NR 507 Weeks 5–8 Notes – Advanced Pathophysiology Study Guide (2025/2026)

Chamberlain University

NR 546 / NR546
Bundle
Weeks 5 to 8 Notes
Advanced Psychopharmacology

,TABLE OF CONTENTS

Week 5 – Mood Disorders


Week 6 – Substance Use Disorders (SUD)


Week 7 – ADHD & Pharmacologic Management


Week 8 – Alzheimer’s Disease & Treatment

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NR 546 Week 5: Mood Disorders
Mood disorders are abnormalities of mood, which include depression, mania, or both. These
disorders occur across a spectrum and affect between 10-20% of the population. Mood disorders
include depressive disorders and bipolar disorder and may be comorbid with other conditions.
Major depressive disorder (MDD) and bipolar disorder (BD) are among the most disabling mental
health disorders. Pervasive symptoms affect mood, thought processes, physical health, work, and
relationships. Death by suicide may result when mood disorders are inadequately diagnosed and
undertreated. Antidepressants account for approximately 15 of the top 200 prescription
medications prescribed and dispensed in the US.
The role of the PMHNP is to determine the malfunctioning brain circuit responsible for the client's
presenting symptoms and select the appropriate medication that targets the associated
neurotransmitter(s).
Unipolar depression, or major depressive disorder (MDD), is one of the most common mental
disorders. Approximately 7.1% of adults in the U.S. have experienced at least one major
depressive episode in the last year, with prevalence highest (13.1%) among individuals aged 18-
25. Common symptoms of MDD include a depressed mood or loss of interest or pleasure in daily
activities, irritability, withdrawal, and problems with sleep, eating, energy, concentration, or self-
worth. Clients with severe depression may experience thoughts of suicide or psychotic
symptoms.
Medication Management for Depression
First-line Treatment
 Selective Serotonin Reuptake Inhibitors (SSRIs)
o MOA:
 inhibit 5-HT reuptake
o Adverse Effects:
 diarrhea, headache, weight gain, sexual side effects
o Prescribing Pearls
 citalopram (Celexa) mild antihistamine effects
 escitalopram (Lexapro) no known drug interactions
 fluoxetine (Prozac) longest half-life
 paroxetine (Paxil) also treats social anxiety and insomnia
 fluvoxamine (Luvox) treats anxious depression, smokers require an increased
dose
 sertraline (Zoloft) also treats social anxiety and hypersomnolence
o Client Education
 Most adverse effects will subside after 4-5 days, once the body adjusts to
increased serotonin levels.

 Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
o MOA:
 inhibit 5-HT reuptake
 inhibit NE reuptake (increase energy, focus)
 increase DA in prefrontal cortex (increase cognition)
o Adverse Effects:
 elevated blood pressure, anxiety, insomnia, constipation
o Prescribing Pearls
 venlafaxine (Effexor) treats both depression and anxiety disorders, ensure
trial of higher dose before switching to a different medication


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 desvenlafaxine (Pristiq) effective for perimenopausal vasomotor symptoms
 duloxetine (Cymbalta) 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
o Client Education
 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.

 Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
o MOA:
 inhibit NE reuptake (increase energy)
 inhibit DA reuptake (increase alertness, motivation)
o Adverse Effects:
 Agitation, headache, dry mouth, constipation, weight loss
o Prescribing Pearls
 bupropion (Wellbutrin) may improve energy, alertness, and motivation; not
first-line treatment for anxiety; contraindicated in clients with a history of
seizures
o Client Education
 Take medication in the morning.
 Stop taking medication if seizures occur.
 Stop taking medication if anxiety is noted.

 Serotonin Antagonist and Reuptake Inhibitors (SARIs)
o MOA:
 Potently block 5-HT2A and 5HT2C receptors, which allow more 5-HT to interact
at postsynaptic 5-HT1A sites
 Serotonin blockade and reuptake inhibition is present at higher doses.
 Trazodone, the most common SARI, also blocks histaminergic and α-
adrenergic receptors.
o Adverse Effects:
 Sedation, drowsiness, blurred vision, constipation, dry mouth
 Serious adverse effect: priapism
o Prescribing Pearls
 Trazodone causes significant sedation, but has a short half-life; because of
these features, low-dose trazodone may be used as an adjunctive treatment
for clients with major depression who report continued difficulty falling or
staying asleep.
 Off-label uses: Insomnia, anxiety
o Client Education
 Potential side effects should be discussed at the initiation of treatment.
 Because of sedative effects, take medication at bedtime.
 Male clients should be warned of the risk of priapism which is a medical
emergency.


Client Education




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