NURS 660 EXAM 2 QUESTIONS WITH ANSWERS STUDY GUIDE 2023

1. Know how to switch patients from one class of antidepressants to another. o MAOI different antidepressant: 14 days, because it takes 14 days for MAO enzymes to come back o Different antidepressant MAOI: need to wait 5 half-lives, which typically takes 5-7 days. Fluoxetine (Prozac) takes 5 weeks due to its long half-life 2. Know the major side effects, adverse reactions, drug interactions, food-drug interactions, applicable lab tests to order when the medication is prescribed and during treatment, the neurotransmitters they work on, pregnancy risk, and the mechanism of action for the following medications: o Citalopram (Celexa): SSRI o Escitalopram (Lexapro): SSRI o Fluoxetine (Prozac): SSRI o Fluvoxamine (Luvox): SSRI o Paroxetine (Paxil): SSRI o Sertraline (Zoloft): SSRI o Duloxetine (Cymbalta): SNRI o Venlafaxine (Effexor): SNRI o Amitriptyline (Elavil): TCA o Clomipramine (Anafranil): TCA o Carbamazepine (Tegretol): Anticonvulsant/ Mood stabilizer o Divalproex (Depakote): Anticonvulsant/ Mood Stabilizer o Gabapentin (Neurontin): Anticonvulsant o Lamotrigine (Lamictal): Anticonvulsant/ Mood Stabilizer (VSSC antagonist) o Lithium: Mood Stabilizer o Bupropion (Wellbutrin): NDRI o Mirtazapine (Remeron): Alpha-2 antagonist/ antidepressant 1. Disinhibits NE and 5HT release via alpha-2 antagonism o Nefazodone (Dutonin): SARI o Trazodone (Desyrel): SARI/ antidepressant o Vilazodone (Viibryd): SPARI (5HT partial agonist reuptake inhibitor) 3. Be able to identify and distinguish between psychiatric emergencies such as serotonin syndrome, hypertensive crisis, Steven Johnson's Syndrome, neuroleptic malignant syndrome and how to manage these emergencies. o Serotonin Syndrome: 1. S/S: fever, tachycardia, HTN, confusion, hyperreflexia, myoclonus 2. Can occur especially if an MOAI is combined with another serotonergic (SSRI, SNRI) 3. Rapid onset, usually seen w/in 24 hours of starting or changing therapy 4. Treatment: Stop the offending med, give benzos, O2 and IV fluids, 5HT blockers o Hypertensive Crisis: 1. Occurs with MAOI and tyramine (caused by increase in DA and NE) 2. S/S: severe chest pain, HA, confusion, blurred vision, N/V, SOB, severe anxiety o Steven Johnson’s Syndrome: 1. S/S: fever and flu-like symptoms, widespread rash and rash around mouth and mucus membranes, fatigue 2. Most worried w/ Lamictal 3. Other meds that cause SJS: Tegretol (to reduce the risk of SJS, test for HLA in pts of Asian descent; Tegretol can also cause toxic epidermal necrolysis) 4. Treatment: immediately stop the offending med, provide supportive treatment o Neuroleptic Malignant Syndrome 4. Know the main differences among SSRIs, SNRIs, MAOIs, and TCAs. o SSRIs 1. Block SERT and inhibit 5HT reuptake 2. General S/E: GI upset (nausea, indigestion, diarrhea), sexual dysfunction, serotonin syndrome, suicidal thoughts, insomnia or hypersomnia 3. **GI upset (indigestion, nausea, diarrhea) are the most common S/E** 4. Do not affect BP o SNRIs 1. Block SERT and NET 2. SNRIs also work on DA, specifically in the prefrontal cortex w/o inhibiting DAT