AANP Psych
A 75-year-old female was diagnosed w depression and started on sertraline (usual dose 50-200mg/day). What dosage would be a good starting dose? a) 25mg once daily b) 25mg twice daily c) 50mg once daily d) 100mg once daily
25mg once daily (usu. start half of recommended lowest dose)
How major depressive disorder is diagnosed
5+ symptoms present of "Sig E Caps" for at least 2 consecutive weeks: S: sleep issues I: interests G: guilt E: energy C: concentration difficulties A: appetite P: psychomotor agitation or irritation S: suicidality
Te use of which of the following drugs ofen mimics generalized anxiety disorder? A. sympathomimetics B. antipsychotics C. anticholinergics D. alpha-beta antagonists
A. sympathomimetics
Support group for alcoholic's family and friends.
AI-Anon
An alternative to methadone that can be used to curb opioid withdrawal symptoms is the use of: A. gabapentin. B. buprenorphine plus naloxone. C. methylnaltrexone. D. topiramate.
B. buprenorphine plus naloxone.
Which of the following agents ofers an intervention for the control of tremor and tachycardia associated with alcohol withdrawal? A. phenobarbital B. clonidine C. verapamil D. naltrexone
B. clonidine
Diagnostic criteria for generalized anxiety disorder include all of the following except: A. difficulty concentrating. B. consistent early morning wakening. C. apprehension. D. irritability.
B. consistent early morning wakening.
During an office visit, a 38-year-old woman states, "I drink way too much but do not know what to do to stop." According to Prochaska's change framework, her statement is most consistent with a person at the stage of: A. precontemplation B. contemplation C. preparation D. action
B. contemplation
The NP can consider presenting treatment options and support for change afer the patient has moved into which of Prochaska's stages? A. precontemplation B. contemplation C. preparation D. action
B. contemplation
In general, pharmacological intervention for patients with depression should: A. be given for about 4 months on average. B. continue for a minimum of 6 months after remis- sion is achieved. C. be continued indefinitely with a first episode of depression. D. be titrated to a lower dose after symptom relief is achieved.
B. continue for a minimum of 6 months after remission is achieved.
Pharmacological intervention in an anxiety disorder should be: A. generally given for about 4 to 6 months. B. continued for at least 6 months after remission is achieved. C. continued indefinitely with a first diagnosis of the condition. D. titrated to a highest dose recommended after symptom relief is achieved.
B. continued for at least 6 months after remission is achieved.
Which of the following is most consistent with the diagnosis of generalize anxiety disorder? A. gastrointestinal upset B. difficulty initiating sleep C. diminished cognitive ability D. consistent early morning wakening
B. difficulty initiating sleep
Use of St. John's wort is known to impact the efec- tiveness of all of the following medications except: A. oral contraceptives. B. fluoroquinolones. C. cyclosporine. D. select antiretrovirals.
B. fluoroquinolones.
Which of the following medications is most likely to cause sexual dysfunction? A. vilazodone (Viibryd®) B. fluoxetine (Prozac) C. nortriptyline (Pamelor®) D. bupropion (Wellbutrin)
B. fluoxetine (Prozac)
High doses or prolonged use of kava kava has been associated with cases of: A. renal impairment. B. hepatotoxicity. C. iron-deficiency anemia. D. hyperthyroidism.
B. hepatotoxicity
When assessing a person with acute opioid withdrawal, you expect to find: A. constipation. B. hypertension. C. hypothermia. D. somnolence.
B. hypertension.
Which of the following is true regarding panic disor- der and agoraphobia? A. More men than women experience panic disorder without agoraphobia. B. More women than men experience panic disorder without agoraphobia. C. More men than women experience panic disorder with agoraphobia. D. More women than men experience panic disorder with agoraphobia.
D. More women than men experience panic disorder with agoraphobia.
DSM-5 criteria for anorexia nervosa include all of the following except: A. refusal to maintain body weight at or above the minimum normal weight for age and height. B. intense fear of gaining weight or becoming fat despite being underweight. C. distorted experience and significance of body weight and shape. D. absence of at least three consecutive menstrual cycles.
D. absence of at least three consecutive menstrual cycles.
All of the following are risk factors for relapse except: A. current episode lasts more than 2 years. B. onset of depression occurs at younger than 20 years of age. C. poor recovery between episodes. D. absence of dysthymia preceding the episode.
D. absence of dysthymia preceding the episode.
Treatment with venlafaxine (Efexor®) can lead to dose-dependent increases in: A. heart rate. B. serum glucose. C. AST/ALT. D. blood pressure.
D. blood pressure.
Which patient presentation is most consistent with the diagnosis of depression? A. recurrent diarrhea and cramping B. difficulty initiating sleep C. diminished cognitive ability D. consistent early morning wakening
D. consistent early morning wakening
Lorazepam or oxazepam is the preferred benzodiazepine for treating alcohol withdrawal symptoms when there is a concomitant history of: A. seizure disorder. B. folate deficiency anemia. C. multiple substance abuse. D. hepatic dysfunction.
D. hepatic dysfunction.
A 24-year-old woman has a new onset of panic disor- der. As part of her clinical presentation, you expect to fnd all of following except: A. peak symptoms at 10 minutes into the panic attack. B. history of agoraphobia. C. report of chest pain during panic attack. D. history of thought disorder.
D. history of thought disorder.
DSM-5 criteria for a substance abuse include all of the following except: A. desire to cut down and/or has tried unsuccessfully in the past. B. inability to maintain major role obligations. C. excessive time spent obtaining substance, using substance, or recovering from its effects. D. involved in at least one incarceration related to substance use in the past 6 months.
D. involved in at least one incarceration related to substance use in the past 6 months.
Dysthymia is characterized by: A. suicidal thoughts. B. multiple incidents of harming oneself. C. social isolation. D. low level depression.
D. low level depression.
Which of the following SSRIs is associated with the greatest anticholinergic efect? A. fluvoxamine B. sertraline C. fluoxetine D. paroxetine
D. paroxetine
Risk of benzodiazepine misuse can be minimized by use of: A. agents with a shorter half-life. B. the drug as an "as-needed" rescue medication for acute anxiety. C. more lipophilic products. D. products with longer duration of action.
D. products with longer duration of action.
Characteristics of binge eating disorder include all of the following except: A. lack of control over the amount and type of food eaten. B. behavior present for at least 6 months. C. marked distress, self-anger, shame, and frustration as a result of binging. D. purging activity after an eating binge.
D. purging activity after an eating binge.
Among the preferred frst-line pharmacological treat- ment options for patients with PTSD include the use of: A. methylphenidate (Ritalin®). B. oxazepam (Serax®). C. lithium carbonate. D. sertraline.
D. sertraline.
Lone elevation of ___ (with/without ALT/AST) is a possible sign of occult alcohol abuse.
GGT - gamma glutamyl transaminase
A questionnaire used to evaluate an individual for confusion and dementia. Will describe an action, such as asking the pt to spell "world" backwards.
MMSE (Mini-Mental State Exam)
A common side effect of __ is erectile dysfunction.
Paroxetine
__ has a short half life compared w/other SSRIs. Patients need to be weaned or they will have withdrawal symptoms.
Paroxetine
85-year-old patient has been diagnosed with moderate depression. What medication class is considered first line? a) atypical antidepressant b) tricyclic antidepressant c) selective serotonin reuptake inhibitor d) serotonin-norephinephrine reuptake inhibitor
c) selective serotonin reuptake inhibitor
What medication class is considered first line in an adult who has mild to moderate depressive disorder? a) atypical antidepressant b) tricyclic antidepressant c) selective serotonin reuptake inhibitor d) serotonin-norephinephrine reuptake inhibitor
c) selective serotonin reuptake inhibitor
Use of funitrazepam (Rohypnol®) has been associated with: A. agitation. B. amnesia. C. increased appetite. D. hallucination.
B. amnesia.
Which of the following agents should be avoided in heavy alcohol users due to a potential risk for hepato- toxicity? A. duloxetine B. desvenlafaxine C. escitalopram D. bupropion
A. duloxetine
AST/ALT ratio of ___ or higher is more likely in alcoholism.
2.0
Which of the following agents has the longest T1/2? A. fluoxetine B. paroxetine C. citalopram D. sertraline
A. fluoxetine
According to DSM-5, a diagnosis of depression must include either depressed mood or which of the following? A. loss of interest or pleasure B. recurrent thoughts of death C. feelings of worthlessness D. weight change (either increase or decrease)
A. loss of interest or pleasure
John is a 47-year-old man who reports constant sadness following the death of his wife in a motor vehicle accident 2 weeks ago. He has not been able to function at work and avoids socializing with friends and family. You recommend: A. giving him time and support during this period of acute grief. B. weekly psychotherapy sessions. C. prescribing an anxiolytic to help with grief symptoms. D. psychotherapy plus a prescription for an antidepressant.
A. giving him time and support during this period of acute grief.
Anxiety in response to a challenging life event is a natural response by the body to: A. help a person focus on the issue at hand. B. diminish the fight-or-flight response. C. impair decision-making under duress.
A. help a person focus on the issue at hand.
The drug buspirone (BuSpar®) has: A. low abuse potential. B. significant antidepressant action. C. a withdrawal syndrome when discontinued, similar to benzodiazepines. D. rapid onset of action.
A. low abuse potential
Which of the following statements concerning panic disorder is false? A. Panic disorder rarely occurs with depression. B. Up to 4% of the general population suffers from panic disorder. C. New onset panic disorder rarely occurs after 45 years of age. D. Family history of panic disorder is a risk factor for the condition.
A. Panic disorder rarely occurs with depression.
Drug treatment options for a patient with bipolar disorder often include all of the following except: A. atomoxetine (Strattera®). B. lithium carbonate. C. risperidone (Risperdal®). D. valproic acid (Depakote®).
A. atomoxetine (Strattera®).
SSRI withdrawal syndrome is best characterized as: A. bothersome but not life-threatening. B. potentially life-threatening. C. most often seen with discontinuation of agents with a long half-life. D. associated with seizure risk.
A. bothersome but not life-threatening.
QT prolongation is a concern with higher doses of: A. citalopram. B. sertraline. C. venlafaxine. D. fluoxetine.
A. citalopram.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for substance use tolerance includes: A. diminished effect with the same amount of substance used. B. desiring to get an amplified effect with higher doses. C. ability to decrease the frequency of substance use. D. absence of withdrawal symptoms when substance is not used for a prolonged period.
A. diminished effect with the same amount of substance used.
Demographic data indicate which of the following persons is most likely to misuse prescription medications? A. a 14-year-old male B. a 24-year-old female C. a 33-year-old male D. a 38-year-old male
B. a 24-year-old female
Peak symptoms of alcohol withdrawal are usually ob- served how long afer alcohol intake is discontinued? A. less than 12 hours B. 12 to 24 hours C. 24 to 36 hours D. more than 36 hours
B. 12 to 24 hours
Te maximum recommended dose of citalopram for patients older than 60 years of age is: A. 10 mg/day. B. 20 mg/day. C. 30 mg/day. D. 40 mg/day.
B. 20 mg/day.
Hyperthermia and a racing heart rate is a potentially life-threatening presentation for a person using: A. cannabis. B. MDMA (e.g., Molly). C. LSD. D. barbiturates.
B. MDMA (e.g., Molly).
Which of the following is most consistent with the di- agnosis of bulimia nervosa? A. Patients with bulimia nervosa usually present asking for treatment. B. Periods of anorexia often occur. C. Hyperkalemia often results from laxative abuse. D. Most patients with bulimia nervosa are significantly obese.
B. Periods of anorexia often occur.
Which of the following statements is false regarding patients with depression and hypochondriasis? A. About 30% of patients with depression also have hypochondriasis. B. These patients are less likely to see a healthcare provider compared to those with depression alone. C. These patients are unable to process objective information that they have no particular health problem. D. They perceive that an existing health problem is far more serious than it is in reality.
B. These patients are less likely to see a healthcare provider compared to those with depression alone.
Which of the following drugs is likely to be the most dangerous when taken in overdose? A. a 4-week supply of fluoxetine B. a 2-week supply of nortriptyline C. a 3-week supply of venlafaxine D. a 3-day supply of diazepam
B. a 2-week supply of nortriptyline
When initiating SSRI therapy for a patient with panic disorder, the NP should consider all of the following except: A. start with a low dose and slowly escalate doses as necessary. B. preferable to use agents that are more energizing than less energizing. C. select agents with a low rate of insomnia and akathisia. D. SSRI therapy can precipitate panic attacks with early use.
B. preferable to use agents that are more energizing than less energizing.
Patient presentation possibly common to anxiety and depression includes: A. feeling of worthlessness. B. psychomotor agitation. C. dry mouth. D. appetite disturbance.
B. psychomotor agitation.
A middle-aged woman who has taken therapeutic dose of lorazepam for the past 6 years wishes to stop taking the medication. You advise her that: A. she can discontinue the drug immediately if she be- lieves it no longer helps with her symptoms. B. rapid withdrawal in this situation can lead to tremors and hallucinations. C. she should taper down the dose of the medication over the next week. D. gastrointestinal upset is typically reported during the first week of benzodiazepine withdrawal.
B. rapid withdrawal in this situation can lead to tremors and hallucinations.
DSM-5 criteria for a substance use disorder include all of the following except: A. substance use in larger amounts or over longer period than intended. B. substance overuse resulting in hospitalization. C. craving or strong desire to use. D. substance use in potentially hazardous positions.
B. substance overuse resulting in hospitalization.
When using trazodone to aid sleep, the drug should be optimally taken _____ prior to sleep. A. immediately B. 15 minutes C. 1 hour D. 2 hours
C. 1 hour
Which of the following statements is true regarding depression and relapse? A. Without maintenance therapy, the relapse rate is typically less than 50% in the first year. B. The risk of relapse is less for those who have experienced multiple episodes of major depressive disorder. C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy. D. Relapse rarely occurs if there is an absence of symptoms after 9 months of treatment discontinuation.
C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy.
Of the following individuals in need of an antidepres- sant, who is the best candidate for fuoxetine (Prozac) therapy? A. an 80-year-old woman with depressed mood 1 year after the death of her husband B. a 45-year-old man with mild hepatic dysfunction C. a 28-year-old man who occasionally "skips a dose" of his prescribed medication D. a 44-year-old man with decreased appetite
C. a 28-year-old man who occasionally "skips a dose" of his prescribed medication
DSM-5 criteria for bulimia nervosa include all of the following except: A. eating an excessively large amount of food within a discrete amount of time. B. a sense of lack of control during binge eating episode. C. binge eating and compensatory behavior occurring at least three times per week. D. self-worth heavily influenced by body shape and weight.
C. binge eating and compensatory behavior occurring at least three times per week.
All of the following pharmacological interventions are used in the treatment of patients with bulimia nervosa except: A. fluoxetine (Prozac®). B. desipramine (Norpramin®). C. bupropion (Wellbutrin®). D. paroxetine (Paxil®).
C. bupropion (Wellbutrin®).
As you develop the initial treatment plan for a woman with panic disorder, you consider prescribing: A. carbamazepine (Tegretol®). B. risperidone (Risperdal). C. citalopram (Celexa®). D. bupropion (Wellbutrin).
C. citalopram (Celexa®).
Sally is a 34-year-old married woman who is diagnosed with major depressive disorder. She feels that it is likely associated with stress resulting from her troubled mar- riage. She is initiated on an SSRI and reports initial im- provement in symptoms. However, over the following months, the medication loses its efectiveness despite her insistence that she is being adherent with the dosing regimen. Tis is likely a result of: A. an inadequate dose of the medication. B. development of tolerance to the SSRI. C. continued or escalated stress from the troubled marriage. D. missed doses despite her insistence on compliance.
C. continued or escalated stress from the troubled marriage.
When discontinuing benzodiazepine treatment afer prolonged use, you recommend: A. terminating treatment immediately. B. decreasing the dose 20% per day. C. decreasing the dose 25% per week. D. decreasing the dose 50% per week.
C. decreasing the dose 25% per week
Which of the following SSRIs is most likely to signif- cantly interact with warfarin? A. citalopram B. paroxetine C. fluoxetine D. sertraline
C. fluoxetine
Which of the following is the anticipated clinical efect of acamprosate (Campral®) in the treatment of alcohol dependence? A. modifies intoxicating effects of alcohol B. causes unpleasant adverse effects of alcohol C. helps to reduce the urge to drink D. minimizes alcohol withdrawal symptoms
C. helps to reduce the urge to drink
Which of the following therapeutic agents is commonly used to help with sleep difficulties such as insomnia associated with PTSD? A. duloxetine B. bupropion C. mirtazapine D. zolpidem
C. mirtazapine
In treatment-resistant patients with panic disorder, which drug class is occasionally used? A. atypical antipsychotic B. selective dopamine reuptake inhibitor C. monoamine oxidase inhibitor D. neuroleptic
C. monoamine oxidase inhibitor
A 44-year-old man has been taking an SSRI for the past 4 months and complains of new onset of sexual dys- function and difficulty achieving orgasm. You advise him that: A. this is a transient side effect often seen in the first weeks of therapy. B. switching to another SSRI would likely be helpful. C. this is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy. D. he should see an urologist for further evaluation.
C. this is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy.
Priapism is a potential adverse efect of which of the following psychotropic medications? A. bupropion B. sertraline C. trazodone D. amitriptyline
C. trazodone
Which of the following is most likely to be noted in a 45-year-old woman with laboratory evidence of chronic excessive alcohol ingestion? A. alanine aminotransferase (ALT) 202 U/L (0 to 31 U/L), mean corpuscular volume (MCV) 70 fL (80 to 96 fL) B. aspartate transaminase (AST) 149 U/L (0 to 31 U/L), MCV 81 fL (80 to 96 fL) C. ALT 88 U/L (0 to 31 U/L), MCV 140 fL (80 to 96 fL) D. AST 80 U/L (0 to 31 U/L), MCV 103 fL (80 to 96 fL)
D. AST 80 U/L (0 to 31 U/L), MCV 103 fL (80 to 96 fL)
A neurological disorder w/symptoms that include hypotension, visual impairment, and coma. Signs: mental confusion, ataxia, stupor. Complication from chronic ETOH abuse.
Korsakoff's syndrome
Depression scale used in older adults, cognitively impaired adults, nursing home residents
PHQ-9
In an older adult, potential side effects of ___: parkinsonism anorexia sinus bradycardia hyponatremia bleeding fragility fractures
SSRIs
What class: Sertraline escitalopram fluoxetine paroxetine citalopram fluvoxamine
SSRIs
Which statement(s) are true regarding symptoms of depression in adolescents? a) their symptoms may be similar to those of adults b) impulsivity is a common finding c) depressed mood is usual d) substance abuse may be initiated during this time e) difficulty thinking/concentrating may be present f) indecisiveness may be present g) hopelessness would be unusual
a) their symptoms may be similar to those of adults b) impulsivity is a common finding c) depressed mood is usual d) substance abuse may be initiated during this time e) difficulty thinking/concentrating may be present f) indecisiveness may be present
Avoid this antidepressant if the patient has a higher risk of seizures.
bupropion
Presentation: lanugo, peripheral edema, amenorrhea, BMI <18.5
anorexia *at higher risk for osteopenia/porosis
A 74-year-old pt has symptoms of depression. Tx with sertraline is being considered. Which studies might be important to order? a) EKG, B12, folate b) B12, folate, TSH c) CBC, B12, folate d) LFTs, B12, folate, CBC, TSH
b) B12, folate, TSH
Which medication is associated with the lowest rate of sexual dysfunction when used in patients being treated for depression? a) paroxetine b) bupropion c) duloxetine d) venlafaxine
b) bupropion (SNRI, not SSRI)
4 weeks ago, an 84 year old female lost her husband of 59 years. She is not sleeping well at nighttime and her appetite is decreased. She is managing her day to day affairs but "isn't herself". How should this be handled? a) diagnose her w depression b) monitor her for worsening of symptoms c) give her a benzo for sleep d) initiate sertraline to help manage her symptoms
b) monitor her for worsening of symptoms
What medication is contraindicated for anorexic/bulimic patients bc it increases the seizure threshold?
bupropion
What medication class is considered first line in a patient who has major depressive disorder? a) atypical antidepressant b) tricyclic antidepressant c) selective serotonin reuptake inhibitor d) serotonin-norephinephrine reuptake inhibitor
d) serotonin-norephinephrine reuptake inhibitor Effexor, Cymbalta, Pristique
Korsakoff's syndrome is caused by __.
chronic thiamine deficiency
An elderly patient who is depressed and has multiple medications can be prescribed __ as it has fewer drug interactions than the other SSRIs.
citalopram
Once an antidepressant is initiated in a young-middle adult, when would you see improvement and resolution of symptoms?
improvement: 2-4 weeks resolution: 6-12 weeks
Once an antidepressant is initiated in an older adult, when would you see improvement and resolution of symptoms?
improvement: 4-6 weeks resolution: 12-16 weeks
Kava-kava and valerian root are natural supplements used for ___. Do not mix with ___.
insomnia/anxiety don't mix w benzos or hypnotics
Why is a big shift being seen from prescribing TCAs to SSRIs?
safety *people can overdose on TCAs, can't on SSRIs
CAGE test
test for identification of ETOH abuse C: do you feel need to CUT down A: are you ANNOYED when someone comments about your drinking? G: do you feel GUILTY about drinking? E: do you need to drink EARLY in the AM?
