NR547 Final Exam- Questions and Answers

NR547 Final Exam Medications for depression SSRIs SNRIs SDRIs TCAs MAOIs SSRIs -Action: inhibit 5-HT reuptake -Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline -Adverse effects: • nausea • agitation • diarrhea • headache • weight gain • sexual side effects SNRIs -inhibit 5-HT reuptake -inhibit NE reuptake (↑ energy, focus) -increase DA in prefrontal cortex (↑ cognition) -Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine -Adverse effects: • elevated blood pressure • nausea • sweating • tremors • anxiety • insomnia • constipation • anorexia • sexual dysfunction SDRIs -inhibit DA reuptake (↑alertness, motivation) -inhibit NE reuptake (↑energy) -Adverse effects: • agitation • headache • dry mouth • constipation • weight loss TCAs -Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors -Examples: amitriptyline, clomipramine, desipramine, doxepin -Common Side Effects: • dry mouth • constipation • blurred vision • urinary retention • sedation • weight gain • hypotension • tachycardia • sexual dysfunction MAOIs -Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it -Examples: isocarboxazid, phenelzine, tranylcypromine -Common Side Effects: • sedation • dizziness • sexual dysfunction • hypertensive crisis Prescribing pearls: citalopram (Celexa) mild antihistamine effects Prescribing pearls: escitalopram (Lexapro) no known drug interactions Prescribing pearls: fluoxetine (Prozac) longest half-life Prescribing pearls: paroxetine (Paxil) also treats social anxiety and insomnia Prescribing pearls: fluvoxamine (Luvox) treats anxious depression smokers require increased dose Prescribing pearls: sertraline (Zoloft) also treats social anxiety and hypersomnolence Prescribing pearls: bupropion (Wellbutrin) NDRI may improve energy, alertness, and motivation; not first line treatment for anxiety; contraindicated in clients with a history of seizures Prescribing pearls: duloxetine (Cymbalta) 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 Prescribing pearls: venlafaxine (Effexor) treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Prescribing pearls: desvenlafaxine (Pristiq) effective for perimenopausal vasomotor symptoms considered when selecting a medication: -Client preference -Prior treatment response -Anticipated adverse effects -Comorbidities -Half-life and interactions -Cost if a medication is not achieving efficacy: -Increase dose gradually -Switch to a different drug within the same class -Switch to drug in a different class -Add a second medication Use to protect against suicide lithium MDD and BPD genetics genetic factors contribute 31-42% of the disease risk in MDD and 59-85% in BPD monoamine hypothesis of depression