(verified) NURS 660 Exam Review (2) Correct Study Guide.

50 questions, all multiple choice, 120minutes to complete it Covering weeks 6 (mood disorders), 7 (antidepressants), and 8 (mood stabilizers) Major Content Areas: • Drug side effects – 10-15 questions • Drug-drug interactions – 5-7 questions • Mechanism of Action – 10-15 questions • Labs/monitoring – 3-5 questions • Medical emergencies (toxicity, overdose, etc.) – 3-5 questions • Neuroanatomy – 2-3 questions Diagnosing unipolar vs bipolar depression   MDD and brain neuroanatomy • SSRIs: AntidepressantCsita:lopram, Escitalopram, Paroxetine, Fluoxetine, Fluvoxamine, Sertraline, • Amitriptyline • SNRIs: • Bupropion • Citalopram Duloxetine, Venlafaxine • Clomipramine • TCAs: • Duloxetine • Escitalopram Amitriptyline, Clomipramine, • Fluoxetine • Other: • Fluvoxamine • Paroxetine Trazodone, Bupropion, Mirtazapine • Sertraline • Trazodone • Venlafaxine SSRIs: 6 drugs – 1 common property, individual differences • All SSRIs work by selectively and potently inhibiting serotonin reuptake • They all inhibit the serotonin transporter aka SERT • Each SSRI has secondary pharmacological actions besides the shared action of blocking SERT. • No two SSRIs have identical secondary pharmacological characteristics • It’s unclear if these secondary actions account for differences in efficacy/tolerability in each patient experience Fluoxetine • 5HT2C antagonism is unique to Prozac • Blocking 5HT2C enhances the release of NE and DA • May be activating/energizing • Improve concentration/motivation • VERY long half-life (2 weeks) • Good for noncompliant patients • Bad in that it takes a long time to clear completely Sertraline • Dopamine transport and Sigma- 1 receptor binding are unique to Sertraline • May be helpful for atypical depressive symptoms such as hypersomnia, anergia, and mood reactivity • Sigma-1 may help with anxiolytic effects and addressing psychotic/delusional depression Paroxetine • Weak NET inhibition, inhibits nitric oxide synthesis, and mild anticholinergic action (M1) are unique to paroxetine • Tends to be calming, potentially sedating • Weight gain/sexual side effects are common • NOTORIOUS for withdrawal reactions if stopped suddenly • May be due to anticholinergic rebound?   Fluvoxamine • Like sertraline in that it works on Sigma-1 (more potently) • No FDA indication for depression   Citalopram • Has 2 enantiomers and mild antihistaminic properties • Inconsistent therapeutic actio n at lower doses, thus often requires higher doses • Higher doses (greater than 40mg) can cause QTc prolongation (FDA black box warning)