NR 546 QUESTIONS AND CORRECT SOLUTIONS

NR 546 QUESTIONS AND CORRECT
SOLUTIONS



Prefrontal Cortex Symptoms of MDD - ANSWER: Concentration
bb bb bb bb bb bb bb



Mental Fatigue
bb



Mood

PFC & Amygdala Symptoms of MDD - ANSWER: Guilt
bb bb bb bb bb bb bb bb



Suicidality
Worthlessness

Striatum Symptoms of MDD - ANSWER: Physical fatigue
bb bb bb bb bb bb bb




Nucleus Accumbens Symptoms of MDD - ANSWER: Pleasure interests
bb bb bb bb bb bb bb bb




Hypothalamus Symptoms of MDD - ANSWER: Sleep bb bb bb bb bb bb



Appetite

Thalamus & Hypothalamus Symptoms of Mania - ANSWER: Decreased sleep/arousal
bb bb bb bb bb bb bb bb bb




Striatum Symptoms of Mania - ANSWER: Motor/agitation
bb bb bb bb bb bb




Prefrontal cortex (PFC) Symptoms of Mania - ANSWER: Risk-taking
bb bb bb bb bb bb bb bb



Talkative/pressured speech bb




Nucleus Accumbens & PFC Symptoms of Mania - ANSWER: Racing thoughts,
bb bb bb bb bb bb bb bb bb bb



grandiosity
bb




PFC & Amygdala Symptoms of Mania - ANSWER: Mood
bb bb bb bb bb bb bb bb




Medication Management - ANSWER: SSRI-Selective Serotonin Reuptake Inhibitors
bb bb bb bb bb bb bb



*Inhibit 5 HT reuptake
bb bb bb



SNRI-Serotonin Norepinephrine Reuptake Inhibitors bb bb bb bb



*inhibit 5-HT reuptake
bb bb



*inhibit NE reuptake (increase energy, focus)
bb bb bb bb bb



*increase DA in prefrontal cortex (increase cognition)
bb bb bb bb bb bb



NDRI-Norepinephrine Dopamine Reuptake inhibitors bb bb bb



*inhibit DA reuptake (increase alertness, motivation)
bb bb bb bb bb



*inhibit NE reuptake (increase energy)
bb bb bb bb

,SARI-Serotonin Antagonist Reuptake Inhibitors bb bb bb




Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside
bb bb bb bb bb bb bb bb bb



after 4-5 days once the body adjusts to increased serotonin levels. - ANSWER:
bb bb bb bb bb bb bb bb bb bb bb bb bb



diarrhea
bb



headache
weight gain bb



sexual side effects bb bb




Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Medications should not be
bb bb bb bb bb bb bb bb



abruptly stopped to avoid discontinuation symptoms. NE effects of the medication
bb bb bb bb bb bb bb bb bb bb bb



may increase anxiety in some clients. Report worsening anxiety to the provider. -
bb bb bb bb bb bb bb bb bb bb bb bb bb



ANSWER: elevated blood pressure
bb bb bb bb



anxiety
insomnia
constipation

Norepinephrine Dopamine Reuptake Inhibitors (NDRI): Take medication in the bb bb bb bb bb bb bb bb



morning. Stop taking medication if seizures occur. Stop taking medication if anxiety is
bb bb bb bb bb bb bb bb bb bb bb bb bb



noted. - ANSWER: agitation
bb bb bb bb



headache
dry mouth
bb



constipation
weight loss bb




escitalopram (Lexapro) SSRI - ANSWER: no known drug interactions
bb bb bb bb bb bb bb bb



best tolerated SSRI
bb bb



27-32 hour half-life good for forgetful prone clients
bb bb bb bb bb bb bb



least CYP reactions
bb bb



Substrate for 3A4 bb bb




citalopram (Celexa) SSRI - ANSWER: mild antihistamine effects; Half-Life: 23-45
bb bb bb bb bb bb bb bb bb



hours
bb



Weak Inhibitor of 2D6bb bb bb




fluoxetine (Prozac) SSRI - ANSWER: longest half-life
bb bb bb bb bb bb



Use caution in patients with comorbid anxiety due to risk for activation and panic
bb bb bb bb bb bb bb bb bb bb bb bb bb



attacks
bb



Half-Life: 2-3 days parent, 2 week metabolite
bb bb bb bb bb bb



Inhibits 2D6 and 3A4 bb bb bb




paroxetine (Paxil) SSRI - ANSWER: also treats social anxiety and insomnia
bb bb bb bb bb bb bb bb bb bb



associated with weight gain bb bb bb



will experience withdrawal with missed dose or abrupt stop
bb bb bb bb bb bb bb bb



Half-Life: 24 hours bb bb



Inhibits 2D6 bb

,fluvoxamine (Luvox) SSRI - ANSWER: treats anxious depression smokers require an
bb bb bb bb bb bb bb bb bb bb



increased dose
bb bb



Half-Life: 9-28 hours bb bb



Inhibits 3A4, 2C9, 1A2 bb bb bb




sertraline (Zoloft) SSRI - ANSWER: also treats social anxiety and hypersomnolence
bb bb bb bb bb bb bb bb bb bb



Half-Life: 22-36 hour parent; 62-104 hour metabolite
bb bb bb bb bb bb



Inhibits 2D6 and 3A4 weakly at low doses
bb bb bb bb bb bb bb




venlafaxine (Effexor) - ANSWER: treats both depression and anxiety disorders, ensure
bb bb bb bb bb bb bb bb bb bb



trial of higher dose before switching to a different medication
bb bb bb bb bb bb bb bb bb bb



Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour
bb bb bb bb bb bb bb bb




duloxetine (Cymbalta) SNRI - ANSWER: effective for atypical pain at higher doses;
bb bb bb bb bb bb bb bb bb bb bb



appropriate for clients who present with somatic symptoms of depression; effective for
bb bb bb bb bb bb bb bb bb bb bb bb



atypical pain, such as fibromyalgia and diabetic neuropathy
bb bb bb bb bb bb bb bb



Half-Life: 12 hours bb bb



Inhibitor of 2D6 bb bb




bupropion (Wellbutrin) - ANSWER: NDRI may improve energy, alertness, and
bb bb bb bb bb bb bb bb bb



motivation; not first-line treatment for anxiety; contraindicated in clients with a history
bb bb bb bb bb bb bb bb bb bb bb bb



of seizures
bb bb



Avoid in patients with comorbid anxiety
bb bb bb bb bb



Half-Life: Parent 10-14 hours; Metabolite 20-27 hours
bb bb bb bb bb bb



Inhibits 2D6 bb




Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER: SARIs potently
bb bb bb bb bb bb bb bb bb



block 5-HT2A and 5HT 2C receptors, which allow more 5-HT to interact at
bb bb bb bb bb bb bb bb bb bb bb bb bb



postsynaptic 5-HT1A sites. Serotonin blockade and reuptake inhibition is present at
bb bb bb bb bb bb bb bb bb bb bb



higher doses.
bb bb




Trazodone - ANSWER: The most common SARI, also blocks histaminergic and α-
bb bb bb bb bb bb bb bb bb bb bb



adrenergic receptors. bb



Half-Life: 3-6 hours bb bb




Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER: Common Adverse
bb bb bb bb bb bb bb bb bb



Effects
bb



· sedation
bb



· drowsiness
bb



· blurred vision
bb bb



· constipation
bb



· dry mouth
bb bb



Serious Adverse Effect bb bb



priapism

, Serotonin norepinephrine receptor agonist, alpha2 receptor agonist - ANSWER:
bb bb bb bb bb bb bb bb



Mirtazapine
bb




Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) -
bb bb bb bb bb bb bb bb



ANSWER: Vilazodone (Viibryd)
bb bb bb



· Inhibits serotonin reuptake with partial 5HT1A agonism
bb bb bb bb bb bb bb



Appropriate for depression/comorbid anxiety, its action is similar to a combination of
bb bb bb bb bb bb bb bb bb bb bb



SSRI and buspirone
bb bb bb




Serotonin multimodal (SMM) - ANSWER: Vortioxetine (Trintellix)
bb bb bb bb bb bb



· Acts as SSRI plus 5HT1A partial agonism
bb bb bb bb bb bb bb



· Improves depression-related cognition
bb bb bb




Tricyclic antidepressants (TCAs) - ANSWER: Tricyclic antidepressants (TCAs)
bb bb bb bb bb bb bb



possess both SRI and NRI properties, but they also block other receptors, including
bb bb bb bb bb bb bb bb bb bb bb bb bb



α1-adrenergic, histamine-1, and muscarinic cholinergic receptors. TCAs are not used
bb bb bb bb bb bb bb bb bb bb



first-line because of the high incidence of adverse effects and the risk of potential
bb bb bb bb bb bb bb bb bb bb bb bb bb bb



overdose and death due to overdose
bb bb bb bb bb bb




Tricyclic antidepressants (TCAs) - ANSWER: Drugs:
bb bb bb bb bb



· amitriptyline (Elavil)
bb bb



· desipramine (Norpramin)
bb bb



· doxepin (Sinequan)
bb bb



· imipramine (Tofranil)
bb bb



· nortriptyline (Pamelor)
bb bb




Tricyclic antidepressants (TCAs) - ANSWER: Common adverse effects of TCAs
bb bb bb bb bb bb bb bb bb



Alpha-1 adrenergic effects-Orthostatic hypotension
bb bb bb



Histamine effects-Sedation bb



Histamine effects-Weight gain bb bb



Anticholinergic effects-Blurred vision bb bb



Anticholinergic effects-Urinary retention bb bb



Anticholinergic effects-Constipation bb



Anticholinergic effects-Dry mouth bb bb




MAOIs - ANSWER: Last choice medication class for depression due to the many
bb bb bb bb bb bb bb bb bb bb bb bb



potential, serious side effects. MAOIs have specific dietary restrictions that when
bb bb bb bb bb bb bb bb bb bb bb



ignored, may be very uncomfortable or very serious for clients.
bb bb bb bb bb bb bb bb bb bb




MAOIs - ANSWER: Drugs:
bb bb bb



· phenelzine (Nardil)
bb bb



· selegiline (Emsam) - MAOI-B
bb bb bb bb



· tranylcypromine (Parnate)
bb bb



· isocarboxazid (Marplan)
bb bb