NURS 660 CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ What two drugs have the most difficulties with withdrawal symptoms.
Answer: Paxil - withdrawal syndromeEffexor - hypertensive crisis Less
likely with Prozac
◍ Carbamazepine (Tegretol) uses.
Answer: partial seizures, generalized tonic-clonic seizures - not 1st line,
non-epilepsy uses like trigeminal neuralgia, acute mania, and migraines2nd
line tx bipolar disorder
◍ What could be combined with lamitrogine during initiation in rapid cycling
bipolar disorder.
Answer: depot long acting resperidone injectable
◍ Seriously Prepare Cities for the Flu Vaccine.
Answer: -Sertaline (Zoloft)--Paroxetine (Paxil)
-Citolpram(Celexa)-Escitalopram (Lexapro)-Fluoxetine HCl
(Prozac)--Fluvoxamine (Luvox)-(Viibryd)Citol
◍ How would you change tx from a the SSRI duloxetine to a MAOI.
Answer: Because of the risk of serotonin toxicity, complete washout of
duloxetine is necessary before starting an MAOI. Duloxetine must be
down-titrated
◍ Citalopram and Lexapro dosing comparison.
Answer: Lexapro is equivalent to half the dose of Citalopram
◍ What drug would be a better choice of SNRI for patients with liver disease?.
Answer: Desvenlafaxine (Pristiq)
◍ Aripiprazole (Abilify).
Answer: Atypical antipsychotic"3rd generation". D2 partial
, agonismManagement of schizophrenia, and acute manic or mixed episodes
in bipolar disorder.Adjunct to treat depression or irritability associated with
autism (ages 6-18)SE: dizziness, insomnia, akasthisia, n/v, weight gain (less
likely to cause), suppresses prolactin levels Interactions- ketoconazole and
other 3a4 inhibitors increase aripiprazole levels.May increase effects of
antihypertensives
◍ lithium MOA.
Answer: Inhibit phosphoinositol cascadeinhibition of glycogen synthase
kinase 3ß (GSK-3ß)[apoptic may be neuroprotectinhibition of inositol
monophosphatase (IMPase).[reduce mania]
◍ High potency antipsychotics.
Answer: 1st gen antipsychotics that have a high affinity for dopamine
receptors have a higher potency (need less of a drug to get an effect)Fewer
anticholinergic effects. Low activity at H1 and M1. Little sedation and
weight gain. Fewer anti-adrenergic effects.Greater risk for EPS, NMS,
tardive dyskinesia, QTC prolongation. Haldol, fluphenazine.
◍ Most common manic/hypomanic symptom during a major depressive
episode with mixed features.
Answer: psychomotor agitation
◍ Medications to treat positive symptoms.
Answer: Antipsychotics
◍ Trazodone (Desyrel).
Answer: Rarely used for depressionat lower doses sedative, used for sleep
◍ Perphenzaine (Trilafon).
Answer: Potent D2 antagonist SE: neuroleptic induced deficit syndrome,
akathisia, EPS, parkonsonism, TD, galactorrhea, urinary retention, sexual
dysfunctionInteractions: Fluoxetine, paroxetine, and bupropion can increase
levels. Antihypertensives have synergistic interaction, increasing risk for
hypotension.Serious adverse events: NMS, jaundice, seizures, CV death in
elderly
,◍ SNRI side effects.
Answer: more weight gainmay increase blood pressurecause sweating and
urinary retention more discontinuation syndrome than SSRI
◍ Lamotrigine (Lamictal) use in bipolar tx.
Answer: Not approved for tx of maniaFirst line tx for bipolar depression,
off-label Tx and stabilizer from below
◍ Valporate MOA.
Answer: weak sodium channel blockerweak inhibitor of enzymes that
deactivate GABAStimulates GABA synthesis
◍ When do you check blood level for lithium.
Answer: After treatment has begunDosage changeSigns of toxicity
◍ Tenessee mood shine.
Answer: giving antidepressant and if activating side effects occur add an
atypical antipsychotic
◍ Adrengeric receptors.
Answer: Benefits unknown.possible side effects:a1- orthostatic hypotension,
dizziness, reflex tachycardiaa2- drug interactions
◍ MDD and brain neruoanatomy -Prefrontal cortex.
Answer: Concentration/interest/pleasurePsychomotor fatigue (mental)Guilt./
suidicality/ worthlessnessMood
◍ When should duloxetine be avoided?.
Answer: Patients with liver disease (alcoholism, hepatitis)
◍ Lurasidone (Latuda).
Answer: Treats schizophrenia and depression.SE: must be taken with 350
calories of solid food for max absorption. Low risk of weight gain
◍ Acute dystonia.
Answer: Sustained muscle contraction in the face, neck, trunk, or
extremities, can affect the larynx. Oculogyric crisis can be a dystonic
reaction. Painful.Onset- quickly, within hours.Reversible with treatment of
, an anticholinergic, benadryl, benzotropine, or congentin.
◍ MDD and brain neuroanatomy -Amydgala.
Answer: Guilt, suicidality, worthlessness
◍ Fluoxetine (Prozac) Cons.
Answer: Long half life and active metabolite may build up (e.g. not a good
choice in patients with hepatic illness)Significant P450 interactions so this
may not be a good choice in pts already on a number of medsInitial
activation may increase anxiety and insomniaMore likely to induce mania
than some of the other SSRIs
◍ Unique side effect of lamotrigine (lamictal).
Answer: RashesStephens Johnson Syndrome
◍ Which anticonvulsive is effective in the tx of neuropathic pain.
Answer: Carbamazepine (Tegretol)
◍ Muscarinic cholinergic.
Answer: Benefits: reduced EPSSE: autonomic side effects such as blurred
vision, dry mouth, constipation, urinary retention, tachycardia, memory
dysfunction.
◍ Drug choice for atypical depressive symptoms of hypersomnia, anergia, and
mood reactivity..
Answer: Sertraline (Zoloft)
◍ What side effects are not seen in Bupropion (Wellbutrin).
Answer: Sexual side effectsWeight gain
◍ Excitalopram (Lexapro) Con.
Answer: Dose-dependent QT interval prolongation with doses of 10-30mg
dailyNausea, headache
◍ Top three anticonvulsants used to tx biplar.
Answer: TegretolDepakoteLamictal
◍ Paxil (paroxetine) receptor.
Answer: Weak NET inhibitorInhibits nitrous oxide synthesismild
QUESTIONS WITH SOLUTIONS GRADED A+
◍ What two drugs have the most difficulties with withdrawal symptoms.
Answer: Paxil - withdrawal syndromeEffexor - hypertensive crisis Less
likely with Prozac
◍ Carbamazepine (Tegretol) uses.
Answer: partial seizures, generalized tonic-clonic seizures - not 1st line,
non-epilepsy uses like trigeminal neuralgia, acute mania, and migraines2nd
line tx bipolar disorder
◍ What could be combined with lamitrogine during initiation in rapid cycling
bipolar disorder.
Answer: depot long acting resperidone injectable
◍ Seriously Prepare Cities for the Flu Vaccine.
Answer: -Sertaline (Zoloft)--Paroxetine (Paxil)
-Citolpram(Celexa)-Escitalopram (Lexapro)-Fluoxetine HCl
(Prozac)--Fluvoxamine (Luvox)-(Viibryd)Citol
◍ How would you change tx from a the SSRI duloxetine to a MAOI.
Answer: Because of the risk of serotonin toxicity, complete washout of
duloxetine is necessary before starting an MAOI. Duloxetine must be
down-titrated
◍ Citalopram and Lexapro dosing comparison.
Answer: Lexapro is equivalent to half the dose of Citalopram
◍ What drug would be a better choice of SNRI for patients with liver disease?.
Answer: Desvenlafaxine (Pristiq)
◍ Aripiprazole (Abilify).
Answer: Atypical antipsychotic"3rd generation". D2 partial
, agonismManagement of schizophrenia, and acute manic or mixed episodes
in bipolar disorder.Adjunct to treat depression or irritability associated with
autism (ages 6-18)SE: dizziness, insomnia, akasthisia, n/v, weight gain (less
likely to cause), suppresses prolactin levels Interactions- ketoconazole and
other 3a4 inhibitors increase aripiprazole levels.May increase effects of
antihypertensives
◍ lithium MOA.
Answer: Inhibit phosphoinositol cascadeinhibition of glycogen synthase
kinase 3ß (GSK-3ß)[apoptic may be neuroprotectinhibition of inositol
monophosphatase (IMPase).[reduce mania]
◍ High potency antipsychotics.
Answer: 1st gen antipsychotics that have a high affinity for dopamine
receptors have a higher potency (need less of a drug to get an effect)Fewer
anticholinergic effects. Low activity at H1 and M1. Little sedation and
weight gain. Fewer anti-adrenergic effects.Greater risk for EPS, NMS,
tardive dyskinesia, QTC prolongation. Haldol, fluphenazine.
◍ Most common manic/hypomanic symptom during a major depressive
episode with mixed features.
Answer: psychomotor agitation
◍ Medications to treat positive symptoms.
Answer: Antipsychotics
◍ Trazodone (Desyrel).
Answer: Rarely used for depressionat lower doses sedative, used for sleep
◍ Perphenzaine (Trilafon).
Answer: Potent D2 antagonist SE: neuroleptic induced deficit syndrome,
akathisia, EPS, parkonsonism, TD, galactorrhea, urinary retention, sexual
dysfunctionInteractions: Fluoxetine, paroxetine, and bupropion can increase
levels. Antihypertensives have synergistic interaction, increasing risk for
hypotension.Serious adverse events: NMS, jaundice, seizures, CV death in
elderly
,◍ SNRI side effects.
Answer: more weight gainmay increase blood pressurecause sweating and
urinary retention more discontinuation syndrome than SSRI
◍ Lamotrigine (Lamictal) use in bipolar tx.
Answer: Not approved for tx of maniaFirst line tx for bipolar depression,
off-label Tx and stabilizer from below
◍ Valporate MOA.
Answer: weak sodium channel blockerweak inhibitor of enzymes that
deactivate GABAStimulates GABA synthesis
◍ When do you check blood level for lithium.
Answer: After treatment has begunDosage changeSigns of toxicity
◍ Tenessee mood shine.
Answer: giving antidepressant and if activating side effects occur add an
atypical antipsychotic
◍ Adrengeric receptors.
Answer: Benefits unknown.possible side effects:a1- orthostatic hypotension,
dizziness, reflex tachycardiaa2- drug interactions
◍ MDD and brain neruoanatomy -Prefrontal cortex.
Answer: Concentration/interest/pleasurePsychomotor fatigue (mental)Guilt./
suidicality/ worthlessnessMood
◍ When should duloxetine be avoided?.
Answer: Patients with liver disease (alcoholism, hepatitis)
◍ Lurasidone (Latuda).
Answer: Treats schizophrenia and depression.SE: must be taken with 350
calories of solid food for max absorption. Low risk of weight gain
◍ Acute dystonia.
Answer: Sustained muscle contraction in the face, neck, trunk, or
extremities, can affect the larynx. Oculogyric crisis can be a dystonic
reaction. Painful.Onset- quickly, within hours.Reversible with treatment of
, an anticholinergic, benadryl, benzotropine, or congentin.
◍ MDD and brain neuroanatomy -Amydgala.
Answer: Guilt, suicidality, worthlessness
◍ Fluoxetine (Prozac) Cons.
Answer: Long half life and active metabolite may build up (e.g. not a good
choice in patients with hepatic illness)Significant P450 interactions so this
may not be a good choice in pts already on a number of medsInitial
activation may increase anxiety and insomniaMore likely to induce mania
than some of the other SSRIs
◍ Unique side effect of lamotrigine (lamictal).
Answer: RashesStephens Johnson Syndrome
◍ Which anticonvulsive is effective in the tx of neuropathic pain.
Answer: Carbamazepine (Tegretol)
◍ Muscarinic cholinergic.
Answer: Benefits: reduced EPSSE: autonomic side effects such as blurred
vision, dry mouth, constipation, urinary retention, tachycardia, memory
dysfunction.
◍ Drug choice for atypical depressive symptoms of hypersomnia, anergia, and
mood reactivity..
Answer: Sertraline (Zoloft)
◍ What side effects are not seen in Bupropion (Wellbutrin).
Answer: Sexual side effectsWeight gain
◍ Excitalopram (Lexapro) Con.
Answer: Dose-dependent QT interval prolongation with doses of 10-30mg
dailyNausea, headache
◍ Top three anticonvulsants used to tx biplar.
Answer: TegretolDepakoteLamictal
◍ Paxil (paroxetine) receptor.
Answer: Weak NET inhibitorInhibits nitrous oxide synthesismild
