Exam (elaborations)
Nr546 Final exam study guide (Latest Update) Download To Score An A
- Course
- NR 546
- Institution
- Chamberlain College Of Nursing
Nr546 Final exam study guide (Latest Update) Download To Score An A
[Show more]
Content preview
FinaleMDD-- Monoamine hypothesis of depression, prescribing considerations- the theory is that
depression is caused by a deficiency in monoamine neurotransmission. And mania is the
opposite - due to an excess of monoamine neurotransmission.
This hasn't really been proven yet, so then the focus shifted to the monoamine receptor
hypothesis - that the abnormality of receptors for monoamine NTs cause depression. In that
case, the lack of NT causes upregulation of receptors.
Also not proven yet. Right now the focus is on regulation of gene expression, growth factors,
environmental factors, and epigenetic changes.
Prescribing considerations
- do not give antidepressants as monotherapy for bipolar - always combine with mood
stabilizer. Must rule out mania or hypomania so don't confuse MDD with BPD and induce
mania.
Monitor infant irritability when prescribe SNRI for breastfeeding.
Also keep in mind: client preference, prior treatment response, anticipated adverse effects,
comorbidities, half life and interactions (if they will forget to take med, choose something longer
acting), cost.
Start patient on drug for 4-8 weeks, on lowest recommended dose. If doesn't work, first
increase dose, then switch to diff drug in same class and give adequate trial of high enough
dose, then switch to a drug in a different class, then add a second med.
For older people - citalopram and escitalopram should be ½ dose, avoid paroxetine if have
history of falls, avoid TCAs prescribed with out CNS depressants.
SSRIs what screens should be completed prior to prescribing a SSRI?
- for SNRIs need to check BP before and during treatment.
Which age group is most at risk when prescribed a SSRI? Why? Kids and adults under 25 -
increased risk of suicide
Which SSRI has the least CYP interactions -
escitalopram (Lexapro).
Good for forgetful people -
fluoxetine (has 2-3 day half life). Also sertraline (27-36 hour ½ life).
Longest acting
fluoxetine has the longest half life 1-2 weeks. When adding or switching antidepressants use
caution for 5 weeks after stopping fluoxetine
More likely to cause discontinuation syndrome. -
paroxetine
Safe in nursing and pregnancy and breastfeeding
sertraline
Contraindicated in pregnancy
paroxetine (risk of atrial septal defect).
Which medications are used as adjuncts?
, Buproprion,
Lowest risk of sexual side effects
buproprion, mirtazapine
What is serotonin syndrome
When use two serotonergic drugs together. Symptoms: mental status changes (agitation,
hallucinations, delirium, coma), autonomic instability (tachycardia, dizziness, diaphoresis,
hyperthermia), neuromuscular symptoms (tremor, rigidity, myoclonus, hyperreflexia,
incoordination), seizures, and/or gastrointestinal symptoms (nausea, vomiting, diarrhea).
Treatment - stop med, supportive care, benzos.
MAOIs black box warning
Suicidal ideation in children, adolescents and young adults
MAOI half life
2-4 hours
SSRIs black box warning
suicidal tendencies
MAOIs (monoamine oxidase inhibitors)
Antidepresents durgs that inhibit the enzyme that deatctiviates dopamine, norepiniphrine, and
serotonin. MAOIs appear to be most effective for treating non-endogenous and atypical
depressions.
Side-effects include anticholnergic effects, insomnia, agitation, confusion, and wieght gain.
when taken in conjuction with other drugs or foods containing tyramine, they can cause a
hypertensive crisis.
Lithium levels can be increased by nonsteroidal anti-inflammatory
drugs (NSAIDs) and angiotensin-converting enzyme (ACE) inhibitors
and decreased by caffeine and mania.
Role of L-Methylfolate in depression treatment
is necessary for the synthesis of monoamines. We generally get l-methylfolate from dietary folic
acid, but about 50% of people are deficient. There are small studies that say that supplementing
l-methylfolate or regular OTC folate may help as adjunctive treatment of depression.
Recommended to try the OTC folate first. Role of L-Methylfolate in depression tx
Suboptimal folate levels in depressed patients (adjunct to antidepressant)
• L-Methylfolate is a bioavailable form of folate
• L-methylfolate, or 6-(S)-5-methyl-tetrahydrofolate, is derived from folate and is the form that
enters the brain and works directly as a methyl donor and monoamine synthesis modulator
Why is L-Methylfolate recommended as an adjunct in depression?
Treatment with l-methylfolate seems to be safe, has few if any side effects, and is generally
less expensive than augmenting with a second branded antidepressant or atypical antipsychotic
Pregnancy
Paroxetine is contraindicated in pregnancy due to the risk of congenital
defects, including atrial septal defects.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ProfGoodlucK. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
53340 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now
