Chamberlain University-Illinois NR 546
NR 546 EXAMS REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
Students also studied
Flashcard sets Study guides
C
Terms in this set (288)
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 Decreased sleep/arousal
Mania
Striatum Symptoms of Mania Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Racing thoughts, grandiosity
Mania
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 diarrhea
(SSRIs): Most adverse effects will subside headache
after 4-5 days once the body adjusts to weight gain
increased serotonin levels. sexual side effects
Serotonin Norepinephrine Reuptake elevated blood pressure
Inhibitors (SNRIs): Medications should not be anxiety
abruptly stopped to avoid discontinuation insomnia
symptoms. NE effects of the medication constipation
may increase anxiety in some clients.
Report worsening anxiety to the provider.
Norepinephrine Dopamine Reuptake agitation
Inhibitors (NDRI): Take medication in the headache
morning. Stop taking medication if seizures dry mouth
occur. Stop taking medication if anxiety is constipation
noted. 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
Serotonin Antagonist and Reuptake SARIs potently block 5-HT2A and 5HT 2C receptors, which
Inhibitors (SARIs) allow more 5-HT to interact at postsynaptic 5-HT1A sites.
Serotonin blockade and reuptake inhibition is present at
higher doses.
Trazodone The most common SARI, also blocks histaminergic and α-
adrenergic receptors.
Half-Life: 3-6 hours
Serotonin Antagonist and Reuptake Common Adverse Effects
Inhibitors (SARIs) · sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect
priapism
Serotonin norepinephrine receptor agonist, Mirtazapine
alpha2 receptor agonist
Serotonin multimodal (SMM)/serotonin Vilazodone (Viibryd)
partial agonist reuptake inhibitor (SPARI) · 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) Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition
Tricyclic antidepressants (TCAs) 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) Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
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
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.
MAOIs Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)
· isocarboxazid (Marplan)
MAOI's Key Points · Clients taking MAOIs are at high risk for hypertensive crisis
if tyramine is ingested.
· Do not prescribe any serotonergic agents within 2 weeks of
MAOI discontinuation due to an increased risk of
serotonin syndrome.
Wait at least 5 half-lives after discontinuing a serotonergic
medication before initiating an MAIO.
Foods to Avoid When Taking MAO- · Red wine (Avoid)
A Medications · Sauerkraut (Avoid)
· Cheese (Avoid)
· Soy (Avoid)
· Smoked meats (Avoid)
NR 546 EXAMS REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
Students also studied
Flashcard sets Study guides
C
Terms in this set (288)
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 Decreased sleep/arousal
Mania
Striatum Symptoms of Mania Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Racing thoughts, grandiosity
Mania
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 diarrhea
(SSRIs): Most adverse effects will subside headache
after 4-5 days once the body adjusts to weight gain
increased serotonin levels. sexual side effects
Serotonin Norepinephrine Reuptake elevated blood pressure
Inhibitors (SNRIs): Medications should not be anxiety
abruptly stopped to avoid discontinuation insomnia
symptoms. NE effects of the medication constipation
may increase anxiety in some clients.
Report worsening anxiety to the provider.
Norepinephrine Dopamine Reuptake agitation
Inhibitors (NDRI): Take medication in the headache
morning. Stop taking medication if seizures dry mouth
occur. Stop taking medication if anxiety is constipation
noted. 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
Serotonin Antagonist and Reuptake SARIs potently block 5-HT2A and 5HT 2C receptors, which
Inhibitors (SARIs) allow more 5-HT to interact at postsynaptic 5-HT1A sites.
Serotonin blockade and reuptake inhibition is present at
higher doses.
Trazodone The most common SARI, also blocks histaminergic and α-
adrenergic receptors.
Half-Life: 3-6 hours
Serotonin Antagonist and Reuptake Common Adverse Effects
Inhibitors (SARIs) · sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect
priapism
Serotonin norepinephrine receptor agonist, Mirtazapine
alpha2 receptor agonist
Serotonin multimodal (SMM)/serotonin Vilazodone (Viibryd)
partial agonist reuptake inhibitor (SPARI) · 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) Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition
Tricyclic antidepressants (TCAs) 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) Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
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
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.
MAOIs Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)
· isocarboxazid (Marplan)
MAOI's Key Points · Clients taking MAOIs are at high risk for hypertensive crisis
if tyramine is ingested.
· Do not prescribe any serotonergic agents within 2 weeks of
MAOI discontinuation due to an increased risk of
serotonin syndrome.
Wait at least 5 half-lives after discontinuing a serotonergic
medication before initiating an MAIO.
Foods to Avoid When Taking MAO- · Red wine (Avoid)
A Medications · Sauerkraut (Avoid)
· Cheese (Avoid)
· Soy (Avoid)
· Smoked meats (Avoid)
