NR546 Final Exam Questions and
Answers 100% Verified.
Pharmacologic Treatment of Bipolar Disorder Lithium
Anticonvulsants
Second generation antipsychotics
Unipolar depression major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%)
among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Bipolar disorder (BD) Chronic condition characterized by extreme fluctuations in mood, energy,
and ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic
features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a history of one
or more major depressive episodes
-high risk for suicide
mania characterized by a persistently elevated, expansive, or irritable mood. Related symptoms
may include inflated self-esteem, increased goal-directed activity or energy, including
grandiosity, decreased need for sleep, excessive talkativeness, racing thoughts, flight of ideas
(FOI), distractibility, psychomotor agitation, and a propensity to be involved in high-risk
activities. Mania leads to significant functional impairment and may include psychotic features
or necessitate hospitalization
Bipolar Type I: requires at least one episode of mania for at least one week (or any
duration if hospitalization due to symptoms is required)
Bipolar Type II: diagnosis requires a current or past hypomanic episode and a current or
past major depressive episode. Symptoms last for at least 4 days but fewer than seven.
,-Hypomanic symptoms are not of sufficient duration or severity to cause significant functional
impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making
bipolar more difficult to diagnose if the client presents in the depression phase.
Cyclothymia: involves the chronic presentation of hypomanic and depressive symptoms that do
not meet the diagnostic criteria for a major depressive or manic/hypomanic episode.
If bipolar depression is mistaken for MDD: antidepressant therapy may precipitate a manic
episode or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults younger
than 25
Antidepressants are used cautiously in clients with bipolar disorder and never as
________________. monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic
or manic episode
DA, NE Dysfunction causes what mood related symptoms Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
5HT, NE Dysfunction causes what mood related symptoms Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
monoamine hypothesis of depression -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
Medication Management for Depression, First-Line Treatment: • Selective Serotonin
Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
SSRI's Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
,-sexual side effects
SNRI's Mechanism of action
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase cognition)
Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation
NDRI's Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss
SSRI Prescribing Pearls: med with mild antihistamine effects citalopram (Celexa)
SSRI Prescribing Pearls: med with no known drug interactions escitalopram (Lexapro)
SSRI Prescribing Pearls: med with longest half-life fluoxetine (Prozac)
SSRI Prescribing Pearls: med that also treats social anxiety and insomnia paroxetine (Paxil)
SSRI Prescribing Pearls: med that treats anxious depression; smokers require an increased dose
fluvoxamine (Luvox)
SSRI Prescribing Pearls: med that also treats social anxiety and hypersomnolence sertraline
(Zoloft)
venlafaxine (Effexor) INDICATION
-Depression
-GAD
-Social anxiety disorder
-Panic disorder
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine.
TESTS
-Check bp before initiating tx & regularly during tx
Starting Dose
-Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-release)
Adverse Effects
-H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual dysfunction,
asthenia, sweating, SIADH, hyponatremia, increase BP
, PEARLS
-treats both depression and anxiety disorders, ensure trial of higher dose before switching to a
different medication
-preferred treatments for treatment-resistant depression
desvenlafaxine (Pristiq) INDICATION
-MDD
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-50 mg/day
Adverse Effects
-Insomnia, sedation, anxiety, dizziness, nausea, vomiting, constipation, decreased appetite,
sexual dysfunction, sweating, SIADH, hyponatremia, increased BP
PEARLS
-effective for perimenopausal vasomotor symptoms
duloxetine (Cymbalta) INDICATION
-MDD
-Diabetic peripheral neuropathic pain
-Fibromyalgia
-GAD
-Chronic musculoskeletal pain
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-Depression initial 40 mg/day in 2 doses.
-Anxiety initial 60 mg once daily.
Adverse Effects
-nausea, diarrhea, decreased appetite, dry mouth, constipation, insomnia, sedation, dizziness,
sexual dysfunction, sweating, increased blood pressure, urinary retention.
Answers 100% Verified.
Pharmacologic Treatment of Bipolar Disorder Lithium
Anticonvulsants
Second generation antipsychotics
Unipolar depression major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%)
among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Bipolar disorder (BD) Chronic condition characterized by extreme fluctuations in mood, energy,
and ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic
features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a history of one
or more major depressive episodes
-high risk for suicide
mania characterized by a persistently elevated, expansive, or irritable mood. Related symptoms
may include inflated self-esteem, increased goal-directed activity or energy, including
grandiosity, decreased need for sleep, excessive talkativeness, racing thoughts, flight of ideas
(FOI), distractibility, psychomotor agitation, and a propensity to be involved in high-risk
activities. Mania leads to significant functional impairment and may include psychotic features
or necessitate hospitalization
Bipolar Type I: requires at least one episode of mania for at least one week (or any
duration if hospitalization due to symptoms is required)
Bipolar Type II: diagnosis requires a current or past hypomanic episode and a current or
past major depressive episode. Symptoms last for at least 4 days but fewer than seven.
,-Hypomanic symptoms are not of sufficient duration or severity to cause significant functional
impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making
bipolar more difficult to diagnose if the client presents in the depression phase.
Cyclothymia: involves the chronic presentation of hypomanic and depressive symptoms that do
not meet the diagnostic criteria for a major depressive or manic/hypomanic episode.
If bipolar depression is mistaken for MDD: antidepressant therapy may precipitate a manic
episode or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults younger
than 25
Antidepressants are used cautiously in clients with bipolar disorder and never as
________________. monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic
or manic episode
DA, NE Dysfunction causes what mood related symptoms Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
5HT, NE Dysfunction causes what mood related symptoms Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
monoamine hypothesis of depression -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
Medication Management for Depression, First-Line Treatment: • Selective Serotonin
Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
SSRI's Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
,-sexual side effects
SNRI's Mechanism of action
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase cognition)
Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation
NDRI's Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss
SSRI Prescribing Pearls: med with mild antihistamine effects citalopram (Celexa)
SSRI Prescribing Pearls: med with no known drug interactions escitalopram (Lexapro)
SSRI Prescribing Pearls: med with longest half-life fluoxetine (Prozac)
SSRI Prescribing Pearls: med that also treats social anxiety and insomnia paroxetine (Paxil)
SSRI Prescribing Pearls: med that treats anxious depression; smokers require an increased dose
fluvoxamine (Luvox)
SSRI Prescribing Pearls: med that also treats social anxiety and hypersomnolence sertraline
(Zoloft)
venlafaxine (Effexor) INDICATION
-Depression
-GAD
-Social anxiety disorder
-Panic disorder
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine.
TESTS
-Check bp before initiating tx & regularly during tx
Starting Dose
-Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-release)
Adverse Effects
-H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual dysfunction,
asthenia, sweating, SIADH, hyponatremia, increase BP
, PEARLS
-treats both depression and anxiety disorders, ensure trial of higher dose before switching to a
different medication
-preferred treatments for treatment-resistant depression
desvenlafaxine (Pristiq) INDICATION
-MDD
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-50 mg/day
Adverse Effects
-Insomnia, sedation, anxiety, dizziness, nausea, vomiting, constipation, decreased appetite,
sexual dysfunction, sweating, SIADH, hyponatremia, increased BP
PEARLS
-effective for perimenopausal vasomotor symptoms
duloxetine (Cymbalta) INDICATION
-MDD
-Diabetic peripheral neuropathic pain
-Fibromyalgia
-GAD
-Chronic musculoskeletal pain
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-Depression initial 40 mg/day in 2 doses.
-Anxiety initial 60 mg once daily.
Adverse Effects
-nausea, diarrhea, decreased appetite, dry mouth, constipation, insomnia, sedation, dizziness,
sexual dysfunction, sweating, increased blood pressure, urinary retention.
