar disorder
-Other psychotic disorders
-Acute agitation/aggression (injection)
-Benzodiazepine withdrawal
Desiprimine (Norpramine)
Treats depression
Brand: Norpramin
-TCA
-Norepinephrine noradrenaline reuptake inhibitor.
-FDA approved for treating depression.
-Off-label: Anxiety, Insomnia,
Neuropathic pain/chronic pain, Treatment-resistant depression.
-More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
(serotonin transporter).
-May have immediate effects in treating insomnia or anxiety.
-If it is not working within 6-8 weeks for depression, it may require a dosage increase or
it may not work at all
-100-200 mg/day (for depression)
50-150 mg/day (for chronic pain).
Desvenlafaxine (Pristiq)
Dual serotonin and norepinephrine reuptake inhibitor-often classified as an
antidepressant.
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