Which class is considered first line for the treatment of Anxiety Disorders?

Which class is considered first line for the treatment of Anxiety Disorders?

 

  Monoamine oxidase inhibitor (MAOI)

 

  Tricyclic antidepressant (TCA)

 

  Benzodiazepine (BZD)

 

  Selective Serotonin Re uptake Inhibitor (SSRI)

 

 Question 2As the PMHNP you are considering adding a Benzodiazepine  After assessing the client you have decided to chose a Benzodiazepine that has a long half life. Which of the following has a long half life?

 

  Xanax (alprazolam)

 

  Klonopin (Clonazepam)

 

  Serax (oxazepam )

 

  Ativan (lorazepam)

 

 Question 3Benzodiazepine medications act on the Gammaaminobutyric (GABA). GABA is thought to be involved in anxiety disorder, because it has an excitation response.  True or False

 

  True

 

  False

 

 Question 4Which of the following disorders generally require tapering up to the highest doses for clinical response?

 

  Agoraphobia

 

  Obsessive Compulsive disorder

 

  Panic Disorder

 

  Major Depressive Disorder

 

 Question 5Which of the following populations are at a higher risk for a paradoxical reaction to Benzodiazepine Class of Medications (BNZ)? SELECT ALL THAT APPLY

 

  Middle aged Female

 

  Patient with a Neurological Disorder

 

  Elderly/ older adults

 

  Patient with Learning Disability

 

 Question 6Which of the following is true of Buspar (Buspirone)? SELECT ALL THAT APPLY

 

  It is highly addictive

 

  FDA approved for Generalized Anxiety Disorder (GAD)

 

  Not know to be sedating

 

  Can be used for Benzodiazepine withdrawal

 

  Partial Agonist of the 5 HT1A

 

 Question 7Which of the following medications are FDA approved for use in Anxiety Disorders? SELECT ALL THAT APPLY

 

  Neurontin (Gabapentin)

 

  Inderal (Propranolol)

 

  Stelazine (trifluoperazine)

 

  Cymbalta (Duloxetine)

 

  Buspar (Buspirone)

 

 Question 8Which of the following patients would not be a good candidate for Xanax (Alprazolam)? SELECT ALL THAT APPLY

 

  A 30 year old healthy female who has panic attacks when flying

 

  A client who has a history of alcohol abuse

 

  A 75 year old male with elevated AST and ALT

 

  A patient who is receiving ECT

 

  a patient who is just starting on an SSRI with Panic Diosrder

 

 Question 9The 56 year old  patient comes to the PMHNP’s office for a follow up after starting Ativan(Lorazepam). He reports he is experiencing difficulty completing his tasks at work, napping frequently throughout the day, trouble with word finding, forgetfulness, and head aches. Which of the following is the most appropriate actions to take?

 

  Increase the does of Ativan (Lorazepam), as it has not been effective

 

  Refer to Neurology for evalution for Early Onset Dementia

 

  Add Benztropine to off set these symptsom

 

  Discontinue the Ativan (Lorazepam), as he is experieincing side effects

 

 Question 10Klonopin (Clonazepam) acts on the GABA-A receptor site. True or False

 

  True

 

  False

 

 Question 11Which of the following is FDA approved for Insomnia?

 

  Desyrel (trazodone)

 

  Zyprexa (Olanzapine)

 

  Seroquel (Quetiapine)

 

  Ambien (Zolpidem)

 

 Question 12The PMHNP is treating a patient with Major Depressive Disorder. She receives maintenance  ECT 1 x week at Concord Hospital. The client reports difficulty with sleep and is requesting a “sleeping pill”. Based on this information, which of the medications following would be the best choice?

 

  Eszopiclone (Lunesta)

 

  Pro Som (Estazolam)

 

  Trizolam (Halcion)

 

  Temazepam (Restoril)

 

 Question 13Which of the following is education that the PMHNP should include when prescribing Zaleplon (Sonata)? Select All That Apply.

 

  Medication should not be abruptly stopped

 

  Be sure to alot 7-8 hours for sleep

 

  Take on an empty stomach for increased efficacy

 

  Take on a full stomach for increased absoprtion and efficacy

 

 Question 14Endogenous melatonin is a hormone secreted by the _____ gland

 

  Adrenal

 

  Pituitary

 

  Parathyroid

 

  Pineal

 

 Question 15Melatonin is FDA approved for Insomnia. True or False

 

  True

 

  False

 

 Question 16Which of the following statements are true about Orexin?

 

  Orexins Works on Histamine 1 receptor

 

  Orexins regulate wakefulness, vigilance, feeding behavior and reward.

 

  Orexins bind to GABA type A receptor

 

  Orexins are released in the monoamine neurotransmitter centers of the brain stem

 

  Lack of orexins is associated with narcolepsy

 

 Question 17You are a PMHNP and have a student with you. Your are reviewing Suvorexant (Belsomra). Which of the following would be correct information about this medications? SELECT ALL THAT APPLY.

 

  It is inexpensive and generally does not require a prior authorization from insurance companies

 

  Schedule IV medication

 

  Recommended to allow at least 7 hours of sleep time

 

  It is dosed between 10-20 mg at bedtime

 

 Question 18The PMHNP is considering ordering Ramelteon (Rozerem) for a patient with insomnia. Which of the following labs would the PMHNP want to pay close attend to?

 

  RBC and Platlets

 

  WBC and ANC

 

  BUN and Creatinine

 

  ALT and AST

 

 Question 19You have decided to prescribe Tasimelteon (Hetlioz) for your patient with Insomnia. During your patient education, the patient says “It sound like I can just buy Melatonin over the counter, why should I get this?” Which of the following would not be a correct answer .

 

  Potency is expected to be greater than OTC

 

  The presciption medication works on a different receptor

 

  The onset of action and Peak plasma levels vary significantly depending on the strength of the supplement

 

  Wide variation in onset of action & peak plasma levels found in supplements

 

 Question 20Your are treating a patient who is suffering from Insomnia. This patient has know history of substance abuse. You need to consider potential for abuse when prescribing. Which of the following medication is known to have a potential for abuse?

 

  Elavil (Amitriptyline)

 

  Desyrl (Trazodone

 

  Ativan (Lorazepam)

 

  Remeron (mirtazapine)

 

 

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