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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 โ 10-15 questions
- (^) Drug-drug interactions โ 5-7 questions
- (^) Mechanism of Action โ 10-15 questions
- (^) Labs/monitoring โ 3-5 questions
- (^) Medical emergencies (toxicity, overdose, etc.) โ 3-5 questions
- (^) Neuroanatomy โ 2-3 questions
MDD and brain neuroanatomy
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 โ 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
- (^) Itโs 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 โSโ 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)