Download 2025-2026 MH701 FINAL EXAM|REAL 600+QUESTIONS AND ANSWERS100% VERIFIED|A+PASS and more Exams Nursing in PDF only on Docsity!
2025 - 2026 MH701 FINAL EXAM|REAL
600+QUESTIONS AND ANSWERS100%
VERIFIED|A+PASS
1 in 6 hospital admissions are due to _______________which is directly linked to polypharmacy an adverse drug reaction Antipsychotic drugs remain first-line in treatment of ______________, even in the elderly. acute psychosis Are acetylcholinesterase inhibitors and cholinesterase inhibitors the same thing Yes. At what stage of Alzheimer's disease does mild cognitive impairment develop? Stage 2 Mild cognitive impairment (MCI) --cognitive deficits, typically mild --interferes with daily life --major risk factor for frank dementia Normal Aging --subtle decline in episodic memory
--no effect on daily life -- Age is the single greatest risk for cognitive declin e Before managing agitation in dementia with medications, what other things should be considered? Consider and treat pain, nicotine withdrawal, medication side effects, understimulation, overstimulation, or other illnesses/infection Benzodiazepines also increase the risk of _________________________in older adults Cognitive decline and MVA Benzodiazepines and sedative hypnotics (including the "Z" drugs) more than double the risk of ______________________________in older adults Falls and hip fracture Can donepezil (Aricept) and memantine (Namenda) be used to treat moderate to severe Alzheimer's disease? Yes Caution should be used in prescribing memantine (Namenda) to individuals with severe _________________impairment. Renal
How can Schizophrenia with psychosis be differentiated from dementia? People with psychosis are often still oriented to person, place and time How effective are ACH inhibitors and NMDA receptor antagonists in the treatment of dementia? May slow progression and improve memory and functional ability, but does not cure the disease How long do cholinesterase inhibitors ta?ke to work? Up to 6 weeks before any improvement in memory or behavior is evident (and months before stabilization of cognition is seen). How long does memantine (Namenda) take to work? It may take months until any stabilization in the degenerative course of it is seen How should SSRIs typically be started in older adults? Start at one half the minimum effective dose and may double after one week if needed If a benzodiazepine must be used (e.g. emergent situation in a hospital setting), Which benzodiazepine is the drug of choice?
Lorazepam (Ativan) --short acting (half-life does not increase with age) --Fewer drug interactions -- No hepatic phase 1 metabolism (which declines with age) --No active metabolites --Available in small doses (0.25-0.5 mg po) --Well absorbed when given IM If an antipsychotic was needed for a person with Lewy body dementia, which might be chose (due to decrease risk of EPS effects)? Quetiapine (Seroquel) If a patient is experiencing acute agitation and/or psychosis to the point of needing antipsychotic medication, which medications are options? SGAs: Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa) or FGAs: Haloperidol (Haldol) Inhibition of butyrylcholinesterase (BuChE) helps present gliosis. What is gliosis? Scarring which occurs within the CNS, after neurons die. The proliferation/hypertrophy of glial cells; usually in response to CNS damage.
Carbamazepine (Tegretol) Oxcarbazepine (Trileptal) Buspirione (Buspar) Trazodone List 2 ways to improve medication adherence:
**1. Patient education
- Family education
- Brown bag test
- Blister packs/Medication planner
- Medication calendar
- Single pharmacy
- Smartphone reminder apps
- Consider cost (can the patient afford the med)
- Simplify med list (de-prescribe as possible)
- Ask about adverse drug effects
- Consider memory issues and cognitive ability to remember to take medications
- Timing (once a day is easier to comply with than qid)** Mood stabilizers are (off label, FDA approved) in the treatment of dementia-related agitation and/or aggression Lithium and valproate may have some additional neuroprotective effects
Mood stabilizers (as a class) are considered ___________risk in older adults? High risk Name a NMDA receptor antagonist Memantine (Namenda) Name a source which lists drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults BEERS criteria (STOPP/START criteria) Anticholinergics (antihistamines, antispasmodics) Tricyclic antidepressants CV meds (alpha blockers, antithrombotics, antiarrythmics, central alpha agonists) Antipsychotics Benzodiazepines Barbiturates sulfonylureas Sliding scale insulin Muscle relaxers Polypharmacy is MOST accurately defined as:
What antipsychotics may be used in the treatment of acute delirium with psychosis and agitation? Haloperidol (Haldol) po or IM Risperidone (Risperdal Olanzapine (Zyprexa) Quetiapine (Seroquel) What are CV risks of SNRIs in older adults? Hypertension Orthostatic hypotension Syncope Arrhythmia Acute ischemia Death in overdose What are concerning side effects of trazodone and mirtazapine in older adults? Sedation Orthostatic hypotension Falls
What are the most common side effects of acetylcholinesterase inhibitors? Gastrointestinal: increased gastic acid secretion (increased risk of ulcers), nausea, vomiting, and weight loss What are the most common side effects of memantine (Namenda)? Usually well tolerated Dizziness, Headache, Constipation What are the risks of atypical antipsychotics in older adults? Cerebrovascular events (stroke) Venous thromboembolism Metabolism syndrome Pancreatitis What are the risks of typical antipsychotics in the elderly? Extrapyramidal symptoms Pseudoparkinsonism Akasthsia
What do cholinesterase inhibitors do? Increase levels of Ach in the brain by blocking acetylcholinesterase (the enzyme that breaks down Ach) What does a score below 12 on MMSE indicate? Severe dementia What does a score of 18-23 on MMSE indicate Mild cognitive impairment, dementia MMSE scoring 24 - 30 No impairment 18 - 23 Mild cognitive impairment 0 - 17 Severe cognitive impairment What does START stand for in the STOPP/START criteria? Screening Tool to Alert providers to the Right Treatment list of common conditions and medications that should be considered
What does STOPP stand for in the STOPP/START criteria? Screening Tool of Older Person's Prescriptions (STOPP) list of potentially dangerous medications in older adults What does the neurotransmitter acetylcholine (Ach) do? Enables learning and memory What effect does the protein "Tau" have on the development of Alzheimer's disease (AD)? Tau is a protein contained within the axons of the nerve cells. In AD, Tau protein builds up and forms tangles in the areas of the brain important for memory What happens if excessive glutamate is released? Excess levels contribute to excitotoxic cell death What is a brief 30-point questionnaire test that is used to screen for cognitive impairment? Commonly used to screen for dementia? MMSE
What is Agnosia? Inability to recognize familiar objects, taste, sounds and other sensations What is Amnesia? partial or total loss of memory What is Aphasia? inability to express oneself or to understand language What is glutamates function regarding memory? It is involved in encoding and consolidation of memories What is known about Alzheimer's (AD) genetics? Early onset, familial AD: APP (chromosome 21) Presenilin 1 (chromosome 14) Presenilin 2 (chromosome 1) Late onset, familial AD:
Apolipoprotien E4 (ApoE e4) chromosome 19 What is the amyloid cascade hypothesis? The proposal that Alzheimer's disease results from accumulation of beta amyloid. this sets off a cascade of events leading to neuronal cell death and dementia What is the black box warning for antipsychotic use in dementia? The use of antipsychotics in older adults with behavioral or psychological symptoms of dementia will raise the risk of death 2 fold. What is the first line SSRI for agitation or aggression associated with dementia? Celexa (citalopram) What is the mechanism of action (MOA) of an NDMA receptor antagonist? It blocks the NMDA receptor, preventing overstimulation of the excitatory neurotransmitter glutamate What is the most common dementia?
Anticholinergics Alcohol withdrawl Anesthesia with surgery Illness/infection What occurs in Alzheimer's disease stage 1? Amyloid accumulates in the brain, but the person remains asymptomatic What pulmonary risks are increased by cholinesterase inhibitors? May exacerbate asthma and other pulmonary disease What symptoms occur in the final stage (stage 3) of Alzheimer's disease? Signs of dementia: Amnesia--loss of memory Aphasia--speech loss Apraxia--loss of motor function, misuse of objects Agnosia--recognition loss Anomia--inability to remember the name of things
What symptoms would make you suspect Lewy body dementia? --No initial Parkinson's symptoms (may appear after 1 year disease duration) --Vivid hallucinations (beginning early in the disease) --Behavioral symptoms --Insidious onset --Dramatic severity fluctuations day to date What type of dementia manifests initially with changes in personality, social behavior, disinhibition, and language deficits that progress over time to more global neurocognitive deficits? Frontotemporal Dementia (Pick's disease) is associated with pronounced atrophy of the frontal lobe What would occur if antipsychotic medications were given to someone with Lewy body dementia? Patients with Lewy body dementia and Parkinson's disease are extremely sensitive to antipsychotic medications. They can develop life-threatening extrapyramidal symptoms (EPS). When is galantamine (Razadyne) contraindicated? In severe liver or kidney disease
