Download NR 546 Final Exam Guide Latest 2025 Exam: Chamberlain’s Verified Q&A for Psychopharmacolo and more Exams Nursing in PDF only on Docsity!
NR 546 Final Exam Guide Latest 2025 Exam: Chamberlain’s
Verified Q&A for Psychopharmacology (New!!!)
Prefrontal Cortex Symptoms of MDD - ANSWERS-Concentration Mental Fatigue Mood PFC & Amygdala Symptoms of MDD - ANSWERS-Guilt Suicidality Worthlessness Striatum Symptoms of MDD - ANSWERS-Physical fatigue Nucleus Accumbens Symptoms of MDD - ANSWERS-Pleasure interests Hypothalamus Symptoms of MDD - ANSWERS-Sleep Appetite Thalamus & Hypothalamus Symptoms of Mania - ANSWERS-Decreased sleep/arousal Striatum Symptoms of Mania - ANSWERS-Motor/agitation Prefrontal cortex (PFC) Symptoms of Mania - ANSWERS-Risk-taking Talkative/pressured speech Nucleus Accumbens & PFC Symptoms of Mania - ANSWERS-Racing thoughts, grandiosity PFC & Amygdala Symptoms of Mania - ANSWERS-Mood
Medication Management - ANSWERS-SSRI-Selective Serotonin Reuptake Inhibitors *Inhibit 5 HT reuptake SNRI-Serotonin Norepinephrine Reuptake Inhibitors *inhibit 5-HT reuptake *inhibit NE reuptake (increase energy, focus) *increase DA in prefrontal cortex (increase cognition) NDRI-Norepinephrine Dopamine Reuptake inhibitors *inhibit DA reuptake (increase alertness, motivation) *inhibit NE reuptake (increase energy) SARI-Serotonin Antagonist Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs): Most adverse effects will subside after 4-5 days once the body adjusts to increased serotonin levels. - ANSWERS- diarrhea headache weight gain sexual side effects Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): 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. - ANSWERS-elevated blood pressure anxiety insomnia constipation
Half-Life: 24 hours Inhibits 2D fluvoxamine (Luvox) SSRI - ANSWERS-treats anxious depression smokers require an increased dose Half-Life: 9-28 hours Inhibits 3A4, 2C9, 1A sertraline (Zoloft) SSRI - ANSWERS-also treats social anxiety and hypersomnolence Half-Life: 22-36 hour parent; 62-104 hour metabolite Inhibits 2D6 and 3A4 weakly at low doses venlafaxine (Effexor) - ANSWERS-treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Half-life: Parent drug 3-7 hour; metabolite has 9-13 hour duloxetine (Cymbalta) SNRI - ANSWERS-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 Half-Life: 12 hours Inhibitor of 2D bupropion (Wellbutrin) - ANSWERS-NDRI may improve energy, alertness, and motivation; not first-line treatment for anxiety; contraindicated in clients with a history of seizures Avoid in patients with comorbid anxiety Half-Life: Parent 10-14 hours; Metabolite 20-27 hours Inhibits 2D Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWERS-SARIs potently
block 5-HT2A and 5HT 2C receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites. Serotonin blockade and reuptake inhibition is present at higher doses. Trazodone - ANSWERS-The most common SARI, also blocks histaminergic and α- adrenergic receptors. Half-Life: 3-6 hours Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWERS-Common Adverse Effects · sedation · drowsiness · blurred vision · constipation · dry mouth Serious Adverse Effect priapism Serotonin norepinephrine receptor agonist, alpha2 receptor agonist - ANSWERS- Mirtazapine Serotonin multimodal (SMM)/serotonin partial agonist reuptake inhibitor (SPARI) - ANSWERS-Vilazodone (Viibryd) · Inhibits serotonin reuptake with partial 5HT1A agonism Appropriate for depression/comorbid anxiety, its action is similar to a combination of SSRI and buspirone Serotonin multimodal (SMM) - ANSWERS-Vortioxetine (Trintellix) · Acts as SSRI plus 5HT1A partial agonism
· phenelzine (Nardil) · selegiline (Emsam) - MAOI-B · tranylcypromine (Parnate) · isocarboxazid (Marplan) MAOI's Key Points - ANSWERS-· Clients taking MAOIs are at 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. Foods to Avoid When Taking MAO-A Medications - ANSWERS-· Red wine (Avoid) · Sauerkraut (Avoid) · Cheese (Avoid) · Soy (Avoid) · Smoked meats (Avoid) Foods to Avoid When Taking MAO-A Medications - ANSWERS-Rationale: Limiting the consumption of tyramine is necessary for orally available MAOIs due to inhibition of MAO-A in the gut. Dietary restrictions are not required for the transdermal formulation of selegiline. Tyramine is present in many aged or preserved foods including aged cheeses, tap and non-pasteurized beers, aged or smoked meat or fish, sauerkraut, kimchee, soy products, and tofu. Foods to be avoided when taking MAO-A medications include wine, meats, sauerkraut, cheese, and soy. Newer Treatments for Resistant Depression - ANSWERS-· The goal of
antidepressant treatment is the remission of symptoms; however, the current treatment response of clients with mood disorders varies widely and is often unsatisfactory. · For example, in clients with MDD, the treatment efficacy of selective serotonin reuptake inhibitors (SSRIs), the most used first-line pharmacological agent is between 48 and 64% with reported remission rates as low as 23.5%. · Treatment-resistant depression occurs when depression persists after the client has adequately trialed at least two antidepressant therapies. Newer Treatments for Resistant Depression - ANSWERS-Esketamine (Spravato)-N- methyl-D-aspartate (NMDA) receptor inhibitor Dextromethorphan/quinidine (Nuedexta)-under investigation for Resistant depression Esketamine (Spravato)-N-methyl-D-aspartate (NMDA) receptor inhibitor - ANSWERS-Nasal spray for the treatment of major depressive disorder (MDD) with acute suicidal ideation or behavior. Esketamine reaches peak onset in the body in between 20-40 minutes. Due to the risk of adverse outcomes due to sedation and dissociation, esketamine must be administered in a supervised healthcare setting Initiating Medication - ANSWERS-· Start patients on a single drug for 4-8 weeks to assess efficacy · Start with the lowest recommended dose to reduce side effects · If not achieving efficacy follow the process below: Increase the dose gradually to the efficacious dose range Switch to a different drug within the same class after an adequate trial which includes higher dosing and a minimum of eight weeks of trial Switch to a drug in a different class after an adequate trial which includes higher
Concerns for Sexual Side Effects - ANSWERS-Bupropion has fewer sexual side effects than other first-line treatments. Bupropion can also be prescribed as an adjunct to a SSRI. Complaining of Brain Fog as part of Depression Symptoms - ANSWERS- Vortioxetine can improve the speed of processing and cognitive function due to its unique mechanism of action. Patient often forgets to take pills - ANSWERS-Fluoxetine has a 2-3 days half-life, an excellent option for forgetful people Pregnancy Considerations for Depression - ANSWERS-Paroxetine is contraindicated in pregnancy due to the risk of congenital defects, including atrial septal defects. Prescribing for older adults with depression - ANSWERS-Citalopram and escitalopram should be dosed at 1/2 dose due to the risk of QTc prolongation -Avoid paroxetine in clients with a history of falls/fractures. -Avoid tricyclic antidepressants prescribed with other central nervous system (CNS) depressants. MEDICATION MANAGEMENT FOR BIPOLAR DISORDER - ANSWERS-· Treatment of bipolar disorder (BD) varies depending on the presenting symptoms. · Some medications are more appropriate for symptoms of mania, while others are better for symptoms of depression. · Medication classes used include mood stabilizers, anticonvulsants, and atypical antipsychotics. Lithium - ANSWERS-ACTION: alters cation transport in the nerve and muscle (downstream signal transduction cascades) Lithium may work by affecting signal transduction, perhaps through its inhibition of second messenger enzymes such as inositol monophosphatase, by modulation of G proteins, or by interaction at various sites within downstream
signal transduction cascades, including glycogen synthetase kinase 3 (GSK3). Lithium - ANSWERS-INDICATIONS: -euphoric mania -rapid cycling -maintenance therapy HALF-LIFE: 18-30 hours Lithium Therapeutic Levels - ANSWERS-Therapeutic levels: 1.0 and 1.5 mEq/L for acute treatment, 0.6 and 1.2 mEq/L for chronic treatment) Lamotrigine (Lamictal) - ANSWERS-ACTION: affects sodium channel ion transport and enhances the activity of y-aminobutyric acid (GABA) Lamotrigine (Lamictal) - ANSWERS-INDICATION: -maintenance therapy -monotherapy for bipolar disorder HALF LIFE: 33 hours Lamotrigine (Lamictal) - ANSWERS-PRESCRIBING PEARLS: This drug is equal in efficacy to lithium. Educate clients and assess for rash at each visit. Ten percent of rashes are benign. There is a risk for rare Stevens-Johnson Syndrome rash and multi-organ failure. Take at bedtime due to sedation side effect. Lamotrigine (Lamictal) - ANSWERS-Therapeutic levels: Not monitored
Second generation antipsychotics - ANSWERS-INDICATION: acute bipolar depression acute manic or mixed episodes bipolar maintenance/adjunct Second generation antipsychotics - ANSWERS-ADVERSE EFFECTS: weight gain sedation GI effects Second generation antipsychotics - ANSWERS-PRESCRIBING PEARLS: Indications vary with each medication. Check for monotherapy vs. adjunct indication. Monitor for extrapyramidal effects. XR form may improve adherence. Monthly injection may improve adherence. Select second generation antipsychotics first to decrease risk of side effects and long-term adverse effects. Carbamazepine (Tegretol) - ANSWERS-ACTION: glutamate voltage gated sodium and calcium channel blocker (Glu-CB) Carbamazepine (Tegretol) - ANSWERS-INDICATION: acute mania mixed mood HALF LIFE: 26-65 hours
Carbamazepine (Tegretol) - ANSWERS-ADVERSE EFFECTS: GI effects Sedation Hyponatremia Neutropenia rash (Stevens-Johnson Syndrome)-Consider genotyping clients with Asian ancestry; the HLA-B 2501 allele increases risk of Steven-Johnson Syndrome Carbamazepine (Tegretol) - ANSWERS-Therapeutic levels: 4-12 mcg/mL; Toxic levels: >12mcg/mL FIRST LINE COMBINATION THERAPY FOR BPI D/O, Current manic episode, with depressive features - ANSWERS-Lithium + Lamotrigine Lithium + Aripiprazole Lithium + Risperdal OR Valproic Acid + Lamotrigine Valproic Acid + Aripiprazole Valproic Acid + Risperdal MANAGEMENT OF ACUTE AGITATION (pacing or fidgeting in mild cases or uncooperative threatening and aggressive behaviors in severe cases) - ANSWERS-- In the inpatient setting, the use of rapid-acting oral antimanic medications is preferred. -When agitation persists, additional rapidly acting pharmacologic therapies may be needed.
· mixed episodes · rapid cycling · hallucinations · BD I Comorbidities · substance use · obsessive-compulsive disorder Demographics · male · younger · lower education level · single Other · poor insight · negative attitude · low self-esteem PRESCRIBING PEARLS - ANSWERS-· Lurasidone (Latuda) should be taken with food, at least 350 calories, for maximum absorption. · Lithium carbonate (Lithobid) starting dose is reduced by at least 50% in clients with renal impairment. · Lithium levels can be increased by nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme (ACE) inhibitors and decreased by caffeine and mania.
Lithium Lab Monitoring - ANSWERS-· serum lithium level · renal function · thyroid function Rationale: Lithium has a narrow therapeutic index and should be monitored carefully. Serum levels should be evaluated 5 days after any dosage change and regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and thyroid function should be evaluated every 6 months. Valproic Acid Lab Monitoring - ANSWERS-· serum valproate level · liver function · CBC Rationale: Valproic acid and its derivatives can cause leukopenia, thrombocytopenia, and hepatotoxicity. Monitor CBC and liver function tests (LFTs) every 3 months for 1 year and then annually Carbamazepine Lab Monitoring - ANSWERS-· serum carbamazepine level · renal function · liver function · CBC Rationale: Carbamazepine can cause blood dyscrasias, hepatotoxicity, and renal failure. Order a CBC, LFT, and renal function every 3 months for 1 year and then annually. Atypical antipsychotic medications Lab Monitoring - ANSWERS-· CBC
· asenapine (acute and mixed mania) · risperidone (monotherapy and adjunct for acute and mixed mania) Age 13 +: · olanzapine (acute and mixed mania) BIPOLAR 1 - ANSWERS-· The diagnosis of bipolar I disorder requires at least one episode of mania for at least one week (or any duration if hospitalization due to symptoms is required). · Mania is 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 1 - ANSWERS-Mania diagnosed by having (1) of either Elevated/expansive mood OR Irritable mood AND (3) or more of: 1.) Inflated self-esteem/grandiosity 2.) Increased goal-directed activity or agitation 3.) Risk Taking 4.) Decreased need for sleep 5.) Distractible/Concentration 6.) More talkative pressured speech 7.) Flight of ideas/racing thoughts. *If mood is only irritable, must have 4 symptoms present above.
BP TYPE II - ANSWERS-· A diagnosis of bipolar II disorder 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 - ANSWERS-· Cyclothymia involves the chronic presentation of hypomanic and depressive symptoms that do not meet the diagnostic criteria for a major depressive or manic/hypomanic episode. Decreased positive affect: DA, NE Dysfunction - ANSWERS-· depressed mood · loss of joy · lack of interest · loss of energy · decreased alertness · decreased self-confidence · appetite changes Increased negative affect: 5HT, NE Dysfunction - ANSWERS-· depressed mood · guilt · fear/anxiety · hostility · irritability
