NR 546 / NR546 Actual Final Exam Guide 2024 Prediction questions (All correct answers, Already graded A)

NR 546 / NR546 Actual Final Exam Guide 2024 Prediction questions (All correct answers, Already graded A) Bipolar disorder (BD) 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 Characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may include inflated self-esteem, increased goal-directed 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: 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: 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. Cyclothymic: 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: 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 ________________. 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 Decreased 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 Increased negative affect: Depressed mood Guilt Fear/anxiety Hostility Irritability Loneliness Appetite changes Monoamine hypothesis of depression -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: • Selective Serotonin Reuptake Inhibitors (SSRIs) • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) • Norepinephrine Dopamine Reuptake Inhibitors (NDRI) • Serotonin Antagonist and Reuptake Inhibitors (SARIs) SSRI's Mechanism of action • inhibit 5-HT reuptake Adverse effects -diarrhea -headache -weight gain -sexual side effects SNRI's 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 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 Citalopram (Celera) SSRI Prescribing Pearls: med with no known drug interactions Escitalopram (Lexapro) SSRI Prescribing Pearls: med with longest half-life Fluoxetine (Prozac) SSRI Prescribing Pearls: med that also treats social anxiety and insomnia Paroxetine (Paxil) SSRI Prescribing Pearls: med that treats anxious depression; smokers require an increased dose Fluvoxamine (Luvox) SSRI Prescribing Pearls: med that also treats social anxiety and hyper somnolence Sertraline (Zoloft) Venlafaxine (Effexor) 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 bop before initiating TX & regularly during TX Starting Dose -Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-release) 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 (Pistil) INDICATION -MDD