Question 1
Question
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
Question 2
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T or F. Recovery from depression is considered an asymptomatic period of more than 2 months.
Question 3
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T or F. Serotonin receptors are only in the brain.
Question 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
Question 5
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Prozac has all of the following qualities except (select all that apply):
Question 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.
Question 7
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T or F. Zoloft is considered weight neutral
Question 8
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FDA warning indicates this dose of Celexa may prolong QT interval.
Question 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
Question 10
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T or F. Escitalopram was designed to have less sexual side effects.
Question 11
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Paxil is not used commonly in primary care because (select all that apply):
Answer
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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
Question 12
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T or F. The sexual side effects of SSRI's will eventually go away.
Question 13
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SSRI's can cause:
Question 14
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T or F. If SSRI's are combined with MAOI's there is an increased risk for serotonin syndrome.
Question 15
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T or F. SSRI's and NSAID's can never be taken together
Question 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
Question 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.
Question 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?"
Question 19
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T or F. The stopping point for titration is based on how the patient feels.
Question 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
Question 21
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The following are characteristics of cymbalta (select all that apply):
Question 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.
Question 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
Question 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):
Answer
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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
Question 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
Question 26
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T or F. Patient's can experience withdrawal by even missing a single dose of an SNRI.
Question 27
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T or F. There are no renal or hepatic dosing adjustments with SNRI's.
Question 28
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T or F. Antidepressant naive patients should be started on an SSRI.
Question 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
Question 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.
Question 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
Question 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
Question 33
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T or F. MAOI's are not commonly prescribed as they have interact with several drugs.
Question 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.
Question 35
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T or F. True Serotonin Syndrome develops rapidly over 24 hours
Question 36
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The following are signs and symptoms of serotonin syndrome (select all that apply):
Answer
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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
Question 37
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T or F. The provider should maximize the dose of drug before changing or adding drugs.
Question 38
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For these patients, you might consider starting them at lower doses of antidepressants (select all that apply):
Question 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)
Question 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
Question 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.
Question 42
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With a partial resolution of depressive symptoms the provider should first:
Question 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.
Question 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.
Question 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.
Question 46
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T or F. SSRI's and SNRI's are FDA approved for anxiety, but usually require lower doses.
Question 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:
Question 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
Question 49
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T or F. It can take 1-2 weeks for a patient to feel a therapeutic effect from BuSpar.
Question 50
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The provider knows the following is true about benzodiazipines:
Answer
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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.
Question 51
Question
Which benzo is used commonly used for alcohol detox due to its long half-life?
Answer
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Valium
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Klonopin
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Ativan
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Xanax
Question 52
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T or F. Benzodiazipines should not be used for more than 12 weeks.
Question 53
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T or F. There are no withdrawal symptoms from stopping benzos.
Question 54
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A anti-depressant that is known to be effective for sleep in lower doses is:
Answer
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Viibyrd
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Trazadone
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Celexa
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Zoloft
Question 55
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T or F. Trazadone is good for early or middle insomnia.
Question 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.
Question 57
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T or F. A rare side effect of trazadone is priapism.
Question 58
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This medication is an attractive choice for older women who have insomnia and diminished appetite:
Answer
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Remeron
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Melatonin
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Ambien
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Trazadone
Question 59
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The provider knows that lower doses of Remeron can cause:
Question 60
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T or F. Ambien has the potential for causing amnesia and odd behaviors.
Question 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:
Answer
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Zolpidem
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Remeron
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Trazadone
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Zoloft
Question 62
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T or F. There is a risk of developing hyponatremia with the use of Trileptal.
Question 63
Question
For patients on Depakote, the PMHNP knows they should monitor their patients LFT's, platelets and plasma levels:
Answer
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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.
Question 64
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T or F. There is a risk for Stevens-Johnson Syndrome in patient's taking Lamictal.
Question 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
Question 66
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T or F. Atypical anti-psychotics can and should be prescribed by PCP's
Question 67
Question
T or F. One dose of olanzapine (Zyprexa) can raise blood sugar.
Question 68
Question
If a patient is taking an atypical anti-psychotic, the provider should monitor for and counsel patient on:
Answer
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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
Question 69
Question
The following atypical anti-psychotics have the biggest risk for metabolic adverse reactions (select all that apply):
Answer
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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)
Question 70
Question
Metabolic Syndrome is defined as:
Answer
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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)
Question 71
Question
T or F. The PMHNP should get a baseline ECG before initiating Geodon due to risk for prolonged QT interval.
Question 72
Question
T or F. Before prescribing meds for migraines, the NP should advise the patient to maintain a migraine diary.
Question 73
Question
The following is true for migraine rescue agents (select all that apply):
Answer
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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
Question 74
Question
T or F. Excedrin migraine has about the same amount of caffeine as two diet cokes or 1 cup of coffee.
Question 75
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T or F. Triptans are vasoconstrictors and block pain pathways in the brainstem.
Question 76
Question
The following is true in the use of triptans like Imitrex (select all that apply):
Answer
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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
Question 77
Question
In the use of triptans for migraines the provider should teach the patient to:
Answer
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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
Question 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.
Question 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:
Question 80
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T or F. Triptans should not be taken with MAOI's and and within 24 hours of Ergots
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
Question 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.
Question 83
Question
The following are common migraine prophylaxis agents (select all that apply):
Question 84
Question
T or F. Mostly common anti-seizure medications are protein bound and require monitoring to ensure therapeutic levels.
Question 85
Question
Along with providing seizure protection, which two medications also help with mood stabilization:
Answer
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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
Question 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.
Question 87
Question
The most common side effects with Cholinesterase Inhibitors are:
Question 88
Question
T or F. With Namenda common side effects include constipation, headache, dizziness and pain.
Question 89
Question
Because Levadopa compete with amino acids for absorption, it is best to take them:
Answer
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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
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.