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NUR 546 EXAM QUESTIONS AND CORRECT ANSWERS
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NUR 546 EXAM QUESTIONS AND CORRECT ANSWERSL-Methylfolate Role in Treatment of Depression
Nutritional management for patients who have suboptimal L-methylfolate and who have
major depressive disorder or schizophrenia
L- methylfolate MOA?
necessary for formation of numerous coenzymes in many metabolic systems,
particularly for purine, pyrimidine, and nucleoprotein synthesis, and maintenance in
erythropoiesis; stimulates WBC and platelet production in folate deficiency anemia.
Why is L-Methylfolate recommended as an adjunct in depression?
Improves response to antidepressants that affect monoamines amongst depressed
patients who do not respond adequately.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Inhibit reuptake of serotonin-therefore increases it; used for depression, OCD, anxiety,
panic disorder (THIS_IS_A_REWRITE: This medication is commonly used for depression
because it has the least amount of side effects.)
fluoxetine (Prozac)
sertraline (Zoloft)
paroxetine (Paxil)
citalopram (Celexa)
*escitalopram (Lexapro) best tolerated
vortioxetine (Brintellix)
Side Effects: dry mouth, blurred vision, insomnia, headache, nervousness, anorexia,
nausea, vomiting, diarrhea, sexual dysfunction, suicidal ideation
Teaching: take in the morning to avoid insomnia, advise pt that may take 3-4 weeks for
medication to work.
, paroxetine (Paxil)
shortest half life, produces the most pronounced discontinuation effects due to
serotonin transporter inhibition and anticholinergic rebound.
* is associated with weight gain and clients will experience withdrawal symptoms if a
dose is missed or given late, often within 25 hours of the last dose which can make this
medication not a great choice for a client who has difficulty taking medications on
schedule treats social anxiety and insomnia
Social anxiety and insomnia medication
Fluoxetine (prozac)
has the longest half-life of the SSRIs up to 2 weeks-appears to produce the fewest
withdrawal symptoms, Fluoxetine is also known to activate clients and cause panic
attacks in clients with comorbid anxiety.
SSRI
serotonin receptors and side effects tip
90% of serotonin receptors are in the GI tract and only 10% are within the brain. GI side
effects are caused by this. Most adverse effects will resolve after 4-5 days once the
body adjusts to increased serotonin levels.
Black Box Warning: Suicide Risk with Antidepressant Drugs
Clients who are depressed are at risk for suicidal ideation or attempts. The suicide risk
may be elevated when therapy is initiated with antidepressants. Antidepressant-induced
suicides are most common in children, adolescents, and adults younger than 25 years.
Escitalopram (Lexapro)
best-tolerated SSRI which is an excellent choice for naive client. Escitalopram has the
fewest drug-drug interactions. This medication has a 27-32-hour half-life which is less
prone to side effects if a dose is late or forgotten. Dosage can be increased at the next
visit if medication is tolerated but efficacy is not achieved with 10 mg
Sertraline (Zoloft)
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