NR546 Psychopharmacology Final Exam | Questions
and Answers complete solutions | 2026-2027 Updates
| Chamberlain
monoamine hypothesis of depression - ANSWER- 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 - ANSWER- NE, DA, 5HT
too little positive affect - ANSWER- -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 - ANSWER- -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 - ANSWER- -client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
,client preference - ANSWER- if no contraindication, then prescribe that med to improve
adherence
prior treatment response - ANSWER- if patient had success with a previous med, prescribe
that one first
anticipated adverse events - ANSWER- -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 - ANSWER- 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 - ANSWER- -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 - ANSWER- if client cant afford medication, they will not benefit. keep cost, insurance
benefits, and pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER- complete remission of symptoms
antidepressant prescribing schedule - ANSWER- -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 - ANSWER- inhibit 5HT reuptake
first line of treatment for depression
SSRI s/e - ANSWER- 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 - ANSWER- head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER- most adverse affects will subside after 4-5 days once body
adjusts to increased serotonin levels
SSRI drugs - ANSWER- citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
citalopram - ANSWER- *has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this drug
escitalopram - ANSWER- *no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
, fluoxetine - ANSWER- *longest half life - prescribe to patient who may forget to take their
meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the long half
life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER- *also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and
anticholinergic rebound
*patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
sertraline - ANSWER- *treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER- treats anxious depression and smokers require increased dose
bupropion - ANSWER- fewer side effects, lowest risk for sexual side effects, use with caution
if pt has comorbid anxiety
screening to be completed before prescribing SSRI - ANSWER- baseline and routine labs
age group most at risk when prescribed SSRI and why - ANSWER- antidepressant induced
suicide is prevalent in children, adolescents, and adults younger than 25 years
SSRI with least CYP450 reactions - ANSWER- escitalopram
best tolerated SSRI - ANSWER- Escitalopram (Lexapro)
which meds are used as adjuncts - ANSWER- benzos, trazadone, antipsychotic meds
sometimes prescribed at low doses for severe depression
which substances increase lithium levels - ANSWER- NSAIDS and ace inhibitors
which substances decrease lithium levels - ANSWER- caffeine
and Answers complete solutions | 2026-2027 Updates
| Chamberlain
monoamine hypothesis of depression - ANSWER- 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 - ANSWER- NE, DA, 5HT
too little positive affect - ANSWER- -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 - ANSWER- -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 - ANSWER- -client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
,client preference - ANSWER- if no contraindication, then prescribe that med to improve
adherence
prior treatment response - ANSWER- if patient had success with a previous med, prescribe
that one first
anticipated adverse events - ANSWER- -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 - ANSWER- 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 - ANSWER- -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 - ANSWER- if client cant afford medication, they will not benefit. keep cost, insurance
benefits, and pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER- complete remission of symptoms
antidepressant prescribing schedule - ANSWER- -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 - ANSWER- inhibit 5HT reuptake
first line of treatment for depression
SSRI s/e - ANSWER- 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 - ANSWER- head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER- most adverse affects will subside after 4-5 days once body
adjusts to increased serotonin levels
SSRI drugs - ANSWER- citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
citalopram - ANSWER- *has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this drug
escitalopram - ANSWER- *no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
, fluoxetine - ANSWER- *longest half life - prescribe to patient who may forget to take their
meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the long half
life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER- *also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and
anticholinergic rebound
*patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
sertraline - ANSWER- *treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER- treats anxious depression and smokers require increased dose
bupropion - ANSWER- fewer side effects, lowest risk for sexual side effects, use with caution
if pt has comorbid anxiety
screening to be completed before prescribing SSRI - ANSWER- baseline and routine labs
age group most at risk when prescribed SSRI and why - ANSWER- antidepressant induced
suicide is prevalent in children, adolescents, and adults younger than 25 years
SSRI with least CYP450 reactions - ANSWER- escitalopram
best tolerated SSRI - ANSWER- Escitalopram (Lexapro)
which meds are used as adjuncts - ANSWER- benzos, trazadone, antipsychotic meds
sometimes prescribed at low doses for severe depression
which substances increase lithium levels - ANSWER- NSAIDS and ace inhibitors
which substances decrease lithium levels - ANSWER- caffeine
