NR 546 EXAM QUESTIONS AND
ANSWERS 100% CORRECT
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
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
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
,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 multimodal (SMM) - ANSWER-Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition
Tricyclic antidepressants (TCAs) - 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) - ANSWER-Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
, Tricyclic antidepressants (TCAs) - 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
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
MAOIs - 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 - ANSWER-Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)
· isocarboxazid (Marplan)
MAOI's Key Points - 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.
ANSWERS 100% CORRECT
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
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
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
,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 multimodal (SMM) - ANSWER-Vortioxetine (Trintellix)
· Acts as SSRI plus 5HT1A partial agonism
· Improves depression-related cognition
Tricyclic antidepressants (TCAs) - 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) - ANSWER-Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
, Tricyclic antidepressants (TCAs) - 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
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
MAOIs - 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 - ANSWER-Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)
· isocarboxazid (Marplan)
MAOI's Key Points - 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.
