Medications Flashcards
7 cards from real Psychiatric-Mental Health Nurse Practitioner Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medications flashcards as text
A patient with treatment-resistant depression is started on ketamine infusions. Which mechanism best explains its rapid antidepressant effect?
Answer: NMDA receptor antagonism followed by AMPA receptor upregulation and BDNF release
Ketamine blocks NMDA receptors, causing a glutamate surge that activates AMPA receptors, releasing BDNF and promoting rapid synaptogenesis in the prefrontal cortex and hippocampus.
Which long-acting injectable antipsychotic formulation has the longest dosing interval, allowing once-every-3-month administration?
Answer: Paliperidone palmitate 3-month (Invega Trinza)
Paliperidone palmitate 3-month (Invega Trinza) is the only LAI antipsychotic approved for once-every-3-month dosing, improving adherence in stabilized patients.
A patient with OCD is not responding to adequate SSRI trials. According to evidence-based guidelines, what is the next pharmacological step?
Answer: Augment with a low-dose antipsychotic such as risperidone or aripiprazole
For SSRI-refractory OCD, augmentation with a low-dose D2-blocking antipsychotic (risperidone, aripiprazole, haloperidol) has the strongest evidence and is guideline-recommended.
A patient with bipolar depression is prescribed quetiapine. At which dose range does quetiapine primarily exert antidepressant effects versus antipsychotic effects?
Answer: Low doses (50-150 mg) for antidepressant via H1/5-HT2 blockade; higher doses for antipsychotic via D2 blockade
At lower doses, quetiapine preferentially blocks H1 and 5-HT2A receptors (contributing to antidepressant/sedating effects); D2 blockade (antipsychotic effect) predominates at higher doses.
A patient on disulfiram for alcohol use disorder inadvertently uses an aftershave containing 70% ethanol. What reaction is expected and what is the mechanism?
Answer: Flushing, nausea, tachycardia, and hypotension due to acetaldehyde accumulation from ALDH inhibition
Disulfiram inhibits aldehyde dehydrogenase (ALDH), causing acetaldehyde to accumulate when any ethanol source is absorbed, producing the aversive disulfiram-ethanol reaction even from topical exposures.
Which of the following best describes the pharmacological profile of buspirone and its clinical implications?
Answer: Buspirone is a 5-HT1A partial agonist with delayed onset (2-4 weeks) and no cross-tolerance with benzodiazepines
Buspirone is a 5-HT1A partial agonist that requires 2-4 weeks for anxiolytic effect; it does not cause dependence or withdrawal but will not prevent benzodiazepine withdrawal in dependent patients.
A PMHNP is evaluating a patient who takes lithium and is prescribed ibuprofen for arthritis pain. What pharmacokinetic concern must be addressed?
Answer: NSAIDs reduce renal prostaglandin synthesis, decreasing GFR and increasing lithium reabsorption, risking toxicity
NSAIDs inhibit prostaglandin-mediated renal efferent arteriolar dilation, reducing GFR and increasing lithium reabsorption in the proximal tubule, potentially raising lithium levels by 25-50%.