NR 546 PSYCHOPHARMACOLOGY FINAL EXAM QUESTIONS WITH DETAILED
ANSWERS
What biomarkers are being used in research to support an AD diagnosis?
CSF amyloid ratio tests, lumipulse FDA approved
research suggests that AD in early stages may cause changes in CSF levels of
multiple markers such as tau and beta amyloid, two markers that form abnormal
brain deposits strongly linked to AD
another potential maker is neurofilament light (NfL)
First-line treatment for dementia-related aggression.
SSRI/SNRI
Which medications have a black box warning for dementia clients?
avoid z-drugs and antidepressants for dementia pts
Which medications include contraindications for other health conditions
Galantamine (Razadyne, Razadyne ER) contraindicated in hepatic or renal
impairment
memantine CYP450 interactions
no interactions with drugs metabolized by CYP450 enzymes
galantamine CYP450 interactions
two major metabolizing enzymes CYP3A4 and CYP2D6 increases the drug
donepezil CYP450 interactions
TAPER. when added to CYP2D6 or CYP3A4 can have peripheral side effects.
Inducers of CYP2D6 and CYP3A4 may increase rate of elimination (ex. nicotine)
monoamine hypothesis of depression
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
NE, DA, 5HT
too little positive affect
-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
-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
-client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
client preference
if no contraindication, then prescribe that med to improve adherence
prior treatment response
if patient had success with a previous med, prescribe that one first
anticipated adverse events
,-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
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
-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
if client cant afford medication, they will not benefit. keep cost, insurance benefits,
and pharmaceutical assistance programs in mind
goal of antidepressant medications
complete remission of symptoms
antidepressant prescribing schedule
-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
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA
inhibit 5HT reuptake
first line of treatment for depression
, SSRI s/e
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
head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education
most adverse affects will subside after 4-5 days once body adjusts to increased
serotonin levels
SSRI drugs
citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
citalopram
*has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if
on this drug
escitalopram
ANSWERS
What biomarkers are being used in research to support an AD diagnosis?
CSF amyloid ratio tests, lumipulse FDA approved
research suggests that AD in early stages may cause changes in CSF levels of
multiple markers such as tau and beta amyloid, two markers that form abnormal
brain deposits strongly linked to AD
another potential maker is neurofilament light (NfL)
First-line treatment for dementia-related aggression.
SSRI/SNRI
Which medications have a black box warning for dementia clients?
avoid z-drugs and antidepressants for dementia pts
Which medications include contraindications for other health conditions
Galantamine (Razadyne, Razadyne ER) contraindicated in hepatic or renal
impairment
memantine CYP450 interactions
no interactions with drugs metabolized by CYP450 enzymes
galantamine CYP450 interactions
two major metabolizing enzymes CYP3A4 and CYP2D6 increases the drug
donepezil CYP450 interactions
TAPER. when added to CYP2D6 or CYP3A4 can have peripheral side effects.
Inducers of CYP2D6 and CYP3A4 may increase rate of elimination (ex. nicotine)
monoamine hypothesis of depression
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
NE, DA, 5HT
too little positive affect
-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
-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
-client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
client preference
if no contraindication, then prescribe that med to improve adherence
prior treatment response
if patient had success with a previous med, prescribe that one first
anticipated adverse events
,-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
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
-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
if client cant afford medication, they will not benefit. keep cost, insurance benefits,
and pharmaceutical assistance programs in mind
goal of antidepressant medications
complete remission of symptoms
antidepressant prescribing schedule
-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
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA
inhibit 5HT reuptake
first line of treatment for depression
, SSRI s/e
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
head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education
most adverse affects will subside after 4-5 days once body adjusts to increased
serotonin levels
SSRI drugs
citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
citalopram
*has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if
on this drug
escitalopram
