NR546 FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

NR546 FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. Pharmacologic Treatment of Bipolar Disorder Correct Answer Lithium Anticonvulsants Second generation antipsychotics 2. Unipolar depression Correct Answer major depressive disorder (MDD) one of the most common mental disorders -Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among individuals aged 18-25 S/S -depressed mood -loss of interest or pleasure in daily activities -irritability -withdrawal -problems with sleep, eating, energy, concentration, or self worth -severe depression: may experience thoughts of suicide or psychotic symptoms. 3. Bipolar disorder (BD) Correct Answer Chronic condition characterized by extreme fluctuations in mood, energy, and ability to function -Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features -many have only experienced only one manic episode in their lifetime -Mood fluctuations may be separated by periods of high stability or may cycle rapidly -diagnosed when a client has one or more episodes of mania or hypomania with a history of one or more major depressive episodes -high risk for suicide 4. mania Correct Answer characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may include inflated self-esteem, increased goal-directed activity or energy, including grandiosity, decreased need for sleep, excessive talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor agitation, and a propensity to be involved in high-risk activities. Mania leads to significant functional impairment and may include psychotic features or necessitate hospitalization 5. Bipolar Type I Correct Answer requires at least one episode of mania for at least one week (or any duration if hospitalization due to symptoms is required) 6. Bipolar Type II Correct Answer diagnosis requires a current or past hypomanic episode and a current or past major depressive episode. Symptoms last for at least 4 days but fewer than seven. -Hypomanic symptoms are not of sufficient duration or severity to cause significant functional impairment, psychosis, or hospitalization. -Anger and irritability are common. -Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar more difficult to diagnose if the client presents in the depression phase. 7. Cyclothymia Correct Answer involves the chronic presentation of hypomanic and depressive symptoms that do not meet the diagnostic criteria for a major depressive or manic/hypomanic episode. 8. If bipolar depression is mistaken for MDD Correct Answer antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar depression -may contribute to the increased incidence of death by suicide in children and adults younger than 25 9. Antidepressants are used cautiously in clients with bipolar disorder and never as ________________ Correct Answer monotherapy -Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic or manic episode 10. DA, NE Dysfunction causes what mood related symptoms Correct Answer Decreased positive affect: depressed mood loss of joy lack of interest loss of energy decreased alertness decreased self-confidence appetite changes 11. 5HT, NE Dysfunction causes what mood related symptoms Correct Answer Increased negative affect: depressed mood guilt fear/anxiety hostility irritability loneliness appetite changes 12. monoamine hypothesis of depression Correct Answer depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess 13. Medication Management for Depression, First-Line Treatment Correct Answer • Selective Serotonin Reuptake Inhibitors (SSRIs) • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) • Norepinephrine Dopamine Reuptake Inhibitors (NDRI) • Serotonin Antagonist and Reuptake Inhibitors (SARIs) 14. SSRI's Correct Answer Mechanism of action • inhibit 5-HT reuptake Adverse effects -diarrhea -headache -weight gain -sexual side effects 15. SNRI's Correct Answer Mechanism of action • inhibit 5-HT reuptake • inhibit NE reuptake (increase energy, focus) • increase DA in prefrontal cortex (increase cognition) Adverse effects -elevated blood pressure -anxiety -insomnia -constipation 16. NDRI's Correct Answer Mechanism of action • inhibit DA reuptake (increase alertness, motivation) • inhibit NE reuptake (increase energy) Adverse effects -agitation -headache -dry mouth -constipation -weight loss 17. SSRI Prescribing Pearls Correct Answer med with mild antihistamine effects: citalopram (Celexa) 18. SSRI Prescribing Pearls Correct Answer med with no known drug interactions: escitalopram (Lexapro) 19. SSRI Prescribing Pearls Correct Answer med with longest half-life: fluoxetine (Prozac) 20. SSRI Prescribing Pearls Correct Answer med that also treats social anxiety and insomnia: paroxetine (Paxil) 21. SSRI Prescribing Pearls Correct Answer med that treats anxious depression; smokers require an increased dose: fluvoxamine (Luvox) 22. SSRI Prescribing Pearls Correct Answer med that also treats social anxiety and hypersomnolence: sertraline (Zoloft) 23. venlafaxine (Effexor) Correct Answer INDICATION -Depression -GAD -Social anxiety disorder -Panic disorder Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine. TESTS -Check bp before initiating tx & regularly during tx Starting Dose -Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-release) Adverse Effects -H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual dysfunction, asthenia, sweating, SIADH, hyponatremia, increase BP PEARLS -treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication -preferred treatments for treatment-resistant depression 24. desvenlafaxine (Pristiq): INDICATION -MDD Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine TESTS -Monitor BP before and during treatment. Starting Dose -50 mg/day Adverse Effects -Insomnia, sedation, anxiety, dizziness, nausea, vomiting, constipation, decreased appetite, sexual dysfunction, sweating, SIADH, hyponatremia, increased BP PEARLS -effective for perimenopausal vasomotor symptoms 25. duloxetine (Cymbalta) Correct Answer INDICATION -MDD -Diabetic peripheral neuropathic pain -Fibromyalgia -GAD -Chronic musculoskeletal pain Mechanism of Action -SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters serotonin, norepinephrine/noradrenaline, and dopamine TESTS -Monitor BP before and during treatment. Starting Dose -Depression initial 40 mg/day in 2 doses. -Anxiety initial 60 mg once daily. Adverse Effects -nausea, diarrhea, decreased appetite, dry mouth, constipation, insomnia, sedation, dizziness, sexual dysfunction, sweating, increased blood pressure, urinary retention. PEARLS -effective for atypical pain at higher doses; fibromyalgia and diabetic neuropathy -appropriate for clients who present with somatic symptoms of depression -Drug interactions: Inhibitors of CYP450 2D6, such as paroxetine, fluoxetine, and quinidine, may increase plasma