Post12 Psych/Seizure/Abuse

An herb thought to be useful in treating memory problems is:
A. Ginseng
B. St John's Wort
C. Ginkgo Biloba
D. Echinacea

Which of the following should patients and/or their caregivers be told when they start taking antidepressant drugs?
A. Drugs often deplete potassium. Keep diet high in potassium rich food.
B. The drugs may stimulate sexual appetite.
C. Dry mouth should be managed with ice chips or sugarless gum.
D. It is safe to use herbal supplements such as St. John's wort to enhance the antidepressant effect of the drugs.

Use of St John's wort with antidepressants can lead to serotonin syndrome. Up to 70% of pts on SSRIs may have reduced libido and inability to reach orgasm. SE include anticholinergic effects such as dry mouth. Avoid sugar gum to reduce cavities.

Fluoxetine (PROZAC) relieves depression by:
A. increasing the amount of serotonin in the synaptic cleft
B. blocking release of norepinephrine from the pre-synaptic nerve
C. increasing the metabolism of MAO (mono-amine oxidase)
D. depressing the metabolism of MAO

Lamotrigine is indicated for:
A. Tonic-clonic seizures
B. Status epilepticus
C. Insomnia
D. Absence seizures

Zolpidem is indicated for:
A. Bipolar disease
B. Absence seizures
C. Tonic-clonic seizures
D. Insomnia

Severe alcohol withdrawal:
A. May not be manifested until several days after alcohol ingestion has stopped.
B. Includes signs and symptoms of hallucinations, agitation, sweating, rapid heart rate.
C. Is treated aggressively with benzodiazepines or the patient could die.
D. All of the above.

Ms. J is brought to the emergency room in a semi-comatose state. She has a low blood pressure and is breathing slowly. Her pupils are pinpoint. These signs and symptoms are most consistent with a drug overdose on which of the following?
A. Amphetamines
B. Cocaine
C. A hallucinogen such as LSD
D. An opiate such as heroin

A patient with a 3 week history of fatigue, sadness, irritability, boredom and difficulty paying attention in school seeks medical attention for insomnia. Sertraline 50 mg/day is furnished but 2 days later the patient states the symptoms have not improved. The best course of action is to:
A. Explain that more time is needed to see effect
B. Increase the dose of sertraline
C. Switch to paroxetine
D. Add zolpidem for the next 6 weeks
She is depressed and is being treated with an appropriate drug and dose. It takes several weeks for an SSRI to rebuild the receptors to give a therapeutic effect. The dose can be increased after a week or so if needed, but 2 days is too early. Zolpidem could be given for sleep but not for that long.

A patient receiving donepezil and memantine comes to the hospital with nausea and vomiting. You note he swallows frequently and drools clear saliva. His skin is wet with sweat. BP is low at 80/50 and heart rate is low at 50. You should treat shock and......
A. give atropine.
B. discontinue the memantine.
C. give physostigimine.
D. increase the donepezil dose.
This patient is in cholinergic crisis, from too much ACh. (Too much parasympathetic.) Block with atropine, an anticholinergic. Physostigmine would increase AcH as would increasing the donepezil dose. This toxicity is from the donepezil, so discontinuing the memantine would not help.

When evaluating care provided by hospitals, the Joint Commission may review whether chemical restraints are used appropriately, in the treatment of patients, or inappropriately, to "police" irritating behavior. Which of the following is an appropriate use of chemical restraints?
A. The nurse administers risperidone to an elderly confused patient who tried to climb over the bedrail when the family has just agreed to leave one member at the bedside around the clock.
B. A patient with a drug overdose is yelling obcenities in the emergency room and other patients are complaining. The nurse gives a dose of haloperidol.
C. The doctor orders vicodin for a delirious patient who has pulled out 2 IV lines in the last hour.
D. A patient is agitated and restless, writhing around in bed which is causing the dressings to be torn off a wound. The nurse gives a dose of midazolam.
Before using any restraints, other options should be tried, such as having a "sitter" at the bedside who can call the nurse if the patient attempts to do something that would be detrimental to their health (such as pull out a tube or fall out of bed). Vicodin is for pain, not to minimize agitated, confused behavior. (If you picked this, be careful that you are answering the question written, not making up your own. It does not say this patient is in pain.) Stopping a patient from using foul language is not necessary for their safety or treatment. Joint Commission would ask us to put the patient in a private room. A patient whose agitated behavior is causing negative effects on the treatment of a wound can be given a chemical restraint.

An herb thought to be useful in treating anxiety and sleeping problems is:
A. Ginseng
B. Senna
C. Kava
D. Saw Palmetto         

The mechanism of action of phenytoin (DILANTIN)is
A. beta receptor blockade.
B. GABA inhibition.
C. calcium channel blockade.
D. reducing sodium transport.

Ethosuximide is indicated for:
A. Partial seizures
B. Tonic-clonic seizures
C. Absence seizures
D. Status epilepticus

An alcoholic who was driving drunk is admitted to the hospital after an auto accident. Which statement is FALSE?
A. Folic acid, thiamine, and multivitamins will probably be ordered.
B. Delirium tremors (DTs) may develop and result in death if the patient is not treated with a drug such as lorazepam (ATIVAN).
C. Alcohol depletes liver fat so the patient will need a diet high in fat.
D. Prolonged night blindness from alcohol may have contributed to the accident.

Mr. B is brought in by ambulance with a drug overdose. He was found outdoors after a relatively cold night. He is in a coma, blood pressure is low, and his body temperature is low. Which drug would you suspect he overdosed on?
A. Alcohol
B. Cocaine
C. A hallucinogen such as LSD
D. Marijuana or hashish

Which of the following are/is a cholinesterase inhibitor(s), appropriate for the treatment of symptoms of Alzheimer's disease?
A. physostigmine, pyridostigmine
B. donepezil, galatamine, rivastigimine
C. memantine
D. carbamazepine, ethosuximide, lamotrigine
Donepezil, Galatamine, and Rivastigimine are acetylchoinesterase inhibitors that increase the amount of AcH in the synapse and improve memory in Alzhiemer's pts. Physostigmine and pyridostigmine are also acetylcholinesterase inhibitors but are used in glaucoma and myasthenia gravis respectively. Memantine is used for Alzheimers but does not work on AChE. The other drugs are used for seizures.