STUDY QUESTIONS AND ANSWERS
FOR NR 546
Prefrontal Cortex Symptoms of MDD - CORRECT ANSWER-Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - CORRECT ANSWER-Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - CORRECT ANSWER-Physical fatigue
Nucleus Accumbens Symptoms of MDD - CORRECT ANSWER-Pleasure interests
Hypothalamus Symptoms of MDD - CORRECT ANSWER-Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - CORRECT ANSWER-Decreased
sleep/arousal
Striatum Symptoms of .Mania .- .CORRECT .ANSWER-Motor/agitation
Prefrontal .cortex .(PFC) .Symptoms .of .Mania .- .CORRECT .ANSWER-Risk-taking
.Talkative/pressured .speech
Nucleus .Accumbens .& .PFC .Symptoms .of .Mania .- .CORRECT .ANSWER-Racing
.thoughts, .grandiosity
PFC .& .Amygdala .Symptoms .of .Mania .- .CORRECT .ANSWER-Mood
Medication .Management .- .CORRECT .ANSWER-SSRI-Selective .Serotonin .Reuptake
.Inhibitors
*Inhibit .5 .HT .reuptake
SNRI-Serotonin .Norepinephrine .Reuptake .Inhibitors
*inhibit .5-HT .reuptake
*inhibit .NE .reuptake .(increase .energy, .focus)
,*increase .DA .in .prefrontal .cortex .(increase
.cognition) .NDRI-Norepinephrine .Dopamine
.Reuptake .inhibitors
*inhibit .DA .reuptake .(increase .alertness, .motivation)
*inhibit .NE .reuptake .(increase .energy)
SARI-Serotonin .Antagonist .Reuptake .Inhibitors
Selective .Serotonin .Reuptake .Inhibitors .(SSRIs): .Most .adverse .effects .will .subside
.after .4-5 .days .once .the .body .adjusts .to .increased .serotonin .levels. .- .CORRECT
.ANSWER- .diarrhea
headache
.weight
.gain
sexual .side .effects
Serotonin .Norepinephrine .Reuptake .Inhibitors .(SNRIs): .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. .-
.CORRECT .ANSWER-elevated .blood .pressure
anxiety
.insomnia
.constipation
Norepinephrine .Dopamine .Reuptake .Inhibitors .(NDRI): .Take .medication .in .the .morning.
.Stop .taking .medication .if .seizures .occur. .Stop .taking .medication .if .anxiety .is .noted. .-
CORRECT .ANSWER-agitation
.headache
dry .mouth
.constipation
.weight .loss
escitalopram .(Lexapro) .SSRI .- .CORRECT .ANSWER-no .known .drug .interactions
.best .tolerated .SSRI
27-32 .hour .half-life .good .for .forgetful .prone .clients
.least .CYP .reactions
Substrate .for .3A4
citalopram .(Celexa) .SSRI .- .CORRECT .ANSWER-mild .antihistamine .effects; .Half-
Life: .23-45 .hours
Weak .Inhibitor .of .2D6
fluoxetine .(Prozac) .SSRI .- .CORRECT .ANSWER-longest .half-life
Use .caution .in .patients .with .comorbid .anxiety .due .to .risk .for .activation .and .panic
.attacks .Half-Life: .2-3 .days .parent, .2 .week .metabolite
Inhibits .2D6 .and .3A4
paroxetine .(Paxil) .SSRI .- .CORRECT .ANSWER-also .treats .social .anxiety .and .insomnia
.associated .with .weight .gain
,will .experience .withdrawal .with .missed .dose .or .abrupt
.stop .Half-Life: .24 .hours
Inhibits .2D6
fluvoxamine .(Luvox) .SSRI .- .CORRECT .ANSWER-treats .anxious .depression .smokers
.require .an .increased .dose
Half-Life: .9-28 .hours
.Inhibits .3A4, .2C9, .1A2
sertraline .(Zoloft) .SSRI .- .CORRECT .ANSWER-also .treats .social .anxiety .and
.hypersomnolence
Half-Life: .22-36 .hour .parent; .62-104 .hour .metabolite
.Inhibits .2D6 .and .3A4 .weakly .at .low .doses
venlafaxine .(Effexor) .- .CORRECT .ANSWER-treats .both .depression .and
.anxiety .disorders, .ensure .trial .of .higher .dose .before .switching .to .a .different
.medication .Half-life: .Parent .drug .3-7 .hour; .metabolite .has .9-13 .hour
duloxetine .(Cymbalta) .SNRI .- .CORRECT .ANSWER-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
Half-Life: .12 .hours
.Inhibitor .of .2D6
bupropion .(Wellbutrin) .- .CORRECT .ANSWER-NDRI .may .improve .energy, .alertness,
.and .motivation; .not .first-line .treatment .for .anxiety; .contraindicated .in .clients .with .a
.history .of .seizures
Avoid .in .patients .with .comorbid .anxiety
Half-Life: .Parent .10-14 .hours; .Metabolite .20-27 .hours
.Inhibits .2D6
Serotonin .Antagonist .and .Reuptake .Inhibitors .(SARIs) .- .CORRECT .ANSWER-SARIs
.potently .block .5-HT2A .and .5HT .2C .receptors, .which .allow .more .5-HT .to .interact .at
.postsynaptic .5-HT1A .sites. .Serotonin .blockade .and .reuptake .inhibition .is .present .at
.higher .doses.
Trazodone .- .CORRECT .ANSWER-The .most .common .SARI, .also .blocks
.histaminergic .and .α-adrenergic .receptors.
Half-Life: .3-6 .hours
Serotonin .Antagonist .and .Reuptake .Inhibitors .(SARIs) .- .CORRECT .ANSWER-Common
.Adverse .Effects
· sedation
· drowsiness
· blurred .vision
· constipation
, · dry .mouth
Serious .Adverse .Effect
.priapism
Serotonin .norepinephrine .receptor .agonist, .alpha2 .receptor .agonist .-
.CORRECT .ANSWER-Mirtazapine
Serotonin .multimodal .(SMM)/serotonin .partial .agonist .reuptake .inhibitor .(SPARI) .-
.CORRECT .ANSWER-Vilazodone .(Viibryd)
· Inhibits .serotonin .reuptake .with .partial .5HT1A .agonism
Appropriate .for .depression/comorbid .anxiety, .its .action .is .similar .to .a .combination .of
.SSRI .and .buspirone
Serotonin .multimodal .(SMM) .- .CORRECT .ANSWER-Vortioxetine .(Trintellix)
· Acts .as .SSRI .plus .5HT1A .partial .agonism
· Improves .depression-related .cognition
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Tricyclic .antidepressants
.(TCAs) .possess .both .SRI .and .NRI .properties, .but .they .also .block .other .receptors,
.including .α1-adrenergic, .histamine-1, .and .muscarinic .cholinergic .receptors. .TCAs .are
.not .used .first-line .because .of .the .high .incidence .of .adverse .effects .and .the .risk .of
.potential .overdose .and .death .due .to .overdose
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Drugs:
· amitriptyline .(Elavil)
· desipramine .(Norpramin)
· doxepin .(Sinequan)
· imipramine .(Tofranil)
· nortriptyline .(Pamelor)
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Common .adverse .effects .of
.TCAs
Alpha-1 .adrenergic .effects-Orthostatic .hypotension
.Histamine .effects-Sedation
Histamine .effects-Weight .gain
.Anticholinergic .effects-Blurred .vision
.Anticholinergic .effects-Urinary .retention
.Anticholinergic .effects-Constipation
.Anticholinergic .effects-Dry .mouth
MAOIs .- .CORRECT .ANSWER-Last .choice .medication .class .for .depression .due .to .the
.many .potential, .serious .side .effects. .MAOIs .have .specific .dietary .restrictions .that .when
.ignored, .may .be .very .uncomfortable .or .very .serious .for .clients.
MAOIs .- .CORRECT .ANSWER-Drugs:
· phenelzine .(Nardil)
FOR NR 546
Prefrontal Cortex Symptoms of MDD - CORRECT ANSWER-Concentration
Mental Fatigue
Mood
PFC & Amygdala Symptoms of MDD - CORRECT ANSWER-Guilt
Suicidality
Worthlessness
Striatum Symptoms of MDD - CORRECT ANSWER-Physical fatigue
Nucleus Accumbens Symptoms of MDD - CORRECT ANSWER-Pleasure interests
Hypothalamus Symptoms of MDD - CORRECT ANSWER-Sleep
Appetite
Thalamus & Hypothalamus Symptoms of Mania - CORRECT ANSWER-Decreased
sleep/arousal
Striatum Symptoms of .Mania .- .CORRECT .ANSWER-Motor/agitation
Prefrontal .cortex .(PFC) .Symptoms .of .Mania .- .CORRECT .ANSWER-Risk-taking
.Talkative/pressured .speech
Nucleus .Accumbens .& .PFC .Symptoms .of .Mania .- .CORRECT .ANSWER-Racing
.thoughts, .grandiosity
PFC .& .Amygdala .Symptoms .of .Mania .- .CORRECT .ANSWER-Mood
Medication .Management .- .CORRECT .ANSWER-SSRI-Selective .Serotonin .Reuptake
.Inhibitors
*Inhibit .5 .HT .reuptake
SNRI-Serotonin .Norepinephrine .Reuptake .Inhibitors
*inhibit .5-HT .reuptake
*inhibit .NE .reuptake .(increase .energy, .focus)
,*increase .DA .in .prefrontal .cortex .(increase
.cognition) .NDRI-Norepinephrine .Dopamine
.Reuptake .inhibitors
*inhibit .DA .reuptake .(increase .alertness, .motivation)
*inhibit .NE .reuptake .(increase .energy)
SARI-Serotonin .Antagonist .Reuptake .Inhibitors
Selective .Serotonin .Reuptake .Inhibitors .(SSRIs): .Most .adverse .effects .will .subside
.after .4-5 .days .once .the .body .adjusts .to .increased .serotonin .levels. .- .CORRECT
.ANSWER- .diarrhea
headache
.weight
.gain
sexual .side .effects
Serotonin .Norepinephrine .Reuptake .Inhibitors .(SNRIs): .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. .-
.CORRECT .ANSWER-elevated .blood .pressure
anxiety
.insomnia
.constipation
Norepinephrine .Dopamine .Reuptake .Inhibitors .(NDRI): .Take .medication .in .the .morning.
.Stop .taking .medication .if .seizures .occur. .Stop .taking .medication .if .anxiety .is .noted. .-
CORRECT .ANSWER-agitation
.headache
dry .mouth
.constipation
.weight .loss
escitalopram .(Lexapro) .SSRI .- .CORRECT .ANSWER-no .known .drug .interactions
.best .tolerated .SSRI
27-32 .hour .half-life .good .for .forgetful .prone .clients
.least .CYP .reactions
Substrate .for .3A4
citalopram .(Celexa) .SSRI .- .CORRECT .ANSWER-mild .antihistamine .effects; .Half-
Life: .23-45 .hours
Weak .Inhibitor .of .2D6
fluoxetine .(Prozac) .SSRI .- .CORRECT .ANSWER-longest .half-life
Use .caution .in .patients .with .comorbid .anxiety .due .to .risk .for .activation .and .panic
.attacks .Half-Life: .2-3 .days .parent, .2 .week .metabolite
Inhibits .2D6 .and .3A4
paroxetine .(Paxil) .SSRI .- .CORRECT .ANSWER-also .treats .social .anxiety .and .insomnia
.associated .with .weight .gain
,will .experience .withdrawal .with .missed .dose .or .abrupt
.stop .Half-Life: .24 .hours
Inhibits .2D6
fluvoxamine .(Luvox) .SSRI .- .CORRECT .ANSWER-treats .anxious .depression .smokers
.require .an .increased .dose
Half-Life: .9-28 .hours
.Inhibits .3A4, .2C9, .1A2
sertraline .(Zoloft) .SSRI .- .CORRECT .ANSWER-also .treats .social .anxiety .and
.hypersomnolence
Half-Life: .22-36 .hour .parent; .62-104 .hour .metabolite
.Inhibits .2D6 .and .3A4 .weakly .at .low .doses
venlafaxine .(Effexor) .- .CORRECT .ANSWER-treats .both .depression .and
.anxiety .disorders, .ensure .trial .of .higher .dose .before .switching .to .a .different
.medication .Half-life: .Parent .drug .3-7 .hour; .metabolite .has .9-13 .hour
duloxetine .(Cymbalta) .SNRI .- .CORRECT .ANSWER-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
Half-Life: .12 .hours
.Inhibitor .of .2D6
bupropion .(Wellbutrin) .- .CORRECT .ANSWER-NDRI .may .improve .energy, .alertness,
.and .motivation; .not .first-line .treatment .for .anxiety; .contraindicated .in .clients .with .a
.history .of .seizures
Avoid .in .patients .with .comorbid .anxiety
Half-Life: .Parent .10-14 .hours; .Metabolite .20-27 .hours
.Inhibits .2D6
Serotonin .Antagonist .and .Reuptake .Inhibitors .(SARIs) .- .CORRECT .ANSWER-SARIs
.potently .block .5-HT2A .and .5HT .2C .receptors, .which .allow .more .5-HT .to .interact .at
.postsynaptic .5-HT1A .sites. .Serotonin .blockade .and .reuptake .inhibition .is .present .at
.higher .doses.
Trazodone .- .CORRECT .ANSWER-The .most .common .SARI, .also .blocks
.histaminergic .and .α-adrenergic .receptors.
Half-Life: .3-6 .hours
Serotonin .Antagonist .and .Reuptake .Inhibitors .(SARIs) .- .CORRECT .ANSWER-Common
.Adverse .Effects
· sedation
· drowsiness
· blurred .vision
· constipation
, · dry .mouth
Serious .Adverse .Effect
.priapism
Serotonin .norepinephrine .receptor .agonist, .alpha2 .receptor .agonist .-
.CORRECT .ANSWER-Mirtazapine
Serotonin .multimodal .(SMM)/serotonin .partial .agonist .reuptake .inhibitor .(SPARI) .-
.CORRECT .ANSWER-Vilazodone .(Viibryd)
· Inhibits .serotonin .reuptake .with .partial .5HT1A .agonism
Appropriate .for .depression/comorbid .anxiety, .its .action .is .similar .to .a .combination .of
.SSRI .and .buspirone
Serotonin .multimodal .(SMM) .- .CORRECT .ANSWER-Vortioxetine .(Trintellix)
· Acts .as .SSRI .plus .5HT1A .partial .agonism
· Improves .depression-related .cognition
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Tricyclic .antidepressants
.(TCAs) .possess .both .SRI .and .NRI .properties, .but .they .also .block .other .receptors,
.including .α1-adrenergic, .histamine-1, .and .muscarinic .cholinergic .receptors. .TCAs .are
.not .used .first-line .because .of .the .high .incidence .of .adverse .effects .and .the .risk .of
.potential .overdose .and .death .due .to .overdose
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Drugs:
· amitriptyline .(Elavil)
· desipramine .(Norpramin)
· doxepin .(Sinequan)
· imipramine .(Tofranil)
· nortriptyline .(Pamelor)
Tricyclic .antidepressants .(TCAs) .- .CORRECT .ANSWER-Common .adverse .effects .of
.TCAs
Alpha-1 .adrenergic .effects-Orthostatic .hypotension
.Histamine .effects-Sedation
Histamine .effects-Weight .gain
.Anticholinergic .effects-Blurred .vision
.Anticholinergic .effects-Urinary .retention
.Anticholinergic .effects-Constipation
.Anticholinergic .effects-Dry .mouth
MAOIs .- .CORRECT .ANSWER-Last .choice .medication .class .for .depression .due .to .the
.many .potential, .serious .side .effects. .MAOIs .have .specific .dietary .restrictions .that .when
.ignored, .may .be .very .uncomfortable .or .very .serious .for .clients.
MAOIs .- .CORRECT .ANSWER-Drugs:
· phenelzine .(Nardil)
