NR546 FINAL EXAM REVIEWS

NR546 FINAL EXAM REVIEWS Pharmacologic Treatment of Bipolar Disorder - CORRECT ANSWER-Lithium Anticonvulsants Second generation antipsychotics Unipolar depression - CORRECT ANSWER-major depressive disorder (MDD) one of the most common mental disorders -Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among individuals aged 18-25 S/S -depressed mood -loss of interest or pleasure in daily activities -irritability -withdrawal -problems with sleep, eating, energy, concentration, or self-worth -severe depression: may experience thoughts of suicide or psychotic symptoms. Bipolar disorder (BD) - CORRECT ANSWER-Chronic condition characterized by extreme fluctuations in mood, energy, and ability to function -Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features -many have only experienced only one manic episode in their lifetime -Mood fluctuations may be separated by periods of high stability or may cycle rapidly -diagnosed when a client has one or more episodes of mania or hypomania with a history of one or more major depressive episodes -high risk for suicide mania - CORRECT ANSWER-characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may include inflated self-esteem, increased goaldirected activity or energy, including grandiosity, decreased need for sleep, excessive talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor agitation, and a propensity to be involved in high-risk activities. Mania leads to significant functional impairment and may include psychotic features or necessitate hospitalization Bipolar Type I: - CORRECT ANSWER-requires at least one episode of mania for at least one week (or any duration if hospitalization due to symptoms is required) Bipolar Type II: - CORRECT ANSWER-diagnosis requires a current or past hypomanic episode and a current or past major depressive episode. Symptoms last for at least 4 days but fewer than seven. -Hypomanic symptoms are not of sufficient duration or severity to cause significant functional impairment, psychosis, or hospitalization. -Anger and irritability are common. -Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar more difficult to diagnose if the client presents in the depression phase. Cyclothymia: - CORRECT ANSWER-involves the chronic presentation of hypomanic and depressive symptoms that do not meet the diagnostic criteria for a major depressive or manic/hypomanic episode. If bipolar depression is mistaken for MDD: - CORRECT ANSWER-antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar depression -may contribute to the increased incidence of death by suicide in children and adults younger than 25 Antidepressants are used cautiously in clients with bipolar disorder and never as ________________. - CORRECT ANSWER-monotherapy -Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic or manic episode DA, NE Dysfunction causes what mood related symptoms - CORRECT ANSWERDecreased positive affect: depressed mood loss of joy lack of interest loss of energy decreased alertness decreased self-confidence appetite changes 5HT, NE Dysfunction causes what mood related symptoms - CORRECT ANSWERIncreased negative affect: depressed mood guilt fear/anxiety hostility irritability loneliness appetite changes monoamine hypothesis of depression - CORRECT ANSWER--depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess Medication Management for Depression, First-Line Treatment: - CORRECT ANSWER-• Selective Serotonin Reuptake Inhibitors (SSRIs) • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) • Norepinephrine Dopamine Reuptake Inhibitors (NDRI) • Serotonin Antagonist and Reuptake Inhibitors (SARIs) SSRI's - CORRECT ANSWER-Mechanism of action • inhibit 5-HT reuptake Adverse effects -diarrhea -headache -weight gain -sexual side effects SNRI's - CORRECT ANSWER-Mechanism of action • inhibit 5-HT reuptake • inhibit NE reuptake (increase energy, focus) • increase DA in prefrontal cortex (increase cognition) Adverse effects -elevated blood pressure -anxiety -insomnia -constipation NDRI's - CORRECT ANSWER-Mechanism of action • inhibit DA reuptake (increase alertness, motivation) • inhibit NE reuptake (increase energy) Adverse effects -agitation -headache -dry mouth -constipation -weight loss SSRI Prescribing Pearls: med with mild antihistamine effects - CORRECT ANSWERcitalopram (Celexa) SSRI Prescribing Pearls: med with no known drug interactions - CORRECT ANSWERescitalopram (Lexapro) SSRI Prescribing Pearls: med with longest half-life - CORRECT ANSWER-fluoxetine (Prozac) SSRI Prescribing Pearls: med that also treats social anxiety and insomnia - CORRECT ANSWER-paroxetine (Paxil) SSRI Prescribing Pearls: med that treats anxious depression; smokers require an increased dose - CORRECT ANSWER-fluvoxamine (Luvox) SSRI Prescribing Pearls: med that also treats social anxiety and hypersomnolence - CORRECT ANSWER-sertraline (Zoloft) venlafaxine (Effexor) - CORRECT ANSWER-INDICATION -Depression -GAD -Social anxiety disorder -Panic disorder Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine. TESTS -Check bp before initiating tx & regularly during tx Starting Dose -Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediaterelease) Adverse Effects -H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual dysfunction, asthenia, sweating, SIADH, hyponatremia, increase BP PEARLS -treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication -preferred treatments for treatment-resistant depression desvenlafaxine (Pristiq) - CORRECT ANSWER-INDICATION -MDD Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine TESTS -Monitor BP before and during treatment. Starting Dose -50 mg/day Adverse Effects -Insomnia, sedation, anxiety, dizziness, nausea, vomiting, constipation, decreased appetite, sexual dysfunction, sweating, SIADH, hyponatremia, increased BP PEARLS -effective for perimenopausal vasomotor symptoms duloxetine (Cymbalta) - CORRECT ANSWER-INDICATION -MDD -Diabetic peripheral neuropathic pain -Fibromyalgia -GAD -Chronic musculoskeletal pain Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine TESTS -Monitor BP before and during treatment. Starting Dose -Depression initial 40 mg/day in 2 doses. -Anxiety initial 60 mg once daily. Adverse Effects -nausea, diarrhea, decreased appetite, dry mouth, constipation, insomnia, sedation, dizziness, sexual dysfunction, sweating, increased blood pressure, urinary retention. PEARLS -effective for atypical pain at higher doses; fibromyalgia and diabetic neuropathy -appropriate for clients who present with somatic symptoms of depression -Drug interactions: Inhibitors of CYP450 2D6, such as paroxetine, fluoxetine, and quinidine, may increase plasma levels of duloxetine and require a dosage reduction of duloxetine. 90% of serotonin receptors are in the __________ and _________ are within the brain - CORRECT ANSWER-GI tract, only 10% *which causes GI side effects client education for specific medication classes: SSRI's - CORRECT ANSWER-Most adverse effects will subside after 4-5 days once the body adjusts to increased serotonin levels