NR546 Final Exam Question and Answers with Rationale 2025

Pharmacologic treatment of bipolar disorder - -lithium Anticonvulsants Second generation antipsychotics Unipolar depression - -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) - -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. NR546 NR546 -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: - -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) NR546 NR546 • 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 (celexa) 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 hypersomnolence - sertraline (zoloft) NR546 NR546 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 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 (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 (pristiq) - -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 NR546 NR546 Duloxetine (cymbalta) - -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 requir