NURS 660 Exam Review (2) Correct Study Guide 2022, Study Guides, Projects, Research of Nursing

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NURS 660 Exam Review (2) Correct Study Guide

50 questions, all multiple choice, 120minutes to complete it Covering weeks 6 (mood disorders), 7 (antidepressants), and 8 (mood stabilizers)

Major Content Areas:

• (^) Drug side effects – 10-15 questions
• (^) Drug-drug interactions – 5-7 questions
• (^) Mechanism of Action – 10-15 questions
• (^) Labs/monitoring – 3-5 questions
• (^) Medical emergencies (toxicity, overdose, etc.) – 3-5 questions
• (^) Neuroanatomy – 2-3 questions

MDD and brain neuroanatomy

• (^) SSRIs:

An tid epressa n tCsita:lopram, Escitalopram, Paroxetine,

Fluoxetine, Fluvoxamine, Sertraline,

• (^) Amitriptyline
• (^) Bupropion
• (^) Citalopram
• (^) Clomipramine
• (^) Duloxetine
• (^) Escitalopram
• (^) Fluoxetine
• (^) Fluvoxamine
• (^) Paroxetine
• (^) Sertraline
• (^) Trazodone
• (^) Venlafaxine
  • (^) SNRIs: Duloxetine, Venlafaxine
  • (^) TCAs: Amitriptyline, Clomipramine,
  • (^) Other: Trazodone, Bupropion, Mirtazapine

SSRIs: 6 drugs – 1 common

property, individual differences

• (^) All SSRIs work by selectively and potently inhibiting serotonin reuptake
• (^) They all inhibit the serotonin

transporter aka SERT

• (^) Each SSRI has secondary pharmacological actions besides the shared action of blocking SERT.
• (^) No two SSRIs have identical secondary pharmacological characteristics
• (^) It’s unclear if these secondary actions account for differences in efficacy/tolerability in each patient experience

Fluoxetine

• (^) 5HT2C antagonism is unique to Prozac
• (^) Blocking 5HT2C enhances the

release of NE and DA

• (^) May be activating/energizing
• (^) Improve concentration/motivation
• (^) VERY long half-life (2 weeks)
• (^) Good for noncompliant patients
• (^) Bad in that it takes a long time to clear completely

Sertraline

• (^) Dopamine transport and Sigma- 1 receptor binding are unique to Sertraline - (^) May be helpful for atypical depressive symptoms such as hypersomnia, anergia, and mood reactivity - (^) Sigma-1 may help with anxiolytic effects and addressing psychotic/delusional depression

Fluvoxamine

• (^) Like sertraline in that it works on Sigma-1 (more potently)
• (^) No FDA indication for depression

Escitalopram

• (^) Only the “S” enantiomer and

no antihistaminic properties

• (^) No dose restrictions, no QTc prolongation risk
• (^) Works purely on SERT
• (^) Tends to be best tolerated

SSRI, very few CYP- interactions

SNRIs: 4 drugs

• (^) Work like SSRIs in that they all inhibit SERT
• (^) Each also inhibits norepinephrine transport (NET) to various degrees
• (^) SNRIs also act on dopamine specifically in the prefrontal cortex without inhibiting dopamine transporter (DAT) - (^) Blocking NE enhances and increases DA in the prefrontal cortex - (^) Less likely to have weight gain - (^) May increase blood pressure, urinary retention, sweating - (^) Venlafaxine - (^) Desvenlafaxine - (^) Duloxetine - (^) Levomilnacipran

Desvenlafaxine

• (^) An active metabolite of venlafaxine
• (^) Has greater NET vs 5HT

compared to venlafaxine

Duloxetine

• (^) SERT > NET (slightly)
• (^) Changed the way we think about

pain (psychic vs somatic)