NURS 660 EXAM 2 QUESTIONS &
ANSWERS 100% CORRECT (FULLY
SOLVED)
Agomelatine (Valdoxan) NRI
Major Side Effects - correct answer- -Nausea and
dizziness are most common
-Other adverse reactions are somnolence, fatigue, insomnia,
headache, anxiety, diarrhea, constipation, upper abdominal
pain, vomiting, hyperhidrosis
-Increase of transaminase levels *Stop if transaminase levels
reach 3 times the upper limit of normal
Agomelatine dosing range - correct answer- Usual
Dosage Range
25-50 mg/day at bedtime
Agomelatine drug interactions - correct answer- Use
of agomelatine with potent CYP450 1A2 inhibitors (e.g.,
fluvoxamine) is contraindicated
,Tramadol increases the risk of seizures in patients taking an
antidepressant (class warning)
Agomelatine lab tests - correct answer- Liver function
tests before initiation of treatment and then at 3 weeks, 6
weeks, 12 weeks, 24 weeks, and thereafter when clinically
indicated
When increasing the dose, liver function tests should be
performed at the same frequency as when initiating treatment
Liver function tests should be repeated within 48 hours in any
patient who develops raised transaminases
Renal Impairment
Drug should be used with caution
Hepatic Impairment
Contraindicated
Cardiac Impairment
Dose adjustment not necessary
,Agomelatine Major Adverse Reactions - correct answer-
-Rare hepatitis, hepatic failure
-Theoretically rare induction of mania (class warning)
-Rare activa-tion of suicidal ideation and behavior (suicidality)
(short-term studies did not show an increase in the risk of
suicidality with antidepressants compared to placebo beyond
age 24) (class warning)
Agomelatine neurotransmitters and moa - correct
answer- Actions at both melatonergic and 5HT2C
receptors may be synergistic and increase norepinephrine and
dopamine neurotransmission in the prefrontal cortex; may
resynchronize circadian rhythms that are disturbed in
depression
No influence on extracellular levels of serotonin
Agomelatine pregnancy risk - correct answer- Not
generally recommended for use during pregnancy, especially
during first trimester
Must weigh the risk of treatment (first trimester fetal
development, third trimester newborn delivery) to the child
against the risk of no treatment (recurrence of depression,
maternal health, infant bonding) to the mother and child
, For many patients this may mean continuing treatment during
pregnancy
Amitriptyline (Elavil) major side effects TCA
Commonly Prescribed for
*Depression
*Endogenous depression
Neuropathic pain/chronic pain
Fibromyalgia
Headache
Low back pain/neck pain
Anxiety
Insomnia
Treatment-resistant depression - correct answer-
Blurred vision, constipation, urinary retention, increased
appetite, dry mouth, nausea, diarrhea, heartburn, unusual taste
in mouth, weight gain
Fatigue, weakness, dizziness, sedation, headache, anxiety,
nervousness, restlessness
Sexual dysfunction (impotence, change in libido)
ANSWERS 100% CORRECT (FULLY
SOLVED)
Agomelatine (Valdoxan) NRI
Major Side Effects - correct answer- -Nausea and
dizziness are most common
-Other adverse reactions are somnolence, fatigue, insomnia,
headache, anxiety, diarrhea, constipation, upper abdominal
pain, vomiting, hyperhidrosis
-Increase of transaminase levels *Stop if transaminase levels
reach 3 times the upper limit of normal
Agomelatine dosing range - correct answer- Usual
Dosage Range
25-50 mg/day at bedtime
Agomelatine drug interactions - correct answer- Use
of agomelatine with potent CYP450 1A2 inhibitors (e.g.,
fluvoxamine) is contraindicated
,Tramadol increases the risk of seizures in patients taking an
antidepressant (class warning)
Agomelatine lab tests - correct answer- Liver function
tests before initiation of treatment and then at 3 weeks, 6
weeks, 12 weeks, 24 weeks, and thereafter when clinically
indicated
When increasing the dose, liver function tests should be
performed at the same frequency as when initiating treatment
Liver function tests should be repeated within 48 hours in any
patient who develops raised transaminases
Renal Impairment
Drug should be used with caution
Hepatic Impairment
Contraindicated
Cardiac Impairment
Dose adjustment not necessary
,Agomelatine Major Adverse Reactions - correct answer-
-Rare hepatitis, hepatic failure
-Theoretically rare induction of mania (class warning)
-Rare activa-tion of suicidal ideation and behavior (suicidality)
(short-term studies did not show an increase in the risk of
suicidality with antidepressants compared to placebo beyond
age 24) (class warning)
Agomelatine neurotransmitters and moa - correct
answer- Actions at both melatonergic and 5HT2C
receptors may be synergistic and increase norepinephrine and
dopamine neurotransmission in the prefrontal cortex; may
resynchronize circadian rhythms that are disturbed in
depression
No influence on extracellular levels of serotonin
Agomelatine pregnancy risk - correct answer- Not
generally recommended for use during pregnancy, especially
during first trimester
Must weigh the risk of treatment (first trimester fetal
development, third trimester newborn delivery) to the child
against the risk of no treatment (recurrence of depression,
maternal health, infant bonding) to the mother and child
, For many patients this may mean continuing treatment during
pregnancy
Amitriptyline (Elavil) major side effects TCA
Commonly Prescribed for
*Depression
*Endogenous depression
Neuropathic pain/chronic pain
Fibromyalgia
Headache
Low back pain/neck pain
Anxiety
Insomnia
Treatment-resistant depression - correct answer-
Blurred vision, constipation, urinary retention, increased
appetite, dry mouth, nausea, diarrhea, heartburn, unusual taste
in mouth, weight gain
Fatigue, weakness, dizziness, sedation, headache, anxiety,
nervousness, restlessness
Sexual dysfunction (impotence, change in libido)
