2023-2024 NR546 Pharmacology Midterm Exam With Answers (298 Solved Questions)

Name: 2023-2024 NR546 Pharmacology Midterm Exam With Answers (298 Solved Questions)
Brand: Chamberlain College of Nursing
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NEWLY UPDATED NR 546 MIDTERM EXAM
2023-2024 WITH ANSWERS
thalamus - -answer-involved in sensory organ and motor
command processing
striatum - -answer-involved in complex motor actions, also
links cognition to motor actions
limbic system - -answer-includes circuits that are associated
with pleasure and reward
basal ganglia - -answer-group of structures involved in
voluntary motor movements
amygdala - -answer-involved in emotional regulation and
perception of odors
corpus callosum - -answer-controls the communication
between the two brain hemispheres
white matter - -answer-contains nerve fibers that connect
neurons from different regions into functional circuits
grey matter - -answer-contains nerve cells and dendrites
brain tissue - -answer-made up of grey matter and white
matter
dorsal striatum - -answer-involved in complex motor actions
and linkage of cognition to motor actions

-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
The field of epigenetics is rapidly growing and can help
explain how gene expression is: - -answer-influenced by
environmental factors and how epigenetics contributes to
the manifestation of mental illness
How does epigenetics impact a person's mental health? - -
answer-internal or external factors activate portions of the
genome that result in the manifestation of mental health
symptoms
-activation is often a result of a stressful event, which, when
combined with the genetic risk, results in the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of
an abnormal gene or of normal genes being "on" when they
should be "off."
What should the PMHNP consider when prescribing chemical
restraints? - -answer--allergy status
-prior med hx for adverse drug reactions r/t the meds
ordered in the chemical restraint
-state regulations regarding chemical restrains must be
reviewed
Are the PMHNP and other staff liable if the client has an
allergic reaction or adverse side effects to the drugs used
for chemical restraint? - -answer-No.
The client has been court-ordered to take the prescribed
medications and the standing order for chemical restraints

is approved. The PMHNP and other staff are not liable if the
patient has an allergic reaction or adverse side effects.
How does reviewing the genetic makeup of a client help
guide the PMHNP in selecting medication for clients? - -
answer--Genetic testing can assist by providing more
information on how clients may respond to certain
psychotropic medications
-provides information on how a client may break down and
metabolize medications based on the cytochrome P450
system.
Tanrıkulu and Erbaş (2020) investigated identical twins to
determine the presence of an inherited link for
schizophrenia and why one twin may develop schizophrenia
when the other does not. When two people have 100%
identical DNA, why don't both persons develop the exact
illnesses? Studies of identical Danish twins found that if one
twin had schizophrenia, the other twin had a 50% lifetime
risk of developing schizophrenia (Lemvigh et al., 2020). Why
is there only half the risk? - -answer-Both environmental and
psychosocial stressors can impact mental health. Although
twins may have identical genes, their gene expression may
be different.
There may be an environmental exposure that turned a gene
"on" that should have been "off" for one twin to develop
schizophrenia and not the other.
central sulcus - -answer-separates the frontal lobe from the
parietal lobe

frontal lobe - -answer-associated with movement,
intelligence, abstract thinking
broca's area - -answer-speech production
temporal lobe - -answer-involves object identification and
auditory signals
cerebellum - -answer-coordination
wernicke's area - -answer-speech comprehension
occipital lobe - -answer-primary visual area
parietal lobe - -answer-keeps us alert to what is going on
around us
sensory cortex - -answer-pain, heat, and other sensations
motor cortex - -answer-movement
hippocampus - -answer-involved in both memory and anxiety
nucleus accumbens - -answer-involved in the reward process
Types of epigenetic changes: - -answer-DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental
health treatment must also be taken into account, including:
- -answer--informed consent

-competence to make healthcare decisions
-off-label prescribing
Informed consent - -answer-Clients have the right to receive
enough information to make decisions about treatment.
-must also be informed about potential risks associated with
medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However,
clients can be forcibly medicated if they are violent toward
themselves or others and when less restrictive methods
have failed
Compliance - -answer-A court order may be issued for a
client to receive treatment against their wishes if they are
considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited
cognitive capabilities or are incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about
their state laws and abiding by them.
Off-Label Prescribing - -answer-Some clients may benefit
from the unapproved use of a drug for symptom
management.
-Example: many SSRIs used to tx anxiety and OCD but are
not FDA approved for use in this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest
recommendations for off-label prescribing.

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Incidence of mental illness-what factors are increasing the
incidence - -answer-Psychological and sociological factors
Lifestyle factors such as a client's smoking status, diet,
exercise, history of medication adherence, or history of
addiction should be considered when prescribing
psychotropic medications
Adherence - -answer-Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - -answer--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - -answer--prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - -answer-the study of what happens to a
drug from the time of administration until the parent drug
and all metabolites leave the body

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CYP450 - -answer-CYP450 enzymes in the gut wall or liver
convert drug substrate into a biotransformed product in the
bloodstream, responsible for degradating of a large # of
psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes,
determined with pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism
from the major CYP450 enzymes and are said to be
"extensive metabolizers", most drug doses are set for these
individuals.
*genetic variants of these enzymes can make poor
metabolizers or ultra rapid metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
ultra rapid metabolizers - -answer-elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping - -answer-the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily
measured and used to predict which patients might need to
have dosage adjustments
-measurement of genes for drug metabolism
most common targets of psychotropic drugs - -answer-G-
protein receptors
-Drug actions at these receptors occur in a spectrum, from
full agonist actions, to partial agonist actions, to
antagonism, and even to inverse agonism.

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Pharmacokinetics concepts - -answer-absorption
distribution
metabolism
excretion
Flockhart Table - -answer-drug interactions that are
mediated by cytochrome P450 enzymes
comprehensive list of drugs and the interactions related to
the cytochrome P450 system
Neurotransmitters - -answer-chemicals released by neurons
to send communication across synaptic clefts to other
neurons
-impact human emotion and behavior
Neurotransmission: - -answer-the chemical transmission of
information between neurons and their target cells
-the chemicals, or neurotransmitters, are released from their
transport vesicles to bind with receptor sites to perform
their duties, which are excitatory or inhibitory
-neurotransmitter then either returned and stored for future
use (reuptake) or inactivated and dissolved by enzymes
-Types: Classic, Retrograde, Volume
Classic neurotransmission - -answer-neurons send electrical
impulses from one part of the cell to another part of the
same cell via their axons
-one neuron hurling a chemical messenger, or
neurotransmitter, at the receptors of a second neuron

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-electrical impulse converted chemical signal at the synapse
in a process known as excitation-secretion coupling, the
first stage of chemical neurotransmission, then back into
electrical impulse in second neuron
-chemical information from the first neuron triggering a
cascade of further chemical messages within the second
neuron to change that neuron's molecular and genetic
functioning
Retrograde neurotransmission - -answer-postsynaptic
neurons "talk back" to their presynaptic neurons
-second neuron to the first at the synapse between them
-Chemicals produced specifically as retrograde
neurotransmitters at some synapses include:
endocannabinoids, gaseous neurotransmitter nitric oxide
(NO), nerve growth factor (NGF).
Volume neurotransmission - -answer-Neurotransmission
without a synapse or nonsynaptic diffusion
neurotransmission
-Chemical messengers sent by one neuron to another can
spill over to sites distant to the synapse by diffusion
-neurotransmission can occur at any compatible receptor
within the diffusion radius of the neurotransmitter
-neurotransmission occurs in chemical "puffs"
-sophisticated "chemical soup."
-example: dopamine action in the prefrontal cortex, at the
sites of autoreceptors on monoamine neurons
Excitatory neurotransmitters: - -answer-increase the
likelihood that the neuron will fire an action potential

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inhibitory neurotransmitters: - -answer-decrease the
likelihood that a neuron will fire an action
neurotransmitters that most impact mental health can be
classified into four major categories: - -answer-cholinergics
-acetylcholine
monoamines
-norepinephrine, dopamine, serotonin, histamine
amino acids
-gamma- amino-butyric acid and glutamate
neuropeptides
Inhibitors: VISA CKGQ - -answer-Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconazole
Grapefruit Juice
Quinidine
-decrease medication metabolism
Inducers: CRAP GPS - -answer-Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital

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Sulfonylureas
-increase medication metabolism
neurotransmitters that may be responsible for a client's
symptoms of depression - -answer-Imbalanced levels of
acetylcholine, norepinephrine, serotonin, histamine, or
glutamate can contribute to symptoms of depression
client who is a poor metabolizer: - -answer-has a lower
concentration of the necessary enzyme to metabolize a
drug, which results in higher blood concentrations of the
drug.
-increase the risk of side effects and adverse reactions
Why is trazodone not used as a front-line antidepressant - -
answer-Its antidepressant that has a secondary effect of
blocking histamine and adrenergic receptors
-causes sedation and somnolence and as a result
*often used as an adjunct in therapy when a depressed
patient has difficulty sleeping
effect on neurotransmitters and side effects: Selective
Serotonin Reuptake Inhibitors (SSRIs) - -answer-Inhibits the
reuptake of serotonin, which can cause nausea, agitation,
headache, and sexual dysfunction
effect on neurotransmitters and side effects: Serotonin and
Norepinephrine Reuptake Inhibitors (SNRIs) - -answer-
Inhibits the reuptake of serotonin and norepinephrine, which
can cause nausea, sweating, insomnia, tremors, sexual
dysfunction

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effect on neurotransmitters and side effects: Tricyclic
Antidepressants - -answer--Inhibits the reuptake of serotonin
and norepinephrine, which can cause sexual dysfunction
-Blocks norepinephrine receptors, which can cause
hypotension and tachycardia
-Blocks histamine receptors, which can cause sedation and
weight gain
-Blocks acetylcholine receptors, which can cause dry
mouth, constipation, blurred vision, and urinary retention
effect on neurotransmitters and side effects: Monoamine
Oxidase Inhibitors (MAOIs) - -answer-Increases
norepinephrine and serotonin by inhibiting the enzyme that
inactivates it, which can cause sedation, dizziness, sexual
dysfunction, and hypertensive crisis
effect on neurotransmitters and side effects:
Benzodiazepines - -answer-Increases the receptor affinity for
GABA, which can cause dependence and confusion
effect on neurotransmitters and side effects: Bupropion - -
answer-Inhibits the reuptake of norepinephrine and
dopamine, which can cause insomnia, dry mouth, tremors,
and seizures
antagonist - -answer-causes a conformational change that
stabilizes the receptor in the baseline state and thus is
"silent."
-blocks the action of a neurotransmitter
agonists - -answer-fully stimulate G-protein-linked receptors

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partial agonists - -answer-stimulate receptors to a lesser
degree than an agonist or natural neurotransmitter
SSRIs, SNRIs, and tricyclic antidepressants increase ________
levels.
___________ do not impact serotonin levels. - -answer-increase
serotonin levels.
Benzodiazepines do not impact serotonin levels.
Is nicotine an inducer or an inhibitor of the CYP 1A2
enzyme? - -answer-inducer
Nicotine is an inducer of the CYP 1A2 enzyme. Does the
PMHNP anticipate Joshua may need a higher or lower dose
of olanzapine to achieve a therapeutic response? - -answer-
Higher
-Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers
the concentration of drugs. Therefore, a higher dose of
olanzapine may be needed to control his symptoms.
Ernesto, a 60-year-old, presents to the PMHNP with report of
having anxiety, frequent occurrences of feeling frozen in
place and like his heart is pounding out of his chest, as well
as having difficulty sleeping.
The PMHNP suspects the client has an elevated level of
which neurotransmitter? - -answer-Norepinephrine
-responsible for the regulation of fight or flight responses
and can impact mood and sleep.
Which of the following is the best medication class for the
PMHNP to prescribe for Ernesto to address his elevated

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norepinephrine levels? - -answer-selective serotonin
reuptake inhibitor would block the reuptake of serotonin,
leaving a larger amount of serotonin available. Increasing
the amount of serotonin would help regulate the feelings of
fear and anxiety. Reducing the occurrence of fear would
help reduce the release of norepinephrine.
A serotonin and norepinephrine reuptake inhibitor would
prevent the reuptake of norepinephrine, which would not
reduce the level of norepinephrine as needed.
Benzodiazepines increase the levels of GABA and do not
impact norepinephrine. A monoamine oxidase inhibitor
would increase levels of norepinephrine.
During a follow up appointment after 4 weeks, the PMHNP
should assess for the need to add which medication to
Ernesto's treatment plan? - -answer-The nurse should assess
for sexual dysfunction and anticipate the potential need for
a phosphodiesterase inhibitor such as sildenafil (Viagra).
-After 4 to 6 weeks, the client should be experiencing full
effects of the SSRI, so the need for a short-term medication
like a benzodiazepine or a beta blocker are not anticipated.
St. John's Wort is contraindicated with an SSRI and can
cause serotonin syndrome.
Glu - -answer-Glutamate
-amino acid
-excitatory neurotransmitter
-"workhorse" of the brain-can affect almost every neuron in
the brain
-affects: energy, memory, learning, neural plasticity
-relay sensory info. and regulate spinal and motor reflexes
-too much: schizophrenia, epilepsy, mania

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-receptors: NMDA, AMPA
GABA - -answer-inhibitory neurotransmitter
-decrease neuroexcitability across the brain
-"chill", take the edge off stress, help people calm down,
relax, destress, sleep
-to little: may experience anxiety or schizophrenia
-slows down everything, even breathing
-affect executive function and motor coordination, increase
risk for accidents
-Increased levels of gamma-aminobutyric acid have a
calming effect.
5HT - -answer-Serotonin
-help regulate mood
-makes relaxed, comfortable, decreases stress, regulate
sleep, arousal, libido, aggression, pain perception
NE - -answer-norepinephrine
-monoamine neurotransmitter
-focus and productivity
-too much due to stress, meds, caffein, stimulants can
cause: nervous, antsy, affect focus
DA - -answer-dopamine
-monoamine neurotransmitter
-regulate mood
-associated with executive function, ability to perform well,
be organized, emotional intelligence
-movement and coordination
-to little: lose pleasure, interest, alertness, self-confidence,
parkinson's disease

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University

Chamberlain College of Nursing

Subject

Pharmacology

2023-2024 NR546 Pharmacology Midterm Exam With Answers (298 Solved Questions)

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