NR546 Psychopharmacology Final exam
204 complete solutions.
NR546 Psychopharmacology Final exam
204 complete solutions.
Monoamine hypothesis of depression - ANSWER depression occurs as a result of deficiency of 1 or all 3
monoamine NT
-occurs due to too little positive affect or too much negative affect
(mania will occur from excess of all 3)
what are the three monoamine NT - ANSWER NE, DA, 5HT
too little positive affect - ANSWER -DA/NE dysfunction
-DA levels low = loss of pleasure, interest, alertness, self-confidence
-DA levels high = hallucinations seen in schizo
-NE (fight or flight) high = antsy, nervous, affects focus ability
-depressed mood, loss of joy, lack of interest, loss of energy, decreased alertness, decreased self-
confidence, appetite changes
too much negative affect - ANSWER -5HT = relaxation, comfort, decreases stress, regulates libido,
arousal, sleep, aggression, pain perception
-5HT/NE dysfunction
-depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite changes
prescribing considerations - ANSWER -client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
,NR546 Psychopharmacology Final exam
204 complete solutions.
-cost
client preference - ANSWER if no contraindication, then prescribe that med to improve adherence
prior treatment response - ANSWER if patient had success with a previous med, prescribe that one first
anticipated adverse events - ANSWER -consider age, family planning, and anticipated adverse effects.
-use adverse effects to pt's advantage (choose a known activating medication for a pt with atypical
depression or choose a sedating medication for a patient with sleep disturbances)
Comorbidities - ANSWER clients with comorbid anxiety may experience worsening symptoms when
taking medications that target NE (SNRIs)
-fluoxetine is known to activate clients and cause panic attacks in clients with comorbid anxiety
half-life interactions - ANSWER -choose a medication with a longer half life to avoid discontinuation
syndrome if your client forgets to take it
-many antidepressants have significant interactions with other meds due to CYP450 enzyme
involvement
cost - ANSWER if client cant afford medication, they will not benefit. keep cost, insurance benefits, and
pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER complete remission of symptoms
antidepressant prescribing schedule - ANSWER -start on a single drug for 4-8 weeks
-if not working:
1. increase dose gradually until efficacy occurs
2. switch to different drug within same drug class after adequate trial which included higher dosing and
a minimum of 8 weeks
,NR546 Psychopharmacology Final exam
204 complete solutions.
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA - ANSWER inhibit 5HT reuptake
first line of treatment for depression
SSRI s/e - ANSWER 7 S's of SSRIs
1. Stomach
2. sexual dysfunction
3. serotonin syndrome
4. sleep difficulties
5. suicidal thoughts
6. stress
7. size (weight)
serotonin s/e - ANSWER head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER most adverse affects will subside after 4-5 days once body adjusts to
increased serotonin levels
SSRI drugs - ANSWER citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
, NR546 Psychopharmacology Final exam
204 complete solutions.
bupropion
citalopram - ANSWER *has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this drug
escitalopram - ANSWER *no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
fluoxetine - ANSWER *longest half life - prescribe to patient who may forget to take their meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the long half life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER *also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and anticholinergic
rebound
*patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
sertraline - ANSWER *treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER treats anxious depression and smokers require increased dose
204 complete solutions.
NR546 Psychopharmacology Final exam
204 complete solutions.
Monoamine hypothesis of depression - ANSWER depression occurs as a result of deficiency of 1 or all 3
monoamine NT
-occurs due to too little positive affect or too much negative affect
(mania will occur from excess of all 3)
what are the three monoamine NT - ANSWER NE, DA, 5HT
too little positive affect - ANSWER -DA/NE dysfunction
-DA levels low = loss of pleasure, interest, alertness, self-confidence
-DA levels high = hallucinations seen in schizo
-NE (fight or flight) high = antsy, nervous, affects focus ability
-depressed mood, loss of joy, lack of interest, loss of energy, decreased alertness, decreased self-
confidence, appetite changes
too much negative affect - ANSWER -5HT = relaxation, comfort, decreases stress, regulates libido,
arousal, sleep, aggression, pain perception
-5HT/NE dysfunction
-depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite changes
prescribing considerations - ANSWER -client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
,NR546 Psychopharmacology Final exam
204 complete solutions.
-cost
client preference - ANSWER if no contraindication, then prescribe that med to improve adherence
prior treatment response - ANSWER if patient had success with a previous med, prescribe that one first
anticipated adverse events - ANSWER -consider age, family planning, and anticipated adverse effects.
-use adverse effects to pt's advantage (choose a known activating medication for a pt with atypical
depression or choose a sedating medication for a patient with sleep disturbances)
Comorbidities - ANSWER clients with comorbid anxiety may experience worsening symptoms when
taking medications that target NE (SNRIs)
-fluoxetine is known to activate clients and cause panic attacks in clients with comorbid anxiety
half-life interactions - ANSWER -choose a medication with a longer half life to avoid discontinuation
syndrome if your client forgets to take it
-many antidepressants have significant interactions with other meds due to CYP450 enzyme
involvement
cost - ANSWER if client cant afford medication, they will not benefit. keep cost, insurance benefits, and
pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER complete remission of symptoms
antidepressant prescribing schedule - ANSWER -start on a single drug for 4-8 weeks
-if not working:
1. increase dose gradually until efficacy occurs
2. switch to different drug within same drug class after adequate trial which included higher dosing and
a minimum of 8 weeks
,NR546 Psychopharmacology Final exam
204 complete solutions.
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA - ANSWER inhibit 5HT reuptake
first line of treatment for depression
SSRI s/e - ANSWER 7 S's of SSRIs
1. Stomach
2. sexual dysfunction
3. serotonin syndrome
4. sleep difficulties
5. suicidal thoughts
6. stress
7. size (weight)
serotonin s/e - ANSWER head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER most adverse affects will subside after 4-5 days once body adjusts to
increased serotonin levels
SSRI drugs - ANSWER citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
, NR546 Psychopharmacology Final exam
204 complete solutions.
bupropion
citalopram - ANSWER *has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this drug
escitalopram - ANSWER *no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
fluoxetine - ANSWER *longest half life - prescribe to patient who may forget to take their meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the long half life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER *also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and anticholinergic
rebound
*patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
sertraline - ANSWER *treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER treats anxious depression and smokers require increased dose
