NR546 / NR 546 Final Exam (2024 / 2025 Update): Advanced Pharmacology Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner | Complete Guide with Questions and Verified Answers - Chamberlain

Final Exam: NR546 / NR 546 Advanced Pharmacology Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner Final Exam Review | 2024 / 2025 Update | Complete Guide Questions and Verified Answers | Updated!! – Chamberlain Q: Adjunct treatment for depression Answer: Antipsychotic medications are sometimes prescribed at low doses as adjunctive medications for severe depression Q: Newer tx for resistant depression: esketamine (Spravato) Answer: nasal spray for the treatment of major depressive disorder (MDD) with acute suicidal ideation or behavior -reaches peak onset in the body in between 20-40 minutes -risk of adverse outcomes due to sedation and dissociation *must be administered in a supervised healthcare setting Q: Newer tx for resistant depression: Ketamine clinics Answer: Ketamine is an N-methyl-D-aspartate (NMDA) receptor inhibitor, results in the downstream release of glutamate -high doses, ketamine may cause psychotic symptoms, in low doses, it has a rapid effect on depression -Ketamine clinics have provided intravenous ketamine for treatment-resistant unipolar and bipolar depression *required frequent dosing, inconvenient, expensive Q: Newer tx for resistant depression: dextromethorphan/quinidine (Nuedexta) Answer: Researchers are investigating, related to NMDA -currently approved by the FDA for the treatment of pseudobulbar affect *combines dextromethorphan and quinidine as an oral treatment Q: considered when selecting an antidepressant medication Answer: Client preference Prior treatment response Anticipated adverse effects Comorbidities Half-life and interactions Cost Q: Antidepressants: Initiating Medication Answer: Start clients on a single drug for 4-8 weeks to assess efficacy. Start with the lowest recommended dose to reduce side effects. If a medication is not achieving efficacy: -Increase the dose gradually to the efficacious dose range. -Switch to a different drug within the same class after an adequate trial which includes higher dosing and a minimum of eight weeks of trial. -Switch to a drug in a different class after an adequate trial which includes higher dosing and a minimum of eight weeks of trial. -Add a second medication as an adjunct. Q: Antidepressants: Discontinuing Medications Answer: Don't suddenly stop or omit doses due to risk of discontinuation syndrome -Paroxetine highest risk due to serotonin transporter inhibition and anticholinergic rebound -If a treatment course has lasted 8 weeks, discontinuation over 1-2 weeks is safe. Once symptoms are in remission, continue treatment for 4-9 months to reduce the risk of relapse Q: Antidepressants Important Prescribing Considerations: Black Box Warning Answer: Suicide Risk with Antidepressant Drugs -Clients with depression may consider or attempt suicide -risk for suicide may increase at the start of treatment -Antidepressant-induced suicide is more prevalent in children, adolescents, and adults younger than 25 years. Q: Antidepressants Important Prescribing Considerations: Drug-Drug Interactions Answer: Most antidepressant medications have serious drug-drug interactions. Carefully review the client's history and current prescriptions before selecting a medication. Q: Antidepressants Important Prescribing Considerations: Serotonin Syndrome Answer: potentially life-threatening condition reported with the use of serotonergic antidepressants -especially when they are used concomitantly with other serotonergic drugs (such as triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John's Wort), and with drugs that impair serotonin metabolism (particularly MAOIs) S/S -mental status changes (e.g., agitation, hallucinations, delirium, and coma) -autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia) -neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination) -seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) If such symptoms occur, clients should discontinue serotonergic agents and initiate treatment of symptoms. Clients should be educated about the signs and symptoms of serotonin syndrome and monitored -particularly during treatment initiation and dose increases. Q: match the specific complaint to the best antidepressant medication: Eric, 49, is concerned about sexual side effects of antidepressant medications Answer: Bupropion -has fewer sexual side effects than other first-line treatments. Bupropion can also be prescribed as an adjunct to a SSRI. Q: match the specific complaint to the best antidepressant medication: Terry, 76, has lost several pounds in the past few months. She has little appetite. Answer: Mirtazapine -may be used to increase appetite/weight gain in older clients. Q: match the specific complaint to the best antidepressant medication: Karl, 35, complains of