NR 546 – Correct Questions and Answers – Practice Questions with Answers and Exam Preparation Material

NR 546 CORRECT QUESTIONS AND
ANSWERS



Prefrontal Cortex Symptoms of MDD - CORRECT ANSWER-Concentration
Mental Fatigue
Mood

PFC & Amygdala Symptoms of MDD - CORRECT ANSWER-Guilt
Suicidality
Worthlessness

Striatum Symptoms of MDD - CORRECT ANSWER-Physical fatigue

Nucleus Accumbens Symptoms of MDD - CORRECT ANSWER-Pleasure interests

Hypothalamus Symptoms of MDD - CORRECT ANSWER-Sleep
Appetite

Thalamus & Hypothalamus Symptoms of Mania - CORRECT ANSWER-Decreased
sleep/arousal

Striatum Symptoms of Mania - CORRECT ANSWER-Motor/agitation

Prefrontal cortex (PFC) Symptoms of Mania - CORRECT ANSWER-Risk-taking
Talkative/pressured speech

Nucleus Accumbens & PFC Symptoms of Mania - CORRECT ANSWER-Racing
thoughts, grandiosity

PFC & Amygdala Symptoms of Mania - CORRECT ANSWER-Mood

Medication Management - CORRECT ANSWER-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. - CORRECT ANSWER-
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. - CORRECT
ANSWER-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. -
CORRECT ANSWER-agitation
headache
dry mouth
constipation
weight loss

escitalopram (Lexapro) SSRI - CORRECT ANSWER-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 - CORRECT ANSWER-mild antihistamine effects; Half-Life:
23-45 hours
Weak Inhibitor of 2D6

fluoxetine (Prozac) SSRI - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-treats anxious depression smokers
require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2

sertraline (Zoloft) SSRI - CORRECT ANSWER-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) - CORRECT ANSWER-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 - CORRECT ANSWER-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) - CORRECT ANSWER-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

Serotonin Antagonist and Reuptake Inhibitors (SARIs) - CORRECT ANSWER-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.

Trazodone - CORRECT ANSWER-The most common SARI, also blocks histaminergic
and α-adrenergic receptors.
Half-Life: 3-6 hours

Serotonin Antagonist and Reuptake Inhibitors (SARIs) - CORRECT ANSWER-Common
Adverse Effects
· sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect

, priapism

Serotonin norepinephrine receptor agonist, alpha2 receptor agonist - CORRECT
ANSWER-Mirtazapine

Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) -
CORRECT ANSWER-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

Serotonin multimodal (SMM) - CORRECT ANSWER-Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition

Tricyclic antidepressants (TCAs) - CORRECT ANSWER-Tricyclic antidepressants
(TCAs) possess both SRI and NRI properties, 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

Tricyclic antidepressants (TCAs) - CORRECT ANSWER-Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)

Tricyclic antidepressants (TCAs) - CORRECT ANSWER-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

MAOIs - CORRECT ANSWER-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.

MAOIs - CORRECT ANSWER-Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)