NR 546 Exam Questions and Complete
Solutions Graded A+
Prefrontal Cortex Symptoms of MDD - Answer: Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - Answer: Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - Answer: Physical fatigue
Nucleus Accumbens Symptoms of MDD - Answer: Pleasure interests
Hypothalamus Symptoms of MDD - Answer: Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - Answer: Decreased sleep/arousal
Striatum Symptoms of Mania - Answer: Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - Answer: Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Mania - Answer: Racing thoughts, grandiosity
PFC & Amygdala Symptoms of Mania - Answer: Mood
,Medication Management - Answer: SSRI-Selective Serotonin Reuptake Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days once the
body adjusts to increased serotonin levels. - Answer: diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly stopped to
avoid discontinuation symptoms. NE effects of the medication may increase anxiety in some clients.
Report worsening anxiety to the provider. - Answer: elevated blood pressure
anxiety
insomnia
constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop taking
medication if seizures occur. Stop taking medication if anxiety is noted. - Answer: agitation
headache
dry mouth
constipation
,weight loss
escitalopram (Lexapro) SSRI - Answer: no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - Answer: mild antihistamine effects; Half-Life: 23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - Answer: longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - Answer: also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - Answer: treats anxious depression smokers require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - Answer: also treats social anxiety and hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
, venlafaxine (Effexor) - Answer: treats both depression and anxiety disorders, ensure trial of higher dose
before switching to a different medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
duloxetine (Cymbalta) SNRI - Answer: effective for atypical pain at higher doses; appropriate for clients
who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and
diabetic neuropathy
Half-Life: 12 hours
Inhibitor of 2D6
bupropion (Wellbutrin) - Answer: NDRI may improve energy, alertness, and motivation; not first-line
treatment for anxiety; contraindicated in clients with a history of seizures
Avoid in patients with comorbid anxiety
Half-Life: Parent 10-14 hours; Metabolite 20-27 hours
Inhibits 2D6
Serotonin Antagonist and Reuptake Inhibitors (SARIs) - Answer: SARIs potently block 5-HT2A and 5HT 2C
receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and
reuptake inhibition is present at higher doses.
Trazodone - Answer: The most common SARI, also blocks histaminergic and α-adrenergic receptors.
Half-Life: 3-6 hours
Serotonin Antagonist and Reuptake Inhibitors (SARIs) - Answer: Common Adverse Effects
· sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect
Solutions Graded A+
Prefrontal Cortex Symptoms of MDD - Answer: Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - Answer: Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - Answer: Physical fatigue
Nucleus Accumbens Symptoms of MDD - Answer: Pleasure interests
Hypothalamus Symptoms of MDD - Answer: Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - Answer: Decreased sleep/arousal
Striatum Symptoms of Mania - Answer: Motor/agitation
Prefrontal cortex (PFC) Symptoms of Mania - Answer: Risk-taking
Talkative/pressured speech
Nucleus Accumbens & PFC Symptoms of Mania - Answer: Racing thoughts, grandiosity
PFC & Amygdala Symptoms of Mania - Answer: Mood
,Medication Management - Answer: SSRI-Selective Serotonin Reuptake Inhibitors
*Inhibit 5 HT reuptake
SNRI-Serotonin Norepinephrine Reuptake Inhibitors
*inhibit 5-HT reuptake
*inhibit NE reuptake (increase energy, focus)
*increase DA in prefrontal cortex (increase cognition)
NDRI-Norepinephrine Dopamine Reuptake inhibitors
*inhibit DA reuptake (increase alertness, motivation)
*inhibit NE reuptake (increase energy)
SARI-Serotonin Antagonist Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days once the
body adjusts to increased serotonin levels. - Answer: diarrhea
headache
weight gain
sexual side effects
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly stopped to
avoid discontinuation symptoms. NE effects of the medication may increase anxiety in some clients.
Report worsening anxiety to the provider. - Answer: elevated blood pressure
anxiety
insomnia
constipation
Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop taking
medication if seizures occur. Stop taking medication if anxiety is noted. - Answer: agitation
headache
dry mouth
constipation
,weight loss
escitalopram (Lexapro) SSRI - Answer: no known drug interactions
best tolerated SSRI
27-32 hour half-life good for forgetful prone clients
least CYP reactions
Substrate for 3A4
citalopram (Celexa) SSRI - Answer: mild antihistamine effects; Half-Life: 23-45 hours
Weak Inhibitor of 2D6
fluoxetine (Prozac) SSRI - Answer: longest half-life
Use caution in patients with comorbid anxiety due to risk for activation and panic attacks
Half-Life: 2-3 days parent, 2 week metabolite
Inhibits 2D6 and 3A4
paroxetine (Paxil) SSRI - Answer: also treats social anxiety and insomnia
associated with weight gain
will experience withdrawal with missed dose or abrupt stop
Half-Life: 24 hours
Inhibits 2D6
fluvoxamine (Luvox) SSRI - Answer: treats anxious depression smokers require an increased dose
Half-Life: 9-28 hours
Inhibits 3A4, 2C9, 1A2
sertraline (Zoloft) SSRI - Answer: also treats social anxiety and hypersomnolence
Half-Life: 22-36 hour parent; 62-104 hour metabolite
Inhibits 2D6 and 3A4 weakly at low doses
, venlafaxine (Effexor) - Answer: treats both depression and anxiety disorders, ensure trial of higher dose
before switching to a different medication
Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
duloxetine (Cymbalta) SNRI - Answer: effective for atypical pain at higher doses; appropriate for clients
who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and
diabetic neuropathy
Half-Life: 12 hours
Inhibitor of 2D6
bupropion (Wellbutrin) - Answer: NDRI may improve energy, alertness, and motivation; not first-line
treatment for anxiety; contraindicated in clients with a history of seizures
Avoid in patients with comorbid anxiety
Half-Life: Parent 10-14 hours; Metabolite 20-27 hours
Inhibits 2D6
Serotonin Antagonist and Reuptake Inhibitors (SARIs) - Answer: SARIs potently block 5-HT2A and 5HT 2C
receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and
reuptake inhibition is present at higher doses.
Trazodone - Answer: The most common SARI, also blocks histaminergic and α-adrenergic receptors.
Half-Life: 3-6 hours
Serotonin Antagonist and Reuptake Inhibitors (SARIs) - Answer: Common Adverse Effects
· sedation
· drowsiness
· blurred vision
· constipation
· dry mouth
Serious Adverse Effect
