NR 546 FINAL STUDY GUIDE QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

NR 546 FINAL STUDY GUIDE QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) Prefrontal Cortex Symptoms of MDD Correct Answer Concentration Mental Fatigue Mood PFC & Amygdala Symptoms of MDD Correct Answer Guilt Suicidality Worthlessness Striatum Symptoms of MDD Correct Answer Physical fatigue Nucleus Accumbens Symptoms of MDD Correct Answer Pleasure interests Hypothalamus Symptoms of MDD Correct Answer Sleep Appetite Thalamus & Hypothalamus Symptoms of Mania Correct Answer Decreased sleep/arousal Striatum Symptoms of Mania Correct Answer Motor/agitation Prefrontal cortex (PFC) Symptoms of Mania Correct Answer Risk-taking Talkative/pressured speech Nucleus Accumbens & PFC Symptoms of Mania Correct Answer Racing thoughts, grandiosity PFC & Amygdala Symptoms of Mania Correct Answer Mood Medication Management Correct 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. Correct 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. Correct 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. Correct Answer agitation headache dry mouth constipation weight loss escitalopram (Lexapro) SSRI Correct 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 Correct Answer mild antihistamine effects; Half-Life: 23-45 hours Weak Inhibitor of 2D6 fluoxetine (Prozac) SSRI Correct 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 Correct 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 Correct Answer treats anxious depression smokers require an increased dose Half-Life: 9-28 hours Inhibits 3A4, 2C9, 1A2 sertraline (Zoloft) SSRI Correct 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) Correct 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 Correct 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) Correct 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) Correct 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 Correct Answer The most common SARI, also blocks histaminergic and α-adrenergic receptors. Half-Life: 3-6 hours Serotonin Antagonist and Reuptake Inhibitors (SARIs) Correct Answer Common Adverse Effects · sedation · drowsiness · blurred vision · constipation · dry mouth Serious Adverse Effect priapism Serotonin norepinephrine receptor agonist, alpha2 receptor agonist Correct Answer Mirtazapine Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) Correct 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 Serotonin multimodal (SMM) Correct Answer Vortioxetine (Trintellix) · Acts as SSRI plus 5HT1A partial agonism · Improves depression-related cognition Tricyclic antidepressants (TCAs) Correct Answer Tricyclic antidepressants (TCAs) possess both SRI and NRI properties, but they also block other receptors, including α1-adrenergic, histamine-1, and muscarinic cholinergic receptors. TCAs are not used first-line because of the high incidence of adverse effects and the risk of potential overdose and death due to overdose Tricyclic antidepressants (TCAs) Correct Answer Drugs: · amitriptyline (Elavil) · desipramine (Norpramin) · doxepin (Sinequan) · imipramine (Tofranil) · nortriptyline (Pamelor) Tricyclic antidepressants (TCAs) Correct Answer Common adverse effects of TCAs Alpha-1 adrenergic effects-Orthostatic hypotension Histamine effects-Sedation Histamine effects-Weight gain Anticholinergic effects-Blurred vision Anticholinergic effects-Urinary retention Anticholinergic effects-Constipation Anticholinergic effects-Dry mouth MAOIs Correct Answer Last choice medication class for depression due to the many potential, serious side effects. MAOIs have specific dietary restrictions that when ignored, may be very uncomfortable or very serious for clients. MAOIs Correct Answer Drugs: · phenelzine (Nardil) · selegiline (Emsam) - MAOI-B · tranylcypromine (Parnate) · isocarboxazid (Marplan) MAOI's Key Points Correct Answer · Clients taking MAOIs are at high risk for hypertensive crisis if tyramine is ingested. · Do not prescribe any serotonergic agents within 2 weeks of MAOI discontinuation due to an increased risk of serotonin syndrome. Wait at least 5 half-lives after discontinuing a serotonergic medication before initiating an MAIO. Foods to Avoid When Taking MAO-A Medications Correct Answer · Red wine (Avoid) · Sauerkraut (Avoid) · Cheese (Avoid) · Soy (Avoid) · Smoked meats (Avoid) Foods to Avoid When Taking MAO-A Medications Correct Answer Rationale: Limiting the consumption of tyramine is necessary for orally available MAOIs due to inhibition of MAO-A in the gut. Dietary restrictions are not required for the transdermal formulation of selegiline. Tyramine is present in many aged or preserved foods including aged cheeses, tap and non-pasteurized beers, aged or smoked meat or fish, sauerkraut, kimchee, soy products, and tofu.