NR 546 FINAL EXAM|VERSIONS 1 AND 2|LATEST
UPDATE 2026|QUESTIONS AND DETAILED
ANSWERS (100% CORRECT) |ALREADY
GRADED A+
Lithium
Anticonvulsants
Second generation antipsychotics - ANSWER✔️Pharmacologic Treatment of Bipolar Disorder
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
-Prototype opioid agonist
-indicated for acute pain
-binds to opioid receptors in the CNS, inhibiting ascending pain pathways, altering the
perception & response to pain
-also produces CNS depression and potentially respiratory depression
,*may be life-threatening, especially if utilized with benzodiazepines, CNS depressants, or
alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and extended-release morphine
(Avinza). - ANSWER✔️Opioid medication: Morphine
-has an almost immediate onset of action when given IV, with a duration of 0.5-1 hour
-More potent than morphine, but short duration of action
-the preferred opioid for those unable to tolerate morphine or hydromorphone and in those with
severe hepatic and renal disease
-same indications as morphine and is also used frequently in procedural sedation and general
anesthesia
-Conversion between fentanyl products is NOT mcg for mcg - ANSWER✔️Opioid medication:
Fentanyl
-Similar opioid agonist as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5 times more potent) -
ANSWER✔️Opioid medication: Hydromorphone
-No longer recommended as an analgesic, and not widely available.
-Has numerous concerning adverse effects such as seizures and delirium. - ANSWER✔️Opioid
medication: Meperidine
-Utilized in detoxification and maintenance treatment of opioid addiction and heroin addiction,
with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors, reducing craving for opioids
and prevents withdrawal symptoms for 24 hours
-potential for abuse, only licensed opioid treatment programs or licensed inpatient hospital units
permitted to order and dispense this medication
-potential for life threatening respiratory depression and QT prolongation
-Equianalgesic conversion ratios between methadone and other opioids are individually variable,
with deaths occurring during conversion from chronic high dose opiate history or opioid abuse to
methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are improved as compared to illicit
drug use, however can have decreased birth weight, length, head circumference -
ANSWER✔️Opioid medication: Methadone (Dolophine, Methadose)
-Medication useful in general anesthesia and procedural sedation
-off label usage as infusions for acute pain, as both a stand-alone treatment, as an adjunctive
option with opioids, as well as an intranasal formulation. - ANSWER✔️Opioid medication:
Ketamine
,-Opioid agonist, with similar indications and side effect profile as other opioids, but that also
blocks reuptake of serotonin and norepinephrine.
-Indicated for acute pain management, with added benefit for patients with neuropathic pain and
nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids, but does have risk of
serotonin syndrome. - ANSWER✔️Opioid medication: Tramadol
-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 - ANSWER✔️monoamine hypothesis of depression
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER✔️Medication Management
for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects - ANSWER✔️SSRI's
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 - ANSWER✔️SNRI's
Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss - ANSWER✔️NDRI's
, citalopram (Celexa) - ANSWER✔️SSRI Prescribing Pearls: med with mild antihistamine effects
escitalopram (Lexapro) - ANSWER✔️SSRI Prescribing Pearls: med with no known drug
interactions
fluoxetine (Prozac) - ANSWER✔️SSRI Prescribing Pearls: med with longest half-life
paroxetine (Paxil) - ANSWER✔️SSRI Prescribing Pearls: med that also treats social anxiety and
insomnia
fluvoxamine (Luvox) - ANSWER✔️SSRI Prescribing Pearls: med that treats anxious depression;
smokers require an increased dose
sertraline (Zoloft) - ANSWER✔️SSRI Prescribing Pearls: med that also treats social anxiety and
hypersomnolence
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 - ANSWER✔️venlafaxine (Effexor)
INDICATION
-MDD
Mechanism of Action
UPDATE 2026|QUESTIONS AND DETAILED
ANSWERS (100% CORRECT) |ALREADY
GRADED A+
Lithium
Anticonvulsants
Second generation antipsychotics - ANSWER✔️Pharmacologic Treatment of Bipolar Disorder
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
-Prototype opioid agonist
-indicated for acute pain
-binds to opioid receptors in the CNS, inhibiting ascending pain pathways, altering the
perception & response to pain
-also produces CNS depression and potentially respiratory depression
,*may be life-threatening, especially if utilized with benzodiazepines, CNS depressants, or
alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and extended-release morphine
(Avinza). - ANSWER✔️Opioid medication: Morphine
-has an almost immediate onset of action when given IV, with a duration of 0.5-1 hour
-More potent than morphine, but short duration of action
-the preferred opioid for those unable to tolerate morphine or hydromorphone and in those with
severe hepatic and renal disease
-same indications as morphine and is also used frequently in procedural sedation and general
anesthesia
-Conversion between fentanyl products is NOT mcg for mcg - ANSWER✔️Opioid medication:
Fentanyl
-Similar opioid agonist as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5 times more potent) -
ANSWER✔️Opioid medication: Hydromorphone
-No longer recommended as an analgesic, and not widely available.
-Has numerous concerning adverse effects such as seizures and delirium. - ANSWER✔️Opioid
medication: Meperidine
-Utilized in detoxification and maintenance treatment of opioid addiction and heroin addiction,
with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors, reducing craving for opioids
and prevents withdrawal symptoms for 24 hours
-potential for abuse, only licensed opioid treatment programs or licensed inpatient hospital units
permitted to order and dispense this medication
-potential for life threatening respiratory depression and QT prolongation
-Equianalgesic conversion ratios between methadone and other opioids are individually variable,
with deaths occurring during conversion from chronic high dose opiate history or opioid abuse to
methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are improved as compared to illicit
drug use, however can have decreased birth weight, length, head circumference -
ANSWER✔️Opioid medication: Methadone (Dolophine, Methadose)
-Medication useful in general anesthesia and procedural sedation
-off label usage as infusions for acute pain, as both a stand-alone treatment, as an adjunctive
option with opioids, as well as an intranasal formulation. - ANSWER✔️Opioid medication:
Ketamine
,-Opioid agonist, with similar indications and side effect profile as other opioids, but that also
blocks reuptake of serotonin and norepinephrine.
-Indicated for acute pain management, with added benefit for patients with neuropathic pain and
nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids, but does have risk of
serotonin syndrome. - ANSWER✔️Opioid medication: Tramadol
-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 - ANSWER✔️monoamine hypothesis of depression
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER✔️Medication Management
for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects - ANSWER✔️SSRI's
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 - ANSWER✔️SNRI's
Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss - ANSWER✔️NDRI's
, citalopram (Celexa) - ANSWER✔️SSRI Prescribing Pearls: med with mild antihistamine effects
escitalopram (Lexapro) - ANSWER✔️SSRI Prescribing Pearls: med with no known drug
interactions
fluoxetine (Prozac) - ANSWER✔️SSRI Prescribing Pearls: med with longest half-life
paroxetine (Paxil) - ANSWER✔️SSRI Prescribing Pearls: med that also treats social anxiety and
insomnia
fluvoxamine (Luvox) - ANSWER✔️SSRI Prescribing Pearls: med that treats anxious depression;
smokers require an increased dose
sertraline (Zoloft) - ANSWER✔️SSRI Prescribing Pearls: med that also treats social anxiety and
hypersomnolence
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 - ANSWER✔️venlafaxine (Effexor)
INDICATION
-MDD
Mechanism of Action
