NR 546 questions with correct answers

Prefrontal Cortex Symptoms of MDD Concentration Mental Fatigue Mood PFC & Amygdala Symptoms of MDD Guilt Suicidality Worthlessness MORE CURIOUS SHORTS - Induction Cooker Striatum Symptoms of MDD Physical fatigue Nucleus Accumbens Symptoms of MDD Pleasure interests Hypothalamus Symptoms of MDD Sleep Appetite Thalamus & Hypothalamus ​Symptoms of Mania Decreased sleep/arousal Striatum​ Symptoms of Mania Motor/agitation Prefrontal cortex (PFC) Symptoms of Mania Risk-taking Talkative/pressured speech Nucleus Accumbens & PFC Symptoms of Mania Racing thoughts, grandiosity PFC & Amygdala Symptoms of Mania Mood Medication Management SSRI-Selective Serotonin Reuptake Inhibitors *Inhibit 5 HT reuptake SNRI-Serotonin Norepinephrine Reuptake Inhibitors *inhibit 5-HT reuptake *inhibit NE reuptake (increase energy, focus) *increase DA in prefrontal cortex (increase cognition) NDRI-Norepinephrine Dopamine Reuptake inhibitors *inhibit DA reuptake (increase alertness, motivation) *inhibit NE reuptake (increase energy) SARI-Serotonin Antagonist Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days once the body adjusts to increased serotonin levels. diarrhea headache weight gain sexual side effects Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly stopped to avoid discontinuation symptoms. NE effects of the medication may increase anxiety in some clients. Report worsening anxiety to the provider. elevated blood pressure anxiety insomnia constipation Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop taking medication if seizures occur. Stop taking medication if anxiety is noted. agitation headache dry mouth constipation weight loss escitalopram (Lexapro) SSRI no known drug interactions best tolerated SSRI 27-32 hour half-life good for forgetful prone clients least CYP reactions Substrate for 3A4 citalopram (Celexa) SSRI mild antihistamine effects; Half-Life: 23-45 hours Weak Inhibitor of 2D6 fluoxetine (Prozac) SSRI longest half-life Use caution in patients with comorbid anxiety due to risk for activation and panic attacks Half-Life: 2-3 days parent, 2 week metabolite Inhibits 2D6 and 3A4 paroxetine (Paxil) SSRI also treats social anxiety and insomnia associated with weight gain will experience withdrawal with missed dose or abrupt stop Half-Life: 24 hours Inhibits 2D6 fluvoxamine (Luvox) SSRI treats anxious depression smokers require an increased dose Half-Life: 9-28 hours Inhibits 3A4, 2C9, 1A2 sertraline (Zoloft) SSRI also treats social anxiety and hypersomnolence Half-Life: 22-36 hour parent; 62-104 hour metabolite Inhibits 2D6 and 3A4 weakly at low doses venlafaxine (Effexor) treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour duloxetine (Cymbalta) SNRI effective for atypical pain at higher doses; appropriate for clients who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy Half-Life: 12 hours Inhibitor of 2D6 bupropion (Wellbutrin) NDRI may improve energy, alertness, and motivation; not first-line treatment for anxiety; contraindicated in clients with a history of seizures Avoid in patients with comorbid anxiety Half-Life: Parent 10-14 hours; Metabolite 20-27 hours Inhibits 2D6 Serotonin Antagonist and Reuptake Inhibitors (SARIs) SARIs potently block 5-HT2A and 5HT 2C receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and reuptake inhibition is present at higher doses. Trazodone The most common SARI, also blocks histaminergic and α-adrenergic receptors. Half-Life: 3-6 hours Serotonin Antagonist and Reuptake Inhibitors (SARIs) Common Adverse Effects · sedation · drowsiness · blurred vision · constipation · dry mouth Serious Adverse Effect priapism Serotonin norepinephrine receptor agonist, alpha2 receptor agonist Mirtazapine Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) Vilazodone (Viibryd) · Inhibits serotonin reuptake with partial 5HT1A agonism Appropriate for depression/comorbid anxiety, its action is similar to a combination of SSRI and buspirone Serotonin multimodal (SMM) Vortioxetine (Trintellix) · Acts as SSRI plus 5HT1A partial agonism · Improves depression-related cognition Tricyclic antidepressants (TCAs) Tricyclic antidepressants (TCAs) possess both SRI and NRI properties, but they also block other receptors, including α1-adrenergic, histamine-1, and muscarinic cholinergic receptors. TCAs are not used first-line because of the high incidence of adverse effects and the risk of potential overdose and death due to overdose Tricyclic antidepressants (TCAs) Drugs: · amitriptyline (Elavil) · desipramine (Norpramin) · doxepin (Sinequan) · imipramine (Tofranil) · nortriptyline (Pamelor) Tricyclic antidepressants (TCAs) Common adverse effects of TCAs Alpha-1 adrenergic effects-Orthostatic hypotension Histamine effects-Sedation Histamine effects-Weight gain Anticholinergic effects-Blurred vision Anticholinergic effects-Urinary retention Anticholinergic effects-Constipation Anticholinergic effects-Dry mouth MAOIs Last choice medication class for depression due to the many potential, serious side effects. MAOIs have specific dietary restrictions that when ignored, may be very uncomfortable or very serious for clients. MAOIs Drugs: · phenelzine (Nardil) · selegiline (Emsam) - MAOI-B · tranylcypromine (Parnate) · isocarboxazid (Marplan) MAOI's Key Points · Clients taking MAOIs are at high risk for hypertensive crisis if tyramine is ingested. ​ · Do not prescribe any serotonergic agents within 2 weeks of MAOI discontinuation due to an increased risk of serotonin syndrome. Wait at least 5 half-lives after discontinuing a serotonergic medication before initiating an MAIO. Foods to Avoid When Taking MAO-A Medications · Red wine (Avoid) · Sauerkraut (Avoid) · Cheese (Avoid) · Soy (Avoid) · Smoked meats (Avoid) Foods to Avoid When Taking MAO-A Medications Rationale: Limiting the consumption of tyramine is necessary for orally available MAOIs due to inhibition of MAO-A in the gut. Dietary restrictions are not required for the transdermal formulation of selegiline. Tyramine is present in many aged or preserved foods including aged cheeses, tap and non-pasteurized beers, aged or smoked meat or fish, sauerkraut, kimchee, soy products, and tofu. Foods to be avoided when taking MAO-A medications include wine, meats, sauerkraut, cheese, and soy.