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Nr546 Final exam study guide
Nursing (Chamberlain University)
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Finale
MDD-- Monoamine hypothesis of depression, prescribing considerations- the theory is that
depression is caused by a deficiency in monoamine neurotransmission. And mania is the
opposite - due to an excess of monoamine neurotransmission.
This hasn't really been proven yet, so then the focus shifted to the monoamine receptor
hypothesis - that the abnormality of receptors for monoamine NTs cause depression. In that
case, the lack of NT causes upregulation of receptors.
Also not proven yet. Right now the focus is on regulation of gene expression, growth factors,
environmental factors, and epigenetic changes.
Prescribing considerations
- do not give antidepressants as monotherapy for bipolar - always combine with mood
stabilizer. Must rule out mania or hypomania so don't confuse MDD with BPD and induce
mania.
Monitor infant irritability when prescribe SNRI for breastfeeding.
Also keep in mind: client preference, prior treatment response, anticipated adverse effects,
comorbidities, half life and interactions (if they will forget to take med, choose something
longer acting), cost.
Start patient on drug for 4-8 weeks, on lowest recommended dose. If doesn't work, first
increase dose, then switch to diff drug in same class and give adequate trial of high enough
dose, then switch to a drug in a different class, then add a second med.
For older people - citalopram and escitalopram should be ½ dose, avoid paroxetine if have
history of falls, avoid TCAs prescribed with out CNS depressants.
SSRIs what screens should be completed prior to prescribing a SSRI?
- for SNRIs need to check BP before and during treatment.
Which age group is most at risk when prescribed a SSRI? Why? Kids and adults under 25 -
increased risk of suicide
Which SSRI has the least CYP interactions -
escitalopram (Lexapro).
Good for forgetful people -
fluoxetine (has 2-3 day half life). Also sertraline (27-36 hour ½ life).
Longest acting
fluoxetine has the longest half life 1-2 weeks. When adding or switching antidepressants use
caution for 5 weeks after stopping fluoxetine
More likely to cause discontinuation syndrome. -
paroxetine
Safe in nursing and pregnancy and breastfeeding
sertraline
Contraindicated in pregnancy
paroxetine (risk of atrial septal defect).
Which medications are used as adjuncts?
Downloaded by Kim Thompson ()
Nr546 Final exam study guide
Nursing (Chamberlain University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Kim Thompson ()
, lOMoARcPSD|49488095
Finale
MDD-- Monoamine hypothesis of depression, prescribing considerations- the theory is that
depression is caused by a deficiency in monoamine neurotransmission. And mania is the
opposite - due to an excess of monoamine neurotransmission.
This hasn't really been proven yet, so then the focus shifted to the monoamine receptor
hypothesis - that the abnormality of receptors for monoamine NTs cause depression. In that
case, the lack of NT causes upregulation of receptors.
Also not proven yet. Right now the focus is on regulation of gene expression, growth factors,
environmental factors, and epigenetic changes.
Prescribing considerations
- do not give antidepressants as monotherapy for bipolar - always combine with mood
stabilizer. Must rule out mania or hypomania so don't confuse MDD with BPD and induce
mania.
Monitor infant irritability when prescribe SNRI for breastfeeding.
Also keep in mind: client preference, prior treatment response, anticipated adverse effects,
comorbidities, half life and interactions (if they will forget to take med, choose something
longer acting), cost.
Start patient on drug for 4-8 weeks, on lowest recommended dose. If doesn't work, first
increase dose, then switch to diff drug in same class and give adequate trial of high enough
dose, then switch to a drug in a different class, then add a second med.
For older people - citalopram and escitalopram should be ½ dose, avoid paroxetine if have
history of falls, avoid TCAs prescribed with out CNS depressants.
SSRIs what screens should be completed prior to prescribing a SSRI?
- for SNRIs need to check BP before and during treatment.
Which age group is most at risk when prescribed a SSRI? Why? Kids and adults under 25 -
increased risk of suicide
Which SSRI has the least CYP interactions -
escitalopram (Lexapro).
Good for forgetful people -
fluoxetine (has 2-3 day half life). Also sertraline (27-36 hour ½ life).
Longest acting
fluoxetine has the longest half life 1-2 weeks. When adding or switching antidepressants use
caution for 5 weeks after stopping fluoxetine
More likely to cause discontinuation syndrome. -
paroxetine
Safe in nursing and pregnancy and breastfeeding
sertraline
Contraindicated in pregnancy
paroxetine (risk of atrial septal defect).
Which medications are used as adjuncts?
Downloaded by Kim Thompson ()
