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CHAMBERLAIN COLLEGE of NURSING
Final Exam Guide
Course: NR546/NR 546 Advanced Pharmacology:
Psychopharmacology
Week 5 – Mood Disorders
, Week 5 – Mood Disorders
o Neurological basis for mood disorders
▪ Genetics
-MDD and BD are heritable
31-42% of disease risk for MDD
59-85% of disease risk for BD
-Causes also include dysfunctions in brain, imbalance of neurotransmitters, life events,
abuse or trauma, SU or meds, menstruation, and season changes
▪ Neuroanatomy
-Insufficient information processing by one or more brain circuits sxs
-MDD sxs can be mapped decreased brain activity in prefrontal cortex and
neurotransmitter imbalances
▪ Neural networks
-Monoamine hypothesis of depression (p264): depression occurs as a result of a
deficiency of one or all 3 monoamine NTs, while mania may result from excess
▪ Neural signaling
-Monoamine NTs: serotonin, dopamine, norepinephrine
o Mood-related symptoms
▪ Decreased positive affect
-DA/NE dysfunction
-Depressed mood, loss of joy and energy, lack of interest, decreased alertness,
decreased self-confidence, appetite changes
▪ Increased negative affect
-5HT/NE dysfunction
-Depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite
changes
o Lifespan considerations
▪ Pregnancy
-Paroxetine is contraindicated d/t risk of atrial septal defects
▪ Breast feeding
-Monitor infant irritability when prescribing SNRIs
▪ Older adults
-May not respond to meds if first episode of depression occurs >65
-Citalopram and escitalopram should be dosed at ½ dose d/t risk of QTc prolongation
-BEERS criteria:
Avoid paroxetine in pts with hx of falls/fractures
Avoid TCAs prescribed with other CNS depressants
▪ Children
-Antidepressants increase risk of death by suicide in pts <25
o Important notes
-90% of serotonin receptors are in GI tract, 10% within brain GI side effects
, o Unipolar depression/Major Depressive Disorder
-Sxs
Depressed mood
Loss of interest or pleasure in daily activities
Irritability
Withdrawal
Problems with eating, sleep, energy, concentration, or self-worth
▪ Malfunctioning brain circuits
-PFC: concentration, mood, mental fatigue
-PFC & amygdala: guilt, suicidality, worthlessness
-Striatum: physical fatigue
-Nucleus accumbens: pleasure, interests
-Hypothalamus: sleep, appetite
o Antidepressants
-The goal of antidepressant tx is the remission of sxs
-Tx-resistant depression occurs when depression persists after pt has trialed at least 2
antidepressant therapies
• SSRI (selective serotonin reuptake inhibitors)
*First-line tx for depression
*Sexual dysfunction is common
*MDQ prior to initiating to r/o BD
MoA:
-Inhibit serotonin reuptake
Adverse effects:
-Diarrhea, HA, wt gain, sexual side effects
Pt education:
-Most adverse effects will subside after 4-5 days once body adjusts to
serotonin levels
Pearls:
➢ Citalopram (Celexa)
-Mild antihistamine effects
➢ Escitalopram (Lexapro)
-NKD interactions/best tolerated SSRI with fewest CYP interactions
➢ Fluoxetine (Prozac)
-Longest half-life
➢ Paroxetine (Paxil)
-Also treats social anxiety and insomnia
-Highest risk of discontinuation syndrome d/t serotonin transporter
inhibition and anticholinergic rebound
➢ Fluvoxamine (Luvox)
-Treats anxious depression; smokers require increased dose
➢ Sertraline (Zoloft)
-Also treats social anxiety and hypersomnolence
CHAMBERLAIN COLLEGE of NURSING
Final Exam Guide
Course: NR546/NR 546 Advanced Pharmacology:
Psychopharmacology
Week 5 – Mood Disorders
, Week 5 – Mood Disorders
o Neurological basis for mood disorders
▪ Genetics
-MDD and BD are heritable
31-42% of disease risk for MDD
59-85% of disease risk for BD
-Causes also include dysfunctions in brain, imbalance of neurotransmitters, life events,
abuse or trauma, SU or meds, menstruation, and season changes
▪ Neuroanatomy
-Insufficient information processing by one or more brain circuits sxs
-MDD sxs can be mapped decreased brain activity in prefrontal cortex and
neurotransmitter imbalances
▪ Neural networks
-Monoamine hypothesis of depression (p264): depression occurs as a result of a
deficiency of one or all 3 monoamine NTs, while mania may result from excess
▪ Neural signaling
-Monoamine NTs: serotonin, dopamine, norepinephrine
o Mood-related symptoms
▪ Decreased positive affect
-DA/NE dysfunction
-Depressed mood, loss of joy and energy, lack of interest, decreased alertness,
decreased self-confidence, appetite changes
▪ Increased negative affect
-5HT/NE dysfunction
-Depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite
changes
o Lifespan considerations
▪ Pregnancy
-Paroxetine is contraindicated d/t risk of atrial septal defects
▪ Breast feeding
-Monitor infant irritability when prescribing SNRIs
▪ Older adults
-May not respond to meds if first episode of depression occurs >65
-Citalopram and escitalopram should be dosed at ½ dose d/t risk of QTc prolongation
-BEERS criteria:
Avoid paroxetine in pts with hx of falls/fractures
Avoid TCAs prescribed with other CNS depressants
▪ Children
-Antidepressants increase risk of death by suicide in pts <25
o Important notes
-90% of serotonin receptors are in GI tract, 10% within brain GI side effects
, o Unipolar depression/Major Depressive Disorder
-Sxs
Depressed mood
Loss of interest or pleasure in daily activities
Irritability
Withdrawal
Problems with eating, sleep, energy, concentration, or self-worth
▪ Malfunctioning brain circuits
-PFC: concentration, mood, mental fatigue
-PFC & amygdala: guilt, suicidality, worthlessness
-Striatum: physical fatigue
-Nucleus accumbens: pleasure, interests
-Hypothalamus: sleep, appetite
o Antidepressants
-The goal of antidepressant tx is the remission of sxs
-Tx-resistant depression occurs when depression persists after pt has trialed at least 2
antidepressant therapies
• SSRI (selective serotonin reuptake inhibitors)
*First-line tx for depression
*Sexual dysfunction is common
*MDQ prior to initiating to r/o BD
MoA:
-Inhibit serotonin reuptake
Adverse effects:
-Diarrhea, HA, wt gain, sexual side effects
Pt education:
-Most adverse effects will subside after 4-5 days once body adjusts to
serotonin levels
Pearls:
➢ Citalopram (Celexa)
-Mild antihistamine effects
➢ Escitalopram (Lexapro)
-NKD interactions/best tolerated SSRI with fewest CYP interactions
➢ Fluoxetine (Prozac)
-Longest half-life
➢ Paroxetine (Paxil)
-Also treats social anxiety and insomnia
-Highest risk of discontinuation syndrome d/t serotonin transporter
inhibition and anticholinergic rebound
➢ Fluvoxamine (Luvox)
-Treats anxious depression; smokers require increased dose
➢ Sertraline (Zoloft)
-Also treats social anxiety and hypersomnolence
