NR 546 Latest Solutions

NR 546 Prefrontal Cortex Symptoms of MDD - ANSWER Concentration Mental Fatigue Mood PFC & Amygdala Symptoms of MDD - ANSWER Guilt Suicidality Worthlessness Striatum Symptoms of MDD - ANSWER Physical fatigue Nucleus Accumbens Symptoms of MDD - ANSWER Pleasure interests Hypothalamus Symptoms of MDD - ANSWER Sleep Appetite Thalamus & Hypothalamus Symptoms of Mania - ANSWER Decreased sleep/arousal Striatum Symptoms of Mania - ANSWER Motor/agitation Prefrontal cortex (PFC) Symptoms of Mania - ANSWER Risk-taking Talkative/pressured speech Nucleus Accumbens & PFC Symptoms of Mania - ANSWER Racing thoughts, grandiosity PFC & Amygdala Symptoms of Mania - ANSWER Mood Medication Management - ANSWER SSRI-Selective Serotonin Reuptake Inhibitors *Inhibit 5 HT reuptake SNRI-Serotonin Norepinephrine Reuptake Inhibitors *inhibit 5-HT reuptake *inhibit NE reuptake (increase energy, focus) *increase DA in prefrontal cortex (increase cognition) NDRI-Norepinephrine Dopamine Reuptake inhibitors *inhibit DA reuptake (increase alertness, motivation) *inhibit NE reuptake (increase energy) SARI-Serotonin Antagonist Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days once the body adjusts to increased serotonin levels. - ANSWER diarrhea headache weight gain sexual side effects Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be abruptly stopped to avoid discontinuation symptoms. NE effects of the medication may increase anxiety in some clients. Report worsening anxiety to the provider. - ANSWER elevated blood pressure anxiety insomnia constipation Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the morning. Stop taking medication if seizures occur. Stop taking medication if anxiety is noted. - ANSWER agitation headache dry mouth constipation weight loss escitalopram (Lexapro) SSRI - ANSWER no known drug interactions best tolerated SSRI 27-32 hour half-life good for forgetful prone clients least CYP reactions Substrate for 3A4 citalopram (Celexa) SSRI - ANSWER mild antihistamine effects; Half-Life: 23-45 hours Weak Inhibitor of 2D6 Fluoxetine (Prozac) SSRI - ANSWER longest half-life Use caution in patients with comorbid anxiety due to risk for activation and panic attacks Half-Life: 2-3 days parent, 2 week metabolite Inhibits 2D6 and 3A4 Paroxetine (Paxil) SSRI - ANSWER also treats social anxiety and insomnia associated with weight gain will experience withdrawal with missed dose or abrupt stop Half-Life: 24 hours Inhibits 2D6 Fluvoxamine (Luvox) SSRI - ANSWER treats anxious depression smokers require an increased dose Half-Life: 9-28 hours Inhibits 3A4, 2C9, 1A2 Sertraline (Zoloft) SSRI - ANSWER also treats social anxiety and hypersomnolence Half-Life: 22-36 hour parent; 62-104 hour metabolite Inhibits 2D6 and 3A4 weakly at low doses Venlafaxine (Effexor) - ANSWER treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour Duloxetine (Cymbalta) SNRI - ANSWER effective for atypical pain at higher doses; appropriate for clients who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy Half-Life: 12 hours Inhibitor of 2D6 Bupropion (Wellbutrin) - ANSWER NDRI may improve energy, alertness, and motivation; not first-line treatment for anxiety; contraindicated in clients with a history of seizures Avoid in patients with comorbid anxiety Half-Life: Parent 10-14 hours; Metabolite 20-27 hours Inhibits 2D6 Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER SARIs potently block 5-HT2A and 5HT 2C receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and reuptake inhibition is present at higher doses. Trazodone - ANSWER The most common SARI, also blocks histaminergic and α-adrenergic receptors. Half-Life: 3-6 hours Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER Common Adverse Effects · sedation · drowsiness · blurred vision · constipation · dry mouth Serious Adverse Effect priapism Serotonin norepinephrine receptor agonist, alpha2 receptor agonist - ANSWER Mirtazapine Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) - ANSWER Vilazodone (Viibryd) · Inhibits serotonin reuptake with partial 5HT1A agonism Appropriate for depression/comorbid anxiety, its action is similar to a combination of SSRI and buspirone