NR546 MIDTERM EXAM EXAM QUESTIONS AND ANSWERS

NR 546 EXAMQUESTIONS AND
ANSWERS
PrefrontalsCortexsSymptomssofsMDDs-sans--Concentration
MentalsFatigue
Mood

PFCs&sAmygdalasSymptomssofsMDDs-sans--Guilt
Suicidality
Worthlessness

StriatumsSymptomssofsMDDs-sans--Physicalsfatigue

NucleussAccumbenssSymptomssofsMDDs-sans--Pleasuresinterests

HypothalamussSymptomssofsMDDs-sans--Sleep
Appetite

Thalamuss&sHypothalamussSymptomssofsManias-sans--Decreasedssleep/arousal

StriatumsSymptomssofsManias-sans--Motor/agitation

Prefrontalscortexs(PFC)sSymptomssofsManias-sans--Risk-taking
Talkative/pressuredsspeech

NucleussAccumbenss&sPFCsSymptomssofsManias-sans--Racingsthoughts,sgrandiosity

PFCs&sAmygdalasSymptomssofsManias-sans--Mood

MedicationsManagements-sans--SSRI-SelectivesSerotoninsReuptakesInhibitors
*Inhibits5sHTsreuptake
SNRI-SerotoninsNorepinephrinesReuptakesInhibitorss
*inhibits5-HTsreuptake
*inhibitsNEsreuptakes(increasesenergy,sfocus)
*increasesDAsinsprefrontalscortexs(increasescognition)
NDRI-NorepinephrinesDopaminesReuptakesinhibitors
*inhibitsDAsreuptakes(increasesalertness,smotivation)
*inhibitsNEsreuptakes(increasesenergy)
SARI-SerotoninsAntagonistsReuptakesInhibitors

SelectivesSerotoninsReuptakesInhibitorss(SSRIs):sMostsadverseseffectsswillssubsidesafters
4-5sdayssoncesthesbodysadjustsstosincreasedsserotoninslevels.s-sans--diarrhea
headache

,weightsgain
sexualssideseffects

SerotoninsNorepinephrinesReuptakesInhibitorss(SNRIs):sMedicationssshouldsnotsbesabrup
tlysstoppedstosavoidsdiscontinuationssymptoms.sNEseffectssofsthesmedicationsmaysincreas
esanxietysinssomesclients.sReportsworseningsanxietystosthesprovider.s-sans--
elevatedsbloodspressure
anxiety
insomnia
constipation

NorepinephrinesDopaminesReuptakesInhibitorss(NDRI):sTakesmedicationsinsthesmorning.s
Stopstakingsmedicationsifsseizuressoccur.sStopstakingsmedicationsifsanxietysissnoted.s-
sans--agitation

headache
drysmouth
constipation
weightsloss

escitaloprams(Lexapro)sSSRIs-sans--nosknownsdrugsinteractions
beststoleratedsSSRI
27-32shourshalf-lifesgoodsforsforgetfulspronesclients
leastsCYPsreactions
Substratesfors3A4

citaloprams(Celexa)sSSRIs-sans--mildsantihistamineseffects;sHalf-Life:s23-45shours
WeaksInhibitorsofs2D6

fluoxetines(Prozac)sSSRIs-sans--longestshalf-life
Usescautionsinspatientsswithscomorbidsanxietysduestosrisksforsactivationsandspanicsattacks
Half-Life:s2-3sdayssparent,s2sweeksmetabolite
Inhibitss2D6sands3A4

paroxetines(Paxil)sSSRIs-sans--alsostreatsssocialsanxietysandsinsomnia
associatedswithsweightsgain
willsexperienceswithdrawalswithsmissedsdosesorsabruptsstop
Half-Life:s24shours
Inhibitss2D6

fluvoxamines(Luvox)sSSRIs-sans--
treatssanxioussdepressionssmokerssrequiresansincreasedsdose
Half-Life:s9-28shours
Inhibitss3A4,s2C9,s1A2

sertralines(Zoloft)sSSRIs-sans--alsostreatsssocialsanxietysandshypersomnolence
Half-Life:s22-36shoursparent;s62-104shoursmetabolite

,Inhibitss2D6sands3A4sweaklysatslowsdoses

venlafaxines(Effexor)s-sans--
treatssbothsdepressionsandsanxietysdisorders,sensurestrialsofshighersdosesbeforesswitching
stosasdifferentsmedication

Half-life:sParentsdrugs3-7shour;smetaboliteshass9-13shour

duloxetines(Cymbalta)sSNRIs-sans--
effectivesforsatypicalspainsatshighersdoses;sappropriatesforsclientsswhospresentswithssomati
cssymptomssofsdepression;seffectivesforsatypicalspain,ssuchsassfibromyalgiasandsdiabeticsn
europathy
Half-Life:s12shours
Inhibitorsofs2D6

bupropions(Wellbutrin)s-sans--
NDRIsmaysimprovesenergy,salertness,sandsmotivation;snotsfirst-
linestreatmentsforsanxiety;scontraindicatedsinsclientsswithsashistorysofsseizures
Avoidsinspatientsswithscomorbidsanxiety
Half-Life:sParents10-14shours;sMetabolites20-27shours
Inhibitss2D6

SerotoninsAntagonistsandsReuptakesInhibitorss(SARIs)s-sans--SARIsspotentlysblocks5-
HT2Asands5HTs2Csreceptors,swhichsallowsmores5-HTstosinteractsatspostsynaptics5-
HT1Assites.sSerotoninsblockadesandsreuptakesinhibitionsisspresentsatshighersdoses.

Trazodones-sans--ThesmostscommonsSARI,salsosblocksshistaminergicsandsα-
adrenergicsreceptors.
Half-Life:s3-6shours

SerotoninsAntagonistsandsReuptakesInhibitorss(SARIs)s-sans--CommonsAdversesEffects
·ssedation
·sdrowsiness
·sblurredsvision
·sconstipation
·sdrysmouth
SerioussAdversesEffect
priapism

Serotoninsnorepinephrinesreceptorsagonist,salpha2sreceptorsagonists-sans--Mirtazapine

Serotoninsmultimodals(SMM)/serotoninspartialsagonistsreuptakesinhibitors(SPARI)s-sans--
Vilazodones(Viibryd)
·sInhibitssserotoninsreuptakeswithspartials5HT1Asagonism
Appropriatesforsdepression/comorbidsanxiety,sitssactionsisssimilarstosascombinationsofsSS
RIsandsbuspirone

, Serotoninsmultimodals(SMM)s-sans--Vortioxetines(Trintellix)
·sActssassSSRIspluss5HT1Aspartialsagonism
·sImprovessdepression-relatedscognition

Tricyclicsantidepressantss(TCAs)s-sans--
Tricyclicsantidepressantss(TCAs)spossesssbothsSRIsandsNRIsproperties,sbutstheysalsosblo
cksothersreceptors,sincludingsα1-adrenergic,shistamine-
1,sandsmuscarinicscholinergicsreceptors.sTCAssaresnotsusedsfirst-
linesbecausesofstheshighsincidencesofsadverseseffectssandsthesrisksofspotentialsoverdosesa
ndsdeathsduestosoverdose

Tricyclicsantidepressantss(TCAs)s-sans--Drugs:
·samitriptylines(Elavil)
·sdesipramines(Norpramin)
·sdoxepins(Sinequan)
·simipramines(Tofranil)
·snortriptylines(Pamelor)

Tricyclicsantidepressantss(TCAs)s-sans--CommonsadverseseffectssofsTCAs
Alpha-1sadrenergicseffects-Orthostaticshypotension
Histamineseffects-Sedation
Histamineseffects-Weightsgain
Anticholinergicseffects-Blurredsvision
Anticholinergicseffects-Urinarysretention
Anticholinergicseffects-Constipation
Anticholinergicseffects-Drysmouth

MAOIss-sans--
Lastschoicesmedicationsclasssforsdepressionsduestosthesmanyspotential,sseriousssideseffec
ts.sMAOIsshavesspecificsdietarysrestrictionssthatswhensignored,smaysbesverysuncomfortabl
esorsverysserioussforsclients.

MAOIss-sans--Drugs:
·sphenelzines(Nardil)
·sselegilines(Emsam)s-sMAOI-B
·stranylcypromines(Parnate)
·sisocarboxazids(Marplan)

MAOI'ssKeysPointss-sans--
·sClientsstakingsMAOIssaresatshighsrisksforshypertensivescrisissifstyraminesissingested.s
·sDosnotsprescribesanysserotonergicsagentsswithins2sweekssofsMAOIsdiscontinuationsduest
osansincreasedsrisksofsserotoninssyndrome.
Waitsatsleasts5shalf-
livessaftersdiscontinuingsasserotonergicsmedicationsbeforesinitiatingsansMAIO.

FoodsstosAvoidsWhensTakingsMAO-AsMedicationss-sans--·sRedswines(Avoid)