Nr 546 Advanced Pharmacology Exam Questions And Answers (Verified

NR 546
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1. Prefrontal Cortex Symptoms of MDD: Concentration
Mental Fatigue
Mood
2. PFC & Amygdala Symptoms of MDD: Guilt
Suicidality
Worthlessness
3. Striatum Symptoms of MDD: Physical fatigue
4. Nucleus Accumbens Symptoms of MDD: Pleasure interests
5. Hypothalamus Symptoms of MDD: Sleep
Appetite
6. Thalamus & Hypothalamus Symptoms of Mania: Decreased sleep/arousal
7. Striatum Symptoms of Mania: Motor/agitation
8. Prefrontal cortex (PFC) Symptoms of Mania: Risk-taking
Talkative/pressured speech
9. Nucleus Accumbens & PFC Symptoms of Mania: Racing thoughts, grandiosity
10. PFC & Amygdala Symptoms of Mania: Mood
11. 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
12. 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


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13. 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
14. 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
15. 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
16. citalopram (Celexa) SSRI: mild antihistamine effects; Half-Life: 23-45 hours
Weak Inhibitor of 2D6
17. 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
18. 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




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19. fluvoxamine (Luvox) SSRI: treats anxious depression smokers require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
20. 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
21. 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
22. 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
23. 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
24. Serotonin Antagonist and Reuptake Inhibitors (SARIs): SARIs potently block 5-HT2A and
5HT 2C receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and reuptake
inhibition is present at higher doses.
25. Trazodone: The most common SARI, also blocks histaminergic and α-adrenergic receptors.
Half-Life: 3-6 hours
26. Serotonin Antagonist and Reuptake Inhibitors (SARIs): Common Adverse Effects
· sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect
priapism



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27. Serotonin norepinephrine receptor agonist, alpha2 receptor agonist: Mirtazap-
ine
28. Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor
(SPARI): Vilazodone (Viibryd)
· Inhibits serotonin reuptake with partial 5HT1A agonism
Appropriate for depression/comorbid anxiety, its action is similar to a combination of SSRI and buspirone
29. Serotonin multimodal (SMM): Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition
30. Tricyclic antidepressants (TCAs): Tricyclic antidepressants (TCAs) possess both SRI and NRI proper-
ties, but they also block other receptors, including α1-adrenergic, histamine-1, and muscarinic cholinergic receptors.
TCAs are not used first-line because of the high incidence of adverse effects and the risk of potential overdose and
death due to overdose
31. Tricyclic antidepressants (TCAs): Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
32. Tricyclic antidepressants (TCAs): Common adverse effects of TCAs
Alpha-1 adrenergic effects-Orthostatic hypotension
Histamine effects-Sedation
Histamine effects-Weight gain
Anticholinergic effects-Blurred vision
Anticholinergic effects-Urinary retention
Anticholinergic effects-Constipation
Anticholinergic effects-Dry mouth
33. MAOIs: Last choice medication class for depression due to the many potential, serious side effects. MAOIs have
specific dietary restrictions that when ignored, may be very uncomfortable or very serious for clients.
34. MAOIs: Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B