NR546 PSYCHOPHARMACOLOGY
FINAL EXAM|| 200 QUESTIONS WITH
VERIFIED ANSWERS
monoamine hypothesis of depression - ANSWER-depression occurs as a result of
deficiency of 1 or all 3 monoamine NT
-occurs due to too little positive affect or too much negative affect
(mania will occur from excess of all 3)
what are the three monoamine NT - ANSWER-NE, DA, 5HT
too little positive affect - ANSWER--DA/NE dysfunction
-DA levels low = loss of pleasure, interest, alertness, self-confidence
-DA levels high = hallucinations seen in schizo
-NE (fight or flight) high = antsy, nervous, affects focus ability
-depressed mood, loss of joy, lack of interest, loss of energy, decreased alertness,
decreased self-confidence, appetite changes
too much negative affect - ANSWER--5HT = relaxation, comfort, decreases stress,
regulates libido, arousal, sleep, aggression, pain perception
-5HT/NE dysfunction
-depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite changes
prescribing considerations - ANSWER--client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
client preference - ANSWER-if no contraindication, then prescribe that med to improve
adherence
prior treatment response - ANSWER-if patient had success with a previous med,
prescribe that one first
anticipated adverse events - ANSWER--consider age, family planning, and anticipated
adverse effects.
-use adverse effects to pt's advantage (choose a known activating medication for a pt
with atypical depression or choose a sedating medication for a patient with sleep
disturbances)
,Comorbidities - ANSWER-clients with comorbid anxiety may experience worsening
symptoms when taking medications that target NE (SNRIs)
-fluoxetine is known to activate clients and cause panic attacks in clients with comorbid
anxiety
half-life interactions - ANSWER--choose a medication with a longer half life to avoid
discontinuation syndrome if your client forgets to take it
-many antidepressants have significant interactions with other meds due to CYP450
enzyme involvement
cost - ANSWER-if client cant afford medication, they will not benefit. keep cost,
insurance benefits, and pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER-complete remission of symptoms
antidepressant prescribing schedule - ANSWER--start on a single drug for 4-8 weeks
-if not working:
1. increase dose gradually until efficacy occurs
2. switch to different drug within same drug class after adequate trial which included
higher dosing and a minimum of 8 weeks
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA - ANSWER-inhibit 5HT reuptake
first line of treatment for depression
citalopram - ANSWER-*has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this
drug
escitalopram - ANSWER-*no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
fluoxetine - ANSWER-*longest half life - prescribe to patient who may forget to take their
meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the
long half life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER-*also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and
anticholinergic rebound
, *patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
SSRI s/e - ANSWER-7 S's of SSRIs
1. Stomach
2. sexual dysfunction
3. serotonin syndrome
4. sleep difficulties
5. suicidal thoughts
6. stress
7. size (weight)
serotonin s/e - ANSWER-head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER-most adverse affects will subside after 4-5 days once
body adjusts to increased serotonin levels
SSRI drugs - ANSWER-citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
sertraline - ANSWER-*treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER-treats anxious depression and smokers require increased dose
bupropion - ANSWER-fewer side effects, lowest risk for sexual side effects, use with
caution if pt has comorbid anxiety
screening to be completed before prescribing SSRI - ANSWER-baseline and routine
labs
age group most at risk when prescribed SSRI and why - ANSWER-antidepressant
induced suicide is prevalent in children, adolescents, and adults younger than 25 years
SSRI with least CYP450 reactions - ANSWER-escitalopram
FINAL EXAM|| 200 QUESTIONS WITH
VERIFIED ANSWERS
monoamine hypothesis of depression - ANSWER-depression occurs as a result of
deficiency of 1 or all 3 monoamine NT
-occurs due to too little positive affect or too much negative affect
(mania will occur from excess of all 3)
what are the three monoamine NT - ANSWER-NE, DA, 5HT
too little positive affect - ANSWER--DA/NE dysfunction
-DA levels low = loss of pleasure, interest, alertness, self-confidence
-DA levels high = hallucinations seen in schizo
-NE (fight or flight) high = antsy, nervous, affects focus ability
-depressed mood, loss of joy, lack of interest, loss of energy, decreased alertness,
decreased self-confidence, appetite changes
too much negative affect - ANSWER--5HT = relaxation, comfort, decreases stress,
regulates libido, arousal, sleep, aggression, pain perception
-5HT/NE dysfunction
-depressed mood, guilt, fear/anxiety, hostility, irritability, loneliness, appetite changes
prescribing considerations - ANSWER--client preference
-prior treatment response
-anticipated adverse effects
-comorbidities
-half-life interactions
-cost
client preference - ANSWER-if no contraindication, then prescribe that med to improve
adherence
prior treatment response - ANSWER-if patient had success with a previous med,
prescribe that one first
anticipated adverse events - ANSWER--consider age, family planning, and anticipated
adverse effects.
-use adverse effects to pt's advantage (choose a known activating medication for a pt
with atypical depression or choose a sedating medication for a patient with sleep
disturbances)
,Comorbidities - ANSWER-clients with comorbid anxiety may experience worsening
symptoms when taking medications that target NE (SNRIs)
-fluoxetine is known to activate clients and cause panic attacks in clients with comorbid
anxiety
half-life interactions - ANSWER--choose a medication with a longer half life to avoid
discontinuation syndrome if your client forgets to take it
-many antidepressants have significant interactions with other meds due to CYP450
enzyme involvement
cost - ANSWER-if client cant afford medication, they will not benefit. keep cost,
insurance benefits, and pharmaceutical assistance programs in mind
goal of antidepressant medications - ANSWER-complete remission of symptoms
antidepressant prescribing schedule - ANSWER--start on a single drug for 4-8 weeks
-if not working:
1. increase dose gradually until efficacy occurs
2. switch to different drug within same drug class after adequate trial which included
higher dosing and a minimum of 8 weeks
3. switch to a drug in a different class after adequate trial and higher dosing
4. add a second med as adjunct
SSRI MOA - ANSWER-inhibit 5HT reuptake
first line of treatment for depression
citalopram - ANSWER-*has a mild antihistamine effect
*causes QT prolongation
citalopram = celexa, think of cel LEXUS (car) = car - get an electrocardiogram if on this
drug
escitalopram - ANSWER-*no known drug interactions, used with polypharmacy
*best tolerated SSRI
*27-32 hr half life
fluoxetine - ANSWER-*longest half life - prescribe to patient who may forget to take their
meds
THINK fluoxetine - when you spent a long week in bed with the FLU (referring to the
long half life)
*use with caution if pt has comorbid anxiety due to risk of activation and panic attacks
paroxetine - ANSWER-*also treats social anxiety disorder
*highest risk of discontinuation syndrome due to serotonin transporter inhibition and
anticholinergic rebound
, *patient will experience withdrawal symptoms if with a missed dose or late dose
*contraindicated in pregnancy due to risk of congenital defects
*avoid in hx of falls/fractures
*associated with weight gain
SSRI s/e - ANSWER-7 S's of SSRIs
1. Stomach
2. sexual dysfunction
3. serotonin syndrome
4. sleep difficulties
5. suicidal thoughts
6. stress
7. size (weight)
serotonin s/e - ANSWER-head, red, fed
head = decreased anxiety, impulsivity, sex drive
red = platelets and bleeding
fed = gi motility and nausea
SSRI pt education - ANSWER-most adverse affects will subside after 4-5 days once
body adjusts to increased serotonin levels
SSRI drugs - ANSWER-citalopram
fluoxetine
paroxetine
sertraline
fluvoxamine
bupropion
sertraline - ANSWER-*treats social anxiety
*27-36 hr half life
*THINK sertraline = "squirt" traline - harsher GI effects, safe for breastfeeding
fluvoxamine - ANSWER-treats anxious depression and smokers require increased dose
bupropion - ANSWER-fewer side effects, lowest risk for sexual side effects, use with
caution if pt has comorbid anxiety
screening to be completed before prescribing SSRI - ANSWER-baseline and routine
labs
age group most at risk when prescribed SSRI and why - ANSWER-antidepressant
induced suicide is prevalent in children, adolescents, and adults younger than 25 years
SSRI with least CYP450 reactions - ANSWER-escitalopram
