NR 547 FINAL EXAM 2024 QUESTIO NS AND ANSWERS (VERIFIED) 100% CORRECT (GRADED A+) | FINAL EXAM STUDYGUIDE WITH DETAILED ANSWERS WITH RATIONALE Medications for depression Correct Answer SSRIs SNRIs SDRIs TCAs MAOIs SSRIs Correct Answer -Action: inhibit 5 -HT reuptake -Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline -Adverse effects: • nausea • agitation • diarrhea • headache • weight gain • sexual side effects SNRIs Correct Answer -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 Correct Answer -inhibit DA reuptake (↑alertness, motivation) -inhibit NE reuptake (↑energy) -Adverse effects: • agitation • headache • dry mouth • constipation • weight loss TCAs Correct Answer -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 visio n • urinary retention • sedation • weight gain • hypotension • tachycardia • sexual dysfunction MAOIs Correct Answer -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) Correct Answer mild antihistamine effects Prescribing pearls: escitalopram (Lexapro) Correct Answer no known drug interactions Prescribing pearls: fluoxetine (Prozac) Correct Answer longest half -
life Prescribing pearls: paroxetine (Paxil) Correct Answer also treats social anxiety and insomnia Prescribing pearls: fluvoxamine ( Luvox) Correct Answer treats anxious depression smokers require increased dose Prescribing pearls: sertraline (Zoloft) Correct Answer also treats social anxiety and hypersomnolence Prescribing pearls: 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 Prescribing pearls: duloxetine (Cymbalta) Correct Answer effective for atypical pain at highe r 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) Correct Answer treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Prescribing pearls: desvenlafaxine (Pristiq) Correct Answer effective for perimenopausal vasomotor symptoms considered when selecting a medication: Correct An swer -Client preference -Prior treatment response -Anticipated adverse effects -Comorbidities -Half-life and interactions -Cost if a medication is not achieving efficacy: Correct Answer -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 Correct Answer lithium MDD and BPD genetics Correct Answer genetic factors contribute 31-42% of the disease risk in MDD and 59-85% in BPD monoamine hypothesis of depression Correct Answer -posits that depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess *Emphasis is now shifted from the monoamines to their receptors and other downstream events such as the regulation of gene expression, growth factors, environmental factors, and epigenetic changes Correct Answer Three principal neurotransmitters -norepinephrine (NE), dopamine (DA), and serotonin 5HT • comprise the monoamine neurotransmitter system • implications for the pathophysiology and treatment of mood disorders • All known pharmacologic treatments for m ood disorders act upon one or more of these three neurotransmitters -Many of the symptoms of mood disorders are hypothesized to involve dysfunction of various combinations of the monoamine neurotransmitters Mood disorders include ____________________ and ___________________ Correct Answer depressive disorders and bipolar disorders Major depressive disorder (MDD) Correct Answer one of the most prevalent psychiatric disorders -estimated that more than 300 million people suffer from -leading cause of disability worldwide -7.1% of adults and 13.3% of adolescents in the U.S. had at least one major depressive episode -An imbalance of specific neurotransmitters, including dopamine, serotonin, and norepinephrine, can influence brain activity and re sult in depression -decreased neurotransmitter activity in the prefrontal cortex (PFC) MDD dx Correct Answer -occurrence of at least one episode of major depression lasting at least two weeks. -must experience 5 or more of the following symptoms in two weeks to be diagnosed with a major depressive episode: • feeling low most of the day for most days • decreased interest in activities • substantial weight loss, significant change in appetite • fidgeting, random movement (i.e. pacing)
life Prescribing pearls: paroxetine (Paxil) Correct Answer also treats social anxiety and insomnia Prescribing pearls: fluvoxamine ( Luvox) Correct Answer treats anxious depression smokers require increased dose Prescribing pearls: sertraline (Zoloft) Correct Answer also treats social anxiety and hypersomnolence Prescribing pearls: 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 Prescribing pearls: duloxetine (Cymbalta) Correct Answer effective for atypical pain at highe r 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) Correct Answer treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Prescribing pearls: desvenlafaxine (Pristiq) Correct Answer effective for perimenopausal vasomotor symptoms considered when selecting a medication: Correct An swer -Client preference -Prior treatment response -Anticipated adverse effects -Comorbidities -Half-life and interactions -Cost if a medication is not achieving efficacy: Correct Answer -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 Correct Answer lithium MDD and BPD genetics Correct Answer genetic factors contribute 31-42% of the disease risk in MDD and 59-85% in BPD monoamine hypothesis of depression Correct Answer -posits that depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess *Emphasis is now shifted from the monoamines to their receptors and other downstream events such as the regulation of gene expression, growth factors, environmental factors, and epigenetic changes Correct Answer Three principal neurotransmitters -norepinephrine (NE), dopamine (DA), and serotonin 5HT • comprise the monoamine neurotransmitter system • implications for the pathophysiology and treatment of mood disorders • All known pharmacologic treatments for m ood disorders act upon one or more of these three neurotransmitters -Many of the symptoms of mood disorders are hypothesized to involve dysfunction of various combinations of the monoamine neurotransmitters Mood disorders include ____________________ and ___________________ Correct Answer depressive disorders and bipolar disorders Major depressive disorder (MDD) Correct Answer one of the most prevalent psychiatric disorders -estimated that more than 300 million people suffer from -leading cause of disability worldwide -7.1% of adults and 13.3% of adolescents in the U.S. had at least one major depressive episode -An imbalance of specific neurotransmitters, including dopamine, serotonin, and norepinephrine, can influence brain activity and re sult in depression -decreased neurotransmitter activity in the prefrontal cortex (PFC) MDD dx Correct Answer -occurrence of at least one episode of major depression lasting at least two weeks. -must experience 5 or more of the following symptoms in two weeks to be diagnosed with a major depressive episode: • feeling low most of the day for most days • decreased interest in activities • substantial weight loss, significant change in appetite • fidgeting, random movement (i.e. pacing)
