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PC707 CNS EXAM QUESTIONS AND ANSWERS (100% Pass)
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PC707 CNS EXAM QUESTIONS AND ANSWERS 2024-2025(100% Pass)
Hydroxyzine (Vistaril)Non-benzodiazepines & pregnancy - Answer ‣ 1st generation
antihistamine
‣ pregnancy category C.
‣ considered safe for short-term treatment of anxiety, insomnia, & exhaustion from
prodromal labor.
Zolpidem (Ambien) Non-benzodiazepines & pregnancy - Answer ‣ category C &
non-benzodiazepine
‣ may be used as a last resort, for short-term treatment as well.
Benzodiazepines & Breastfeeding - Answer ‣ Those w/ a long half-life (Diazepam
(Valium) & Clonazepam (Klonopin)) should be avoided, as ♀ will 🚫 be able to time
breastfeeding to minimize infant exposure.
‣ Short-term use of those w/ a shorter half-life (Midazolam (Versed) & Lorazepam
(Ativan)) is likely safe w/ breastfeeding.
Patient Teaching BF w/ benzodiazepine use - Answer ‣ recommend ♀ time feedings to
reduce exposure & observe the infant for drowsiness, sedation, inadequate weight gain,
& developmental issues.
‣ If excessive sedation occurs, monitoring serum levels is indicated.
‣ Some ♀ may opt to "pump & dump" & temporarily formula feed.
‣ discuss risks, benefits, & unknowns
‣ consultation is advised before prescribing--especially if the infant is premature.
Non-benzodiazepines & Breastfeeding: - Answer ‣ Buspirone (BuSpar) contraindicated
(limited data).
,‣ Hydroxyzine (Vistaril) short-term use in small doses is likely safe
‣ if the ♀ is 🚫 suffering from insomnia, a newer, non-sedating antihistamines is
recommended as 1st line.
‣ Due to low levels in the breastmilk & a short-half life, Zolpidem (Ambien) is considered
safe w/ breastfeeding.
Anti-depressant medications MOA - Answer ‣ block the reuptake of norepinephrine,
serotonin, & some dopamine from the pre-synaptic neuron, thereby ↑ing the amount of
neurotransmitter in the synapse.
‣ There are several different receptors for serotonin & norepinephrine.
‣ Different anti-depressants block specific combinations of these receptors in an
attempt to refine the effects of the neurotransmitters.
Why is it essential that the advanced practice nurse become familiar w/ evidence-based
guidelines regarding treatment of mental health disorders? - Answer mental health
disorders, when combined w/ alcohol & substance abuse are the most disabling of all
illnesses in terms of years of life lost due to disability.
Evidence based treatment recommendation for moderate to severe depression -
Answer combination of medication & counseling is the most effective approach to
treatment.
Antidepressants generally fall into one of the following categories: - Answer 1. Selective
serotonin reuptake inhibitors (SSRIs)
2. Serotonin norepinephrine reuptake inhibitors (SNRIs)
3. Tricyclic antidepressants (TCAs)
4. Monoamine oxidase inhibitors (MOAIs)
5. Other
drugs of choice for depression and/or chronic anxiety. - Answer SSRIs & SNRIs are
some of the most commonly prescribed medications.
,Why are SSRI's & SNRI's drug of choice for anxiety & depression? - Answer They have:
‣ low abuse potential
‣ lack of lethality w/ overdose
‣ ↑ effectiveness.
SSRI's SNRI's SE during initial treatment - Answer ‣ ↑ed suicidal ideation
‣ Sedation or insomnia (depending on the SSRI selected).
‣ Sexual dysfunction
‣ psychomotor retardation or agitation.
Time for SSRI's & SNRI's to reach therapeutic effect - Answer It will take 2-3 wks to see
an initial effect & up to 6 wks to achieve a full effect;
What do you tell a patient who complains they are 🚫 getting any better after a two-week
trial? - Answer it is important that they are told that it may take six weeks to achieve the
maximum benefit from the medication.
Pt education for medications known to have a high risk for nausea and/or sedation -
Answer have the patient take it at bedtime
These S/E's typically disappear after 2 weeks.
Antidepressants known to have a high risk for nausea/sedation - Answer ‣ paroxetine
‣ citalopram
Patient education for medications known to be more activating & may cause insomnia -
Answer patient should take this in the morning.
These S/E's typically disappear after 2 weeks.
Antidepressants known to be more activating, causing insomnia - Answer fluoxetine
, (Prozac®)
Serotonin Syndrome - Answer ‣ rare but serious complication that can occur w/ the use
of serotonic agents
‣ occurs from overdose or drug to drug interactions.
It is essential to review the current medication list prior to prescribing serotonergic
drugs.
symptoms of serotonin syndrome - Answer may range from mild to severe include:
‣ confusion
‣ agitation
‣ clonus
‣ fever
‣ tremor
‣ hyperreflexia
‣ respiratory failure & death
SNRIs MOA - Answer ‣ boost serotonin & norepinephrine throughout the brain
‣ boost dopamine in the prefrontal cortex. Venlafaxine (Effexor) was the first SNRI
marketed in the U.S. Desvenlafaxine SR (Pristiq), duloxetine (Cymbalta) are other SNRIs
currently on the market.
Atypical antidepressants examples - Answer ‣ bupropion hydrochloride (Wellbutrin)
‣ triazolopyridine (Trazodone).
Bupropion - Answer ‣ atypical antidepressant that has been used as an aid for smoking
cessation called Zyban.
‣ Contraindicated in patients w/ history of seizure risk.
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