Exam (elaborations)
NR547 Final Exam
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Exam of 53 pages for the course NR547 at NR547 (NR547 Final Exam)
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NR547 Final ExamMedications for depression - ANSWER SSRIs
SNRIs
SDRIs
TCAs
MAOIs
SSRIs - ANSWER -Action: inhibit 5-HT reuptake
-Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline
-Adverse effects:
• nausea
• agitation
• diarrhea
• headache
• weight gain
• sexual side effects
SNRIs - ANSWER -inhibit 5-HT reuptake
-inhibit NE reuptake (↑ energy, focus)
-increase DA in prefrontal cortex (↑ cognition)
-Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
-Adverse effects:
• elevated blood pressure
• nausea
• sweating
• tremors
• anxiety
• insomnia
• constipation
• anorexia
• sexual dysfunction
SDRIs - ANSWER -inhibit DA reuptake (↑alertness, motivation)
-inhibit NE reuptake (↑energy)
-Adverse effects:
• agitation
• headache
• dry mouth
• constipation
• weight loss
TCAs - ANSWER -Action: inhibits the reuptake of serotonin and norepinephrine;
blocks norepinephrine, histamine, and acetylcholine receptors
-Examples: amitriptyline, clomipramine, desipramine, doxepin
-Common Side Effects:
• dry mouth
• constipation
,• blurred vision
• urinary retention
• sedation
• weight gain
• hypotension
• tachycardia
• sexual dysfunction
MAOIs - ANSWER -Action: increases norepinephrine and serotonin by inhibiting
the enzyme that inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine
-Common Side Effects:
• sedation
• dizziness
• sexual dysfunction
• hypertensive crisis
Prescribing pearls: citalopram (Celexa) - ANSWER mild antihistamine effects
Prescribing pearls: escitalopram (Lexapro) - ANSWER no known drug interactions
Prescribing pearls: fluoxetine (Prozac) - ANSWER longest half-life
Prescribing pearls: paroxetine (Paxil) - ANSWER also treats social anxiety and
insomnia
Prescribing pearls: fluvoxamine (Luvox) - ANSWER treats anxious depression
smokers require increased dose
Prescribing pearls: sertraline (Zoloft) - ANSWER also treats social anxiety and
hypersomnolence
Prescribing pearls: bupropion (Wellbutrin) - ANSWER NDRI may improve energy,
alertness, and motivation; not first line treatment for anxiety; contraindicated in
clients with a history of seizures
Prescribing pearls: duloxetine (Cymbalta) - 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
Prescribing pearls: venlafaxine (Effexor) - ANSWER treats both depression and
anxiety disorders, ensure trial of higher dose before switching to a different
medication
Prescribing pearls: desvenlafaxine (Pristiq) - ANSWER effective for
perimenopausal vasomotor symptoms
considered when selecting a medication: - ANSWER -Client preference
-Prior treatment response
-Anticipated adverse effects
,-Comorbidities
-Half-life and interactions
-Cost
if a medication is not achieving efficacy: - ANSWER -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
Use to protect against suicide - ANSWER lithium
MDD and BPD genetics - ANSWER genetic factors contribute 31-42% of the
disease risk in MDD and 59-85% in BPD
monoamine hypothesis of depression - ANSWER -posits that depression occurs as
a result of a deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other
downstream events such as the regulation of gene expression, growth factors,
environmental factors, and epigenetic changes
- ANSWER Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
• implications for the pathophysiology and treatment of mood disorders
• All known pharmacologic treatments for mood disorders act upon one or more of
these three neurotransmitters
-Many of the symptoms of mood disorders are hypothesized to involve dysfunction of
various combinations of the monoamine neurotransmitters
Mood disorders include ____________________ and ___________________ -
ANSWER depressive disorders and bipolar disorders
Major depressive disorder (MDD) - ANSWER one of the most prevalent psychiatric
disorders
-estimated that more than 300 million people suffer from
-leading cause of disability worldwide
-7.1% of adults and 13.3% of adolescents in the U.S. had at least one major
depressive episode
-An imbalance of specific neurotransmitters, including dopamine, serotonin, and
norepinephrine, can influence brain activity and result in depression
-decreased neurotransmitter activity in the prefrontal cortex (PFC)
MDD dx - ANSWER -occurrence of at least one episode of major depression lasting
at least two weeks.
-must experience 5 or more of the following symptoms in two weeks to be diagnosed
with a major depressive episode:
• feeling low most of the day for most days
, • decreased interest in activities
• substantial weight loss, significant change in appetite
• fidgeting, random movement (i.e. pacing)
• decreased energy
• sense of guilt or worthlessness
• lack of focus or ability to make decisions
• repeated thoughts of death and suicide
risk factors associated with major depressive disorder (MDD) - ANSWER female
gender
older adults with multiple health problems and disabilities
non-white populations
family history of MDD, suicide attempts and completion, substance abuse
history of abuse/neglect
financial, job loss, divorce, or other life stressors
low socioeconomic status
lack of relationships and support systems
Certain conditions are associated with depression, including: - ANSWER epilepsy
post-stroke
Parkinson's disease
multiple sclerosis
degenerative brain disease
Alzheimer's disease
coronary artery disease
depression in malignancy
hypothyroidism
hyperthyroidism
hyperparathyroidism
Cushing's syndrome
Addison's disease
diabetes mellitus
key symptoms of depression: - ANSWER depressed mood and a loss of interest or
pleasure
-may also present with physical symptoms, including fatigue, inattention, poor
appetite, decreased libido, psychomotor retardation, or agitation
-often report difficulty sleeping, lack of motivation, or trouble completing tasks
-severe cases, depressed clients may report delusions or hallucinations
-may even present as catatonia
MDD by severity: mild, moderate, or severe - ANSWER Mild: The intensity of
symptoms is manageable with minimal impairment in functioning. There are few
symptoms beyond those required for diagnosis.
Moderate: The number of symptoms, intensity, or impairment in functioning is
between mild and severe.
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