A+ NR546 PSYCHOPHARM FINAL EXAM QUESTIONS AND
ANSWERS LATEST UPDATE
Ketamine
N-methyl-D-aspartate (NMDA) receptor inhibitor that results in the downstream release
of glutamate. While in high doses, ketamine may cause psychotic symptoms, in low
doses, it has a rad effect on depression. Clinics have provided intravenous ketamine for
treatment resistant unipolar and bipolar depression; however, the treatment was not
FDA approved until March of 2019. Effects were short lived and required frequent
dosing, which was inconvenient and expensive.
Dextromethorphan/ Quinidine (Nuedexta)
Researchers are investigating another medication related to NMDA for the treatment of
treatment-resistant depression. Currently approved by the FDA for the treatment of
pseudobulbar affect, combines dextromethorphan and quinidine as an oral treatment.
How to choose an antidepressant
Client preference
Prior treatment responses
Anticipated adverse effects
Comorbidities
Half life and interactions
Cost
Monoamine Hypothesis
Deficiency in serotonin (5-HT), norepinephrine (NE), and dopamine (DA). Guides
antidepressant selection based on symptom profile.
SSRIs
Screen for cardiac issues, bipolar disorder. Caution: <25 years (suicide risk).
Sertraline
Least CYP interaction, good tolerance.
Paroxetine
Discontinuation syndrome.
Fluoxetine, Sertraline
, Early activation.
Lithium Interactions
Increase levels: NSAIDs, ACE inhibitors, thiazide diuretics. Decrease levels: Caffeine,
theophylline.
Serotonin Syndrome
Symptoms: Agitation, clonus, hyperthermia. Causes: Combining serotonergic drugs.
Pharmacologic Adjuncts
Buspirone, atypical antipsychotics, L-methylfolate.
Medication Comparisons
SSRIs + Stimulants: Can worsen anxiety. Buspirone similar to SSRIs.
MAOIs
Short half-life; irreversible. Tyramine food interactions.
Bipolar Disorder
Mood stabilizers: Lithium, valproic acid, carbamazepine, lamotrigine.
General Medication Knowledge
Avoid bupropion in eating disorders (seizure risk). Trazodone risk: Priapism.
Elderly-safe
Sertraline, escitalopram.
QTc prolongation
Citalopram.
L-Methylfolate
Active folate form, supports neurotransmitter synthesis.
Reward Circuits
VTA to Nucleus accumbens (dopamine). Prefrontal cortex: Impulse control. Amygdala:
Emotional memory.
Addiction Medications
Alcohol: Naltrexone, acamprosate, disulfiram. Opioids: Methadone, buprenorphine,
naltrexone. Nicotine: NRT, varenicline, bupropion.
Initiation Protocols
Buprenorphine: After mild withdrawal (COWS greater than or equal to 8-12). Naltrexone
(opioid): 7-10 days opioid-free.
ANSWERS LATEST UPDATE
Ketamine
N-methyl-D-aspartate (NMDA) receptor inhibitor that results in the downstream release
of glutamate. While in high doses, ketamine may cause psychotic symptoms, in low
doses, it has a rad effect on depression. Clinics have provided intravenous ketamine for
treatment resistant unipolar and bipolar depression; however, the treatment was not
FDA approved until March of 2019. Effects were short lived and required frequent
dosing, which was inconvenient and expensive.
Dextromethorphan/ Quinidine (Nuedexta)
Researchers are investigating another medication related to NMDA for the treatment of
treatment-resistant depression. Currently approved by the FDA for the treatment of
pseudobulbar affect, combines dextromethorphan and quinidine as an oral treatment.
How to choose an antidepressant
Client preference
Prior treatment responses
Anticipated adverse effects
Comorbidities
Half life and interactions
Cost
Monoamine Hypothesis
Deficiency in serotonin (5-HT), norepinephrine (NE), and dopamine (DA). Guides
antidepressant selection based on symptom profile.
SSRIs
Screen for cardiac issues, bipolar disorder. Caution: <25 years (suicide risk).
Sertraline
Least CYP interaction, good tolerance.
Paroxetine
Discontinuation syndrome.
Fluoxetine, Sertraline
, Early activation.
Lithium Interactions
Increase levels: NSAIDs, ACE inhibitors, thiazide diuretics. Decrease levels: Caffeine,
theophylline.
Serotonin Syndrome
Symptoms: Agitation, clonus, hyperthermia. Causes: Combining serotonergic drugs.
Pharmacologic Adjuncts
Buspirone, atypical antipsychotics, L-methylfolate.
Medication Comparisons
SSRIs + Stimulants: Can worsen anxiety. Buspirone similar to SSRIs.
MAOIs
Short half-life; irreversible. Tyramine food interactions.
Bipolar Disorder
Mood stabilizers: Lithium, valproic acid, carbamazepine, lamotrigine.
General Medication Knowledge
Avoid bupropion in eating disorders (seizure risk). Trazodone risk: Priapism.
Elderly-safe
Sertraline, escitalopram.
QTc prolongation
Citalopram.
L-Methylfolate
Active folate form, supports neurotransmitter synthesis.
Reward Circuits
VTA to Nucleus accumbens (dopamine). Prefrontal cortex: Impulse control. Amygdala:
Emotional memory.
Addiction Medications
Alcohol: Naltrexone, acamprosate, disulfiram. Opioids: Methadone, buprenorphine,
naltrexone. Nicotine: NRT, varenicline, bupropion.
Initiation Protocols
Buprenorphine: After mild withdrawal (COWS greater than or equal to 8-12). Naltrexone
(opioid): 7-10 days opioid-free.
