NR 546 Midterm Exam Study Guide Complete Guide (2023/2024)

Midterm Exam Review the weekly Explore section content and required readings as noted within your Student Lesson Plan for Learning Success. Review the Tables you have completed. Each week will 17-18 questions. Week 1 Functional neuroanatomy- brain anatomy and physiology covered in both the course Explore section and readings. If a particular area of the brain is affected, what is the expected response? What symptoms would you expect to see? Link the assessment to the affected brain area. For example, if a client comes to your office with complaints of (fill in physical complaint) what are of the brain is affected? Focus on those within the Explore section and your readings. Ethical issues- covered in both the course Explore section and readings Epigenetics- covered in both the course Explore section and readings. Why is epigenetics important? How does epigenetics impact a person’s mental health? Genetics- the CYP 450 impact is discussed in course Explore section. How does the CYP450 affect pharmacodynamics and pharmacokinetics? What are some very common/concerning interactions? Incidence of mental illness-what factors are increasing the incidence? This is covered in course Explore section Week 2 CYP450-how this affects metabolism. Review Stahl Ch 2 . Inducers & Inhibitors- review Stahl p.49. How does an inhibitor or inducer affect medication efficacy? Note the most common inhibitors and inducers noted in your Stahl readings. You will see these mentioned on boards. Make sure 10.22 CCK to review carbamazepine. Is this medication an inhibitor or an inducer? How does combining carbamazepine with another medication affect your prescribing? Are dose adjustments necessary? Agonists/Antagonists (full, partial, reverse)- know definitions, be able to apply this to a clinical situation. Think about how this is applied clinically. For example- if a medication is an agonist, how does that affect transmission? Review Stahl’s agonist spectrum section. Review the figures regarding agonists. Neurotransmission- covered in both the course Explore section and readings. What are the types of neurotransmission? Review retrograde, signal transduction cascades. Why do some medications take weeks for the client to notice a response? Which neurotransmission process causes this? Week 3 Dopamine pathways-know the four pathways, the functions, and adverse effects. If given a scenario with an adverse effect, you should be able to select the responsible pathway. FGA/SGA-know the risks and benefits of each class including affected neurotransmitters, adverse effects. Which medication class is first line? Which medication is associated with higher incidence of EPS or metabolic side effects? How are these medication classes similar? How are they different? Medications-know most common benefits, adverse effects, black box warnings and specialized testing for these medications. Pay attention to medications that stand out from the others either for their benefits or their risks. Are there medication combinations that are associated with an adverse reaction? Be prepared to select a medication based on its profile (i.e., lowest weight gain, lowest cardiometabolic risk, etc. ) • Which medications are noted for decreased risk of death by suicide? (There are 2.) Review your completed antipsychotic table for the next section. Medications-know indication, mechanism of action, adverse and starting dosing of the medications on your table. Look at the clinical pearls that you listed; this will reinforce the 10.22 CCK unique characteristics of certain medications. signs, symptoms, and treatment NMS- tardive dyskinesia- A hyperkinetic movement disorder characterized by abnormal facial and tongue movements (e.g., tongue protrusions, facial grimacing and chewing movements) and quick, jerky limb movements. Can occur from long-term blockade of D2 receptors in the nigrostriatal DA pathway. Occurs annually in about 5% of clients. 25% of clients will develop symptoms within 5 years of medication start. Failure to discontinue typical antipsychotics prior to symptom onset can result in this permanent condition. akathisia- Inner restlessness leading to repetitive motion (rocking, tapping fingers) acute dystonia- Involuntary contractions of muscles; can cause pain Week 4 Benzodiazepines- appropriate prescribing practices, review the risks and benefits of prescribing. Which benzodiazepine is safe in lactation? Which benzodiazepine should not be prescribed in pregnancy? Know recommended length of treatment and how to wean. Review diversion prevention practices. Know the fight or flight response. Pathophysiology of Fear and worry-know what areas of the brain and which neurotransmitters are affected. GAD treatment- recommended actions for efficacy PTSD- which medication is FDA approved? OCD approved treatments. Which medication is first line? Lifespan considerations- which medications are appropriate for the elderly? Which medications should be avoided in the elderly? In lactation? 10.22 CCK Medications-know indication, mechanism of action, adverse and starting dosing of the medications on your anxiolytic table. Pay attention to buspirone. Final Exam Week 5 Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line treatments for major depressive disorder. MDD- major depressive disorder, is heritable include a depressed mood or loss of interest or pleasure in daily activities, irritability, withdrawal, and problems with sleep, eating, energy, concentration, or self-worth. Clients with severe depression may experience thoughts of suicide or psychotic symptoms. Monoamine hypothesis of depression, That depression results from a decrease in monoamine neurotransmitters such as dopamine, norepinephrine (also known as noradrenaline) and serotonin in the central nervous system. monoamine neurotransmitters are norepinephrine, dopamine and serotonin. The classic monoamine hypothesis of depression posits that 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; however, this hypothesis has limitations. acknowledged that depression is more complex than this simple theory but agrees that the monoamine hypothesis is helpful to understand the physiological functioning of these NTs. Emphasis is now shifted from the monoamines to their receptors and other downstream events such as the regulation of gene expression, growth factors, environmental factors, and 10.22 CCK epigenetic changes prescribing considerations- do not give antidepressants as monotherapy for bipolar - always combine with mood stabilizer. Must rule out mania or hypomania so don't confuse MDD with BPD and induce mania. Monitor infant irritability when prescribe SNRI for breastfeeding. Also keep in mind: client preference, prior treatment response, anticipated adverse effects, comorbidities, half life and interactions (if they will forget to take med, choose something longer acting), cost. Start patient on drug for 4-8 weeks, on lowest recommended dose. If doesn't work, first increase dose, then switch to diff drug in same class and give adequate trial of high enough dose, then switch to a drug in a different class, then add a second med. 1.If first-line medication treatments are not successful after several weeks, consider increasing dosage first, 3. then switching to another medication in the same class. 4. Adding or switching to a second class of medication may be alternate options. duloxetine paroxetine fluoxetine utilize CYP450 2D6 and therefore have potential for drug interactions. Longest Wait for 14 days to change another meds. Fluvoxamine (Luvox): is only approved for treatment of obsessive-compulsive disorder (OCD) in the United States For older people - citalopram and escitalopram should be ½ dose, due to risk of QTc prolongation. avoid paroxetine if have history of falls, avoid TCAs prescribed with out CNS depressants 10.22 CCK SSRIs what screens should be completed prior to prescribing a SSRI? SNRI need to check BP before and during treatment. Venalafaxine (Effexor) can cause hypertension. One drug that boosts both serotonin and norepinephrine. Hypertension (likely related to norepinephrine's effects on the peripheral vascular system). Which age group is most at risk when prescribed a SSRI? Why? Kids and adults under 25 - increased risk of suicide The risk for suicide may increase at the start of treatment with antidepressants SSRIs are approved for 1st line treatment of OCD. BZOs are not first line treatment for OCD. Which SSRI has the least CYP interactions, escitalopram (Lexapro). which is best tolerated, escitalopram (Lexapro). 27–32-hour half-life which is less prone to side effects if a dose is late or forgotten. Dosage can be increased at the next visit if medication is tolerated but efficacy is not achieved with 10 mg. longest acting, fluoxetine (Prozac) has the longest half life 1-2 weeks. When adding or switching antidepressants use caution for 5 weeks after stopping fluoxetine more likely to cause discontinuation syndrome? Paroxetine (Paxil)- Contraindicated in pregnancy (risk of atrial septal defect). Also treats social anxiety and insomnia. Has a short half-life (less than 1 day) and is very rapidly absorb 10.22 CCK Good for forgetful people - fluoxetine (has 2-3 day half life). should be used with caution in clients with comorbid anxiety due to the risk of activation and panic attacks. Sertraline a 27–36-hour half-life which is less likely to cause withdrawal symptoms if a dose is late or missed. Safe in pregnancy and breastfeeding. Also treats social anxiety and hypersomnolence. has more GI side effects. Trazadone is the most common SARI blocks histaminergic and alpha adrenergic receptors. Short half-life, use as adjunct tx for major depression who can’t sleep. Off label for Insomnia and anxiety. S/E: Sedation, drowsiness, blurred vision, constipation, dry mouth. Because of sedative effects, take medication at bedtime. Male clients should be warned of risk of priapism which is a medical emergency. Which medications are used as adjuncts? Bupropion (Wellbutrin)–should be used with caution in clients with comorbid anxiety. Can also be prescribed as an adjunct to a SSRI. Boosts dopamine and norepinephrine but lacks serotonin involvement. Does not cause the sexual side effects seen with SSRI's and SNRI's. help people quit smoking. Mirtazapine (Remerol) – may be used to increase appetite/weight gain in older clients, and sedation. Lowest risk of sexual side effects: buproprion, mirtazapine Vortioxetine – for Brain fog Trazadome fo difficult to sleep, not first line for depression due to the significant sedation side effect.