NR 546 COMPLETE FINAL EXAM STUDY GUIDE WITH
PRACTICE QUESTIONS AND VERIFIED ANSWERS 2025–
2026
Prefrontal Cortex Symptoms of MDD - Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - Physical fatigue
Nucleus Accumbens Symptoms of MDD - Pleasure interests
Hypothalamus Symptoms of MDD - Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - Decreased sleep/arousal
Striatum Symptoms of Mania - Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - Risk-taking
Talkative/pressured speech
,Nucleus Accumbens & PFC Symptoms of Mania - Racing thoughts, grandiosity
PFC & Amygdala Symptoms of Mania - Mood
Medication Management - SSRI-Selective Serotonin Reuptake Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days
once the body adjusts to increased serotonin levels. - diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly
stopped to avoid discontinuation symptoms. NE effects of the medication may increase anxiety
in some clients. Report worsening anxiety to the provider. - elevated blood pressure
anxiety
insomnia
,constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop
taking medication if seizures occur. Stop taking medication if anxiety is noted. - agitation
headache
dry mouth
constipation
weight loss
escitalopram (Lexapro) SSRI - no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - mild antihistamine effects; Half-Life: 23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
, Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - treats anxious depression smokers require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - also treats social anxiety and hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
venlafaxine (Effexor) - treats both depression and anxiety disorders, ensure trial of higher dose
before switching to a different medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
duloxetine (Cymbalta) SNRI - effective for atypical pain at higher doses; appropriate for clients
who present with somatic symptoms of depression; effective for atypical pain, such as
fibromyalgia and diabetic neuropathy
Half-Life: 12 hours
Inhibitor of 2D6
bupropion (Wellbutrin) - NDRI may improve energy, alertness, and motivation; not first-line
treatment for anxiety; contraindicated in clients with a history of seizures
Avoid in patients with comorbid anxiety
Half-Life: Parent 10-14 hours; Metabolite 20-27 hours
Inhibits 2D6
PRACTICE QUESTIONS AND VERIFIED ANSWERS 2025–
2026
Prefrontal Cortex Symptoms of MDD - Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - Physical fatigue
Nucleus Accumbens Symptoms of MDD - Pleasure interests
Hypothalamus Symptoms of MDD - Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - Decreased sleep/arousal
Striatum Symptoms of Mania - Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - Risk-taking
Talkative/pressured speech
,Nucleus Accumbens & PFC Symptoms of Mania - Racing thoughts, grandiosity
PFC & Amygdala Symptoms of Mania - Mood
Medication Management - SSRI-Selective Serotonin Reuptake Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days
once the body adjusts to increased serotonin levels. - diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly
stopped to avoid discontinuation symptoms. NE effects of the medication may increase anxiety
in some clients. Report worsening anxiety to the provider. - elevated blood pressure
anxiety
insomnia
,constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop
taking medication if seizures occur. Stop taking medication if anxiety is noted. - agitation
headache
dry mouth
constipation
weight loss
escitalopram (Lexapro) SSRI - no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - mild antihistamine effects; Half-Life: 23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
, Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - treats anxious depression smokers require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - also treats social anxiety and hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
venlafaxine (Effexor) - treats both depression and anxiety disorders, ensure trial of higher dose
before switching to a different medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
duloxetine (Cymbalta) SNRI - effective for atypical pain at higher doses; appropriate for clients
who present with somatic symptoms of depression; effective for atypical pain, such as
fibromyalgia and diabetic neuropathy
Half-Life: 12 hours
Inhibitor of 2D6
bupropion (Wellbutrin) - NDRI may improve energy, alertness, and motivation; not first-line
treatment for anxiety; contraindicated in clients with a history of seizures
Avoid in patients with comorbid anxiety
Half-Life: Parent 10-14 hours; Metabolite 20-27 hours
Inhibits 2D6
