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NR 546/ NR546 FINAL EXAM: (NEW 2025/ 2026
UPDATE) ADVANCED PHARMACOLOGY:
PSYCHOPHARMACOLOGY FOR THE PMHNP REVIEW|
QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS)- CHAMBERLAIN
1. 90% of serotonin receptors are in the __________ and _________ are within the
brain - ANS ✓GI tract, only 10%
*which causes GI side effects
2. client education for specific medication classes: SSRI's - ANS ✓Most adverse
effects will subside after 4-5 days once the body adjusts to increased serotonin levels
3. client education for specific medication classes: SNRI's - ANS ✓-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.
4. client education for specific medication classes: NDRI's - ANS ✓-Take medication
in the morning.
-Stop taking medication if seizures occur.
-Stop taking medication if anxiety is noted.
5. Other tx options: SARI's - ANS ✓Serotonin Antagonist and Reuptake Inhibitors
-potently block 5-HT2A and 5HT 2C receptors, allow more 5-HT to interact at postsynaptic
5-HT1A sites
-Trazodone most common
-adverse effects:
• sedation
• drowsiness
• blurred vision
• constipation
• dry mouth
• severe: priapism (Medical emergency)
Patient education: side effects, take at HS due to sedation
Off-label uses: insomnia, anxiety
6. Mirtazapine (Remeron) - ANS ✓INDICATION
-MDD
Mechanism of Action
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-Serotonin norepinephrine receptor agonist, alpha2 receptor agonist. Boosts neurotransmitters
serotonin and norepinephrine/noradrenaline.
TESTS
-Monitor weight and BMI during tx
Starting Dose
-15 mg/day in the evening
Adverse Effects
-Sedation, weight gain, dry mouth, constipation, abnormal dreams, confusion, hypotension,
Changes in urinary function.
Flu-like symptoms may indicate low white blood cell or granulocyte count.
PEARLS
-sedation/drowsiness, useful for clients with insomnia.
-increased appetite/weight gain, useful for clients with depression-related weight loss
-Precautions: May cause photosensitivity, avoid alcohol (increase sedation)
7. Vilazodone (Viibryd) - ANS ✓INDICATION
-MDD
Mechanism of Action
-Dual-acting serotonin reuptake inhibitor plus 5HT1A partial agonist. Boosts
neurotransmitter serotonin.
TESTS
-None for healthy individuals
Starting Dose
-10 mg/day
Adverse Effects
-Nausea, diarrhea, vomiting, insomnia, dizziness, bruising, sexual dysfunction, SIADH.
-Rare: Bleeding, hyponatremia.
PEARLS
-Appropriate for depression/comorbid anxiety, action similar to combination of SSRI and
buspirone.
-Precautions: Not approved in children
8. Vortioxetine (Trintellix) - ANS ✓INDICATION
-MDD
Mechanism of Action
-Multimodal antidepressant, Serotonin multimodal (SMM)
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-Increases release of serotonin, norepinephrine, dopamine, glutamate, acetylcholine, and
histamine and reduces the release of GABA
TESTS
-None for healthy individuals
Starting Dose
-10 mg/day
Adverse Effects
-nausea, vomiting, constipation, sexual dysfuction.
PEARLS
-Improves depression-related cognition
-Long half-life means vortioxetine can generally be abruptly discontinued.
-Not approved in children
9. Trazodone (Desyrel) - ANS ✓INDICATION
-Depression
Mechanism of Action
-SARI (serotonin 2 antagonist/reuptake inhibitor). Blocks serotonin 2A receptors.
TESTS
-None for healthy individuals
Starting Dose
-150 mg/day in divided doses
Adverse Effects
-dizziness, sedation, hypotension, Nausea, vomiting, edema, blurred vision, constipation, dry
mouth, headache, incoordination, tremor, hypotension, syncope, occasional sinus
bradycardia.
-Rare: rash, priapism.
10. Tricyclic antidepressants - ANS ✓SRI and NRI properties, but they also block α1-
adrenergic, histamine-1, and muscarinic cholinergic receptors
-not used first-line because of the high incidence of adverse effects and the risk of potential
overdose and death
• amitriptyline (Elavil)
• desipramine (Norpramin)
• doxepin (Sinequan)
• imipramine (Tofranil)
• nortriptyline (Pamelor)
11. Alpha-1 adrenergic effects - ANS ✓Orthostatic hypotension
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12. Anticholinergic effects - ANS ✓Dry mouth
Blurred vision
Urinary retention
Constipation
13. Histamine effects - ANS ✓Weight gain
Sedation
14. MAOIs - ANS ✓first developed, LAST CHOICE medication class for depression due
to the many potential, serious side effects
-specific dietary restrictions, Foods that contain tyramine should be avoided (Red wine,
Sauerkraut, Cheese, Soy, Smoked meats)
-block enzymes responsible for the breakdown of 5-HT, NE, and DA
• two primary forms of the MAO enzyme: MAO-A and MAO-B
• both located in the brain, MAO-A also in gut
Drugs:
-phenelzine (Nardil) - duration 14 days
-selegiline (Emsam) - MAOI-B - duration 14 days
-tranylcypromine (Parnate) -duration 14-30 days
-isocarboxazid (Marplan) - duration 14 days
Side effects:
-Confusion
-Dizziness
-Insomnia
-Sedation
-Vivid dreams
Pearls:
-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
15. MAO-A - ANS ✓breaks down 5-HT, DA, NE, and tyramine
-used to treat depression and anxiety
"A" is for antidepressant or anxiolytic
16. MAO-B - ANS ✓responsible for the breakdown of dopamine, phenylethylamine, and
tyramine
-used to treat Parkinson's disease; however, high-dose selegiline (Emsam) may be used to
treat anxiety or depression
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