NR 547 Week 5
1. Prescribing pearls: duloxetine (Cymbalta): effective for atypical pain at higherdoses;
appropriate for clients who present with somatic symptoms of depression; effective for
atypical pain, such as fibromyalgia and diabetic neuropathy
2. Prescribing pearls: venlafaxine (Effexor): treats both depression and anxietydisorders,
ensure trial of higher dose before switching to a different medication
3. Prescribing pearls: desvenlafaxine (Pristiq): effective for perimenopausalvasomotor
symptoms
4. considered when selecting a medication:: -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
5. if a medication is not achieving efficacy:: -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
6. Use to protect against suicide: lithium
7. MDD and BPD genetics: genetic factors contribute 31-42% of the disease riskin MDD
and 59-85% in BPD
8. monoamine hypothesis of depression: -posits that depression occurs as aresult of a
deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other down-stream
events such as the regulation of gene expression, growth factors, environ-mental factors, and
epigenetic changes
9. : Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
, • implications for the pathophysiology and treatment of mood disorders
• All known pharmacologic treatments for mood disorders act upon one or more ofthese three
neurotransmitters
-Many of the symptoms of mood disorders are hypothesized to involve dysfunctionof various
combinations of the monoamine neurotransmitters
10. Mood disorders include and
: depressive disorders and bipolar disorders
11. Major depressive disorder (MDD): one of the most prevalent psychiatric dis-orders
-estimated that more than 300 million people suffer from
-leading cause of disability worldwide
-7.1% of adults and 13.3% of adolescents in the U.S. had at least one majordepressive episode
-An imbalance of specific neurotransmitters, including dopamine, serotonin, and
norepinephrine, can influence brain activity and result in depression
-decreased neurotransmitter activity in the prefrontal cortex (PFC)
12. MDD dx: -occurrence of at least one episode of major depression lasting at leasttwo weeks.
-must experience 5 or more of the following symptoms in two weeks to be diagnosedwith a
major depressive episode:
• feeling low most of the day for most days
• decreased interest in activities
• substantial weight loss, significant change in appetite
• fidgeting, random movement (i.e. pacing)
• decreased energy
• sense of guilt or worthlessness
• lack of focus or ability to make decisions
• repeated thoughts of death and suicide
13. risk factors associated with major depressive disorder (MDD): female gen-der
older adults with multiple health problems and disabilitiesnon-white populations
family history of MDD, suicide attempts and completion, substance abusehistory of
abuse/neglect
financial, job loss, divorce, or other life stressorslow socioeconomic status
lack of relationships and support systems
1. Prescribing pearls: duloxetine (Cymbalta): effective for atypical pain at higherdoses;
appropriate for clients who present with somatic symptoms of depression; effective for
atypical pain, such as fibromyalgia and diabetic neuropathy
2. Prescribing pearls: venlafaxine (Effexor): treats both depression and anxietydisorders,
ensure trial of higher dose before switching to a different medication
3. Prescribing pearls: desvenlafaxine (Pristiq): effective for perimenopausalvasomotor
symptoms
4. considered when selecting a medication:: -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
5. if a medication is not achieving efficacy:: -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
6. Use to protect against suicide: lithium
7. MDD and BPD genetics: genetic factors contribute 31-42% of the disease riskin MDD
and 59-85% in BPD
8. monoamine hypothesis of depression: -posits that depression occurs as aresult of a
deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other down-stream
events such as the regulation of gene expression, growth factors, environ-mental factors, and
epigenetic changes
9. : Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
, • implications for the pathophysiology and treatment of mood disorders
• All known pharmacologic treatments for mood disorders act upon one or more ofthese three
neurotransmitters
-Many of the symptoms of mood disorders are hypothesized to involve dysfunctionof various
combinations of the monoamine neurotransmitters
10. Mood disorders include and
: depressive disorders and bipolar disorders
11. Major depressive disorder (MDD): one of the most prevalent psychiatric dis-orders
-estimated that more than 300 million people suffer from
-leading cause of disability worldwide
-7.1% of adults and 13.3% of adolescents in the U.S. had at least one majordepressive episode
-An imbalance of specific neurotransmitters, including dopamine, serotonin, and
norepinephrine, can influence brain activity and result in depression
-decreased neurotransmitter activity in the prefrontal cortex (PFC)
12. MDD dx: -occurrence of at least one episode of major depression lasting at leasttwo weeks.
-must experience 5 or more of the following symptoms in two weeks to be diagnosedwith a
major depressive episode:
• feeling low most of the day for most days
• decreased interest in activities
• substantial weight loss, significant change in appetite
• fidgeting, random movement (i.e. pacing)
• decreased energy
• sense of guilt or worthlessness
• lack of focus or ability to make decisions
• repeated thoughts of death and suicide
13. risk factors associated with major depressive disorder (MDD): female gen-der
older adults with multiple health problems and disabilitiesnon-white populations
family history of MDD, suicide attempts and completion, substance abusehistory of
abuse/neglect
financial, job loss, divorce, or other life stressorslow socioeconomic status
lack of relationships and support systems
