WEEK 8 NR 546 ACTUAL EXAM COMPLETE
33 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+||BRAND NEW!!.
Pharmacologic Treatment of Bipolar Disorder - answer-Lithium
Anticonvulsants
Second generation antipsychotics
Unipolar depression - answer-major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest
(13.1%) among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Lewy Body Dementias (LBD) - answer-Dementia with Lewy bodies (DLB) and the
related Parkinson's disease dementia (PDD)
-10-15% of all cases of dementia
-abnormal accumulation of a protein called α-synuclein
• aggregate to form oligomers, eventually turning into "Lewy bodies" & Lewy neurites, as
neurons degenerate
The Amyloid cascade Hypothesis - answer-Alzheimer disease (AD) is caused by the
accumulation of toxic Aβ, which form into plaques, hyperphosphorylation of tau,
neurofibrillary tangle formation, synaptic dysfunction, and ultimately neuron loss with
memory loss and dementia
risk of developing AD - answer--inheritance of two copies of APOE4 leads to a tenfold
increased AD risk
-APOE2 gene appears to offer some protection from AD
-APOE3 gene (the most common form of the APOE gene) conveys a risk that falls
between APOE2 and APOE4
,Non-pharmacological options for behavioral symptoms in dementia - answer-• Address
unmet needs (hunger, pain, thirst, boredom)
• Identify/modify environmental stressors
• Identify/modify daily routine stressors
• Caregiver support/training
• Behavior modification
• Group/individual therapy
• Problem solving
• Distraction
• Provide outlets for pent-up energy (exercise, activities)
• Avoid behavior triggers
• Increase social engagement
• Relaxation techniques
• Reminiscence therapy
• Music therapy
• Aromatherapy
• Pet therapy
Tx dementia-related psychosis - answer-Pimavanserin
-hypothetically reduces overactivity in the psychosis network caused by plaques,
tangles, Lewy bodies, or strokes, presumably by lowering the normal 5HT2A stimulation
to surviving glutamate neurons that have lost their GABA inhibition by
neurodegeneration
-approved for the treatment of Parkinson's disease psychosis & there are positive trials
in dementia-related psychosis
Neuronal Networks of Agitation in Alzheimer Disease - answer-imbalance in "top-down"
cortical inhibition with "bottom-up" limbic and emotional drives
Targeting Multimodal Neurotransmitters (Norepinephrine, Serotonin, and Dopamine) for
the Symptomatic Treatment of Agitation in Alzheimer Disease - answer-Brexpiprazole
-serotonin-dopamine-norepinephrine antagonist/partial agonist
-combines several simultaneous mechanisms to quell the excessive activity of the
agitation network in AD
-warning for increased mortality in dementia-related psychosis, using this agent for
agitation in AD and in doses lower than those generally used to treat psychosis in
schizophrenia may provide a greater safety margin
Targeting Glutamate for the Symptomatic Treatment of Agitation in Alzheimer Disease -
answer-dextromethorphan-bupropion
-The NMDA antagonist dextromethorphan (DXM), in combination with the
norepinephrine-dopamine reuptake inhibitor (NDRI) bupropion, is in testing as a
treatment for agitation
Apathy - answer-diminished motivation and reduced goal-directed behavior,
accompanied by decreased emotional responsiveness
,-lack of motivation is at the core of apathy
-affects approximately 90% of patients with dementia
-one of the most persistent and frequent secondary behavioral symptoms of dementia
-shown to predict disease-worsening
-if med needed for apathy: cholinesterase inhibitors are first-line in AD, FTD patients
may benefit more from SSRI's/SNRI's
Bipolar disorder (BD) - answer-Chronic condition characterized by extreme fluctuations
in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or
psychotic features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a
history of one or more major depressive episodes
-high risk for suicide
mania - answer-characterized by a persistently elevated, expansive, or irritable mood.
Related symptoms may include inflated self-esteem, increased goal-directed activity or
energy, including grandiosity, decreased need for sleep, excessive talkativeness, racing
thoughts, flight of ideas (FOI), distractibility, psychomotor agitation, and a propensity to
be involved in high-risk activities. Mania leads to significant functional impairment and
may include psychotic features or necessitate hospitalization
Bipolar Type I: - answer-requires at least one episode of mania for at least one week (or
any duration if hospitalization due to symptoms is required)
Bipolar Type II: - answer-diagnosis requires a current or past hypomanic episode and a
current or past major depressive episode. Symptoms last for at least 4 days but fewer
than seven.
-Hypomanic symptoms are not of sufficient duration or severity to cause significant
functional impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms,
making bipolar more difficult to diagnose if the client presents in the depression phase.
Cyclothymia: - answer-involves the chronic presentation of hypomanic and depressive
symptoms that do not meet the diagnostic criteria for a major depressive or
manic/hypomanic episode.
If bipolar depression is mistaken for MDD: - answer-antidepressant therapy may
precipitate a manic episode or induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults
younger than 25
, Antidepressants are used cautiously in clients with bipolar disorder and never as
________________. - answer-monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a
hypomanic or manic episode
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss
SSRI Prescribing Pearls: med with mild antihistamine effects - answer-citalopram
(Celexa)
SSRI Prescribing Pearls: med with no known drug interactions - answer-escitalopram
(Lexapro)
SSRI Prescribing Pearls: med with longest half-life - answer-fluoxetine (Prozac)
SSRI Prescribing Pearls: med that also treats social anxiety and insomnia - answer-
paroxetine (Paxil)
SSRI Prescribing Pearls: med that treats anxious depression; smokers require an
increased dose - answer-fluvoxamine (Luvox)
SSRI Prescribing Pearls: med that also treats social anxiety and hypersomnolence -
answer-sertraline (Zoloft)
venlafaxine (Effexor) - answer-INDICATION
-Depression
-GAD
-Social anxiety disorder
-Panic disorder
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine.
TESTS
-Check bp before initiating tx & regularly during tx
Starting Dose
-Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-
release)
