NRNP 6635 FINAL EXAM TEST QUESTIONS AND
VERIFIED ANSWERS
Question 2:
Debi is a 15-year-old girl who is currently being treated for depression. Her parents
have been very proactive and involved in her care, and Debi has achieved remission 2
months after beginning treatment with a combination of pharmacotherapy and cognitive
behavioral therapy. While counseling Debi's parents about important issues in
management, the PMHNP advises that:
A. There is a > 50% likelihood that Debi's younger sibling will develop depressive
symptoms
B. The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically need long-term pharmacologic management
to prevent relapses
Agomelatine
Brand: Valdoxan
-Melatonin multimodal (Mel-MM)
-Agonist at melatonergic 1 and melatonergic 2 receptors
-Antagonist at 5HT2C receptors
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
Amitriptyline (Elavil)
Tricyclic antidepressant.
Aripiprazole (Abilify)
Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine
receptor antagonist in high concentration and also stimulates increase of dopamine in
low concentrations. Side effects: insomnia, akathisia.
Brexpiprazole (Rexulti)
,Treatment for depression. Atypical antipsychotic
Bupropion (Wellbutrin)
Antidepressant and smoking cessation aid, It can treat depression and help people quit
smoking. It can also prevent depression caused by seasonal affective disorder (SAD).
Citalopram (Celexa)
Antidepressant, SSRI: 20-40 mg qd.
Clomipramine (Anafranil)
-Serotonin reuptake inhibitor (S-RI)
-Tricyclic antidepressant (TCA)
-Parent drug is a potent serotonin reuptake inhibitor
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
-Increases serotonergic neurotransmission by blocking the serotonin reuptake pump
(transporter), -Desensitization of serotonin receptors, especially serotonin 1A receptors
-Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
pump (transporter), -Desensitization of beta adrenergic receptors
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
-Lacks dopamine transporters
-Increases dopamine neurotransmission in this part of the brain
**FDA Approved for Pediatrics in tx Obsessive-compulsive disorder (OCD) (ages 10
and older)
*Off-Label for Pediatric Use: Depression, Severe and treatment-resistant, depression,
Cataplexy syndrome, Anxiety, Insomnia,
Neuropathic pain/chronic pain
-Full therapeutic benefits may take 2-8 weeks
-Dosing: in Peds/Adolescents/Adults:
100-250mg/day
Cyamemazine (Tercian)
Treatment for depression.
-Known as cyamepromazine
-Typical antipsychotic drug of the phenothiazine class.
-Treatment for schizophrenia
and psychosis-associated
anxiety
,-Behaves like an atypical
antipsychotic, due to its
potent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-HT2A).
-Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist,
serotonin dopamine antagonist)
-Commonly Prescribed for (not FDA approved):
-Schizophrenia
-Anxiety associated with psychosis (short-term)
-Anxiety associated with nonpsychotic disorders, including mood disorders and
personality disorders (short-term)
-Severe depression
-Bipolar disorder
-Other psychotic disorders
-Acute agitation/aggression (injection)
-Benzodiazepine withdrawal
Desiprimine (Norpramine)
Treats depression
Brand: Norpramin
-TCA
-Norepinephrine noradrenaline reuptake inhibitor.
-FDA approved for treating depression.
-Off-label: Anxiety, Insomnia,
Neuropathic pain/chronic pain, Treatment-resistant depression.
-More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
(serotonin transporter).
-May have immediate effects in treating insomnia or anxiety.
-If it is not working within 6-8 weeks for depression, it may require a dosage increase or
it may not work at all
-100-200 mg/day (for depression)
50-150 mg/day (for chronic pain).
, Desvenlafaxine (Pristiq)
Dual serotonin and norepinephrine reuptake inhibitor-often classified as an
antidepressant.
-FDA approved to tx MDD.
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/o, PTSD, PMDD
-Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack
dopamine transporters) med can increase dopamine neurotransmission in this part of
the brain
-
Risperidone (Risperdal)
Atypical Antipsychotic (most "typical" of atypicals)
Side effects: EPS (dose-dependent), TD, significant increases in PRL (check PRL
levels)
--> most dopaminergic of Atypicals
IM formulation is available
Amphetamines
drugs that stimulate neural activity, causing speeded-up body functions and associated
energy and mood changes
Dextroamphetamine
CNS stimulant
Mech: Inc catecholamines at the synaptic cleft, especially NE and dopamine.
Use: ADHD, narcolepsy, apetite control
Atomoxetine (Strattera)
- BBW
> Risk of suicidal ideation; monitor for suicidal thinking or behavior, worsening, or
unusual behavior
- Contraindications
> Glaucoma, pheochromocytoma, MAO I use within past 14 days
- Warning
> Rare, but severe hepatotoxicity (most within 120 days of start of treatment)
SE
> Headache, insomnia, somnolence, dry mouth, nausea, abdominal pain, decrease in
appetite, nausea, etc.
> Priapism
NOTE
VERIFIED ANSWERS
Question 2:
Debi is a 15-year-old girl who is currently being treated for depression. Her parents
have been very proactive and involved in her care, and Debi has achieved remission 2
months after beginning treatment with a combination of pharmacotherapy and cognitive
behavioral therapy. While counseling Debi's parents about important issues in
management, the PMHNP advises that:
A. There is a > 50% likelihood that Debi's younger sibling will develop depressive
symptoms
B. The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically need long-term pharmacologic management
to prevent relapses
Agomelatine
Brand: Valdoxan
-Melatonin multimodal (Mel-MM)
-Agonist at melatonergic 1 and melatonergic 2 receptors
-Antagonist at 5HT2C receptors
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
Amitriptyline (Elavil)
Tricyclic antidepressant.
Aripiprazole (Abilify)
Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine
receptor antagonist in high concentration and also stimulates increase of dopamine in
low concentrations. Side effects: insomnia, akathisia.
Brexpiprazole (Rexulti)
,Treatment for depression. Atypical antipsychotic
Bupropion (Wellbutrin)
Antidepressant and smoking cessation aid, It can treat depression and help people quit
smoking. It can also prevent depression caused by seasonal affective disorder (SAD).
Citalopram (Celexa)
Antidepressant, SSRI: 20-40 mg qd.
Clomipramine (Anafranil)
-Serotonin reuptake inhibitor (S-RI)
-Tricyclic antidepressant (TCA)
-Parent drug is a potent serotonin reuptake inhibitor
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
-Increases serotonergic neurotransmission by blocking the serotonin reuptake pump
(transporter), -Desensitization of serotonin receptors, especially serotonin 1A receptors
-Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
pump (transporter), -Desensitization of beta adrenergic receptors
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
-Lacks dopamine transporters
-Increases dopamine neurotransmission in this part of the brain
**FDA Approved for Pediatrics in tx Obsessive-compulsive disorder (OCD) (ages 10
and older)
*Off-Label for Pediatric Use: Depression, Severe and treatment-resistant, depression,
Cataplexy syndrome, Anxiety, Insomnia,
Neuropathic pain/chronic pain
-Full therapeutic benefits may take 2-8 weeks
-Dosing: in Peds/Adolescents/Adults:
100-250mg/day
Cyamemazine (Tercian)
Treatment for depression.
-Known as cyamepromazine
-Typical antipsychotic drug of the phenothiazine class.
-Treatment for schizophrenia
and psychosis-associated
anxiety
,-Behaves like an atypical
antipsychotic, due to its
potent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-HT2A).
-Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist,
serotonin dopamine antagonist)
-Commonly Prescribed for (not FDA approved):
-Schizophrenia
-Anxiety associated with psychosis (short-term)
-Anxiety associated with nonpsychotic disorders, including mood disorders and
personality disorders (short-term)
-Severe depression
-Bipolar disorder
-Other psychotic disorders
-Acute agitation/aggression (injection)
-Benzodiazepine withdrawal
Desiprimine (Norpramine)
Treats depression
Brand: Norpramin
-TCA
-Norepinephrine noradrenaline reuptake inhibitor.
-FDA approved for treating depression.
-Off-label: Anxiety, Insomnia,
Neuropathic pain/chronic pain, Treatment-resistant depression.
-More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
(serotonin transporter).
-May have immediate effects in treating insomnia or anxiety.
-If it is not working within 6-8 weeks for depression, it may require a dosage increase or
it may not work at all
-100-200 mg/day (for depression)
50-150 mg/day (for chronic pain).
, Desvenlafaxine (Pristiq)
Dual serotonin and norepinephrine reuptake inhibitor-often classified as an
antidepressant.
-FDA approved to tx MDD.
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/o, PTSD, PMDD
-Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack
dopamine transporters) med can increase dopamine neurotransmission in this part of
the brain
-
Risperidone (Risperdal)
Atypical Antipsychotic (most "typical" of atypicals)
Side effects: EPS (dose-dependent), TD, significant increases in PRL (check PRL
levels)
--> most dopaminergic of Atypicals
IM formulation is available
Amphetamines
drugs that stimulate neural activity, causing speeded-up body functions and associated
energy and mood changes
Dextroamphetamine
CNS stimulant
Mech: Inc catecholamines at the synaptic cleft, especially NE and dopamine.
Use: ADHD, narcolepsy, apetite control
Atomoxetine (Strattera)
- BBW
> Risk of suicidal ideation; monitor for suicidal thinking or behavior, worsening, or
unusual behavior
- Contraindications
> Glaucoma, pheochromocytoma, MAO I use within past 14 days
- Warning
> Rare, but severe hepatotoxicity (most within 120 days of start of treatment)
SE
> Headache, insomnia, somnolence, dry mouth, nausea, abdominal pain, decrease in
appetite, nausea, etc.
> Priapism
NOTE
