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NR546 / NR 546 Final Exam Advanced Pharmacology Psychopharmacology

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 45 pages. Originally published on StudyMerit.

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45
Academic year
2025/2026
Language
English

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NR546 – Advanced Pharmacology: Psychopharmacology for Psychiatric-Mental Health Nurse Practitioner Exam Study Guide – Final Exam Exam Format: Non-Cumulative exam Question Type: Multiple Choice Number of Questions : 75 Number of Points: 150 points Time Allotted: 90 Minutes Testing Timeframe: The final exam will be available starting on Wednesday of Week 8 at 12:01 am MT until Saturday of Week 8 at 11:59 pm MT. Exam Coverage Week 5: Content Areas: 1. Mood Disorder Mood disorders are abnormalities of mood, which include depression, mania, or both. These disorders occur across a spectrum and affect between 10-20% of the population (Coleman et al., 2020). Mood disorders include depressive disorders and bipolar disorder and may be comorbid with other conditions. Major depressive disorder (MDD) and bipolar disorder (BD) are among the most disabling mental health disorders (Sall et al., 2021). Pervasive symptoms affect mood, thought processes, physical health, work, and relationships. Death by suicide may result when mood disorders are inadequately diagnosed and undertreated. Antidepressants account for approximately 15 of the top 200 prescription medications prescribed and dispensed in the United States (Chisholm-Burns et al., 2019). 2. Neurobiological Basis for Mood Disorders Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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3. Bipolar Disorders Bipolar disorder (BD) is a chronic condition characterized by extreme fluctuations in mood, energy, and the ability to function. The World Mental Health Survey Initiative reported total lifetime prevalence estimates of 2.4% (Yatham et al., 2018). Clients with BD may experience recurrent episodes and remissions. Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features. Most bipolar depression clients experience depression symptoms, and many have experienced only one manic episode in their lifetime. Mood fluctuations may be separated by periods of high stability or may cycle rapidly. BD is diagnosed when a client has one or more episodes of mania or hypomania with a history of one or more major depressive episodes. BD is associated with significant morbidity and mortality. Clients diagnosed with bipolar disorder are at high risk for suicide. Correct and early diagnosis and treatment are essential to prevent complications and maximize treatment response 4. Pharmacologic Treatment of Major Depressive Disorder a. Selective serotonin reuptake inhibitors (SSRIs) b. Serotonin-norepinephrine reuptake inhibitors (SNRIs) c. Norepinephrine and dopamine reuptake inhibitors (NDRIs) d. Serotonin antagonists and reuptake inhibitors (SARIs) e. Miscellaneous antidepressants f. Monoamine oxidase (MAO)-B inhibitors g. Adjunct: antipsychotics 5. Prescribing Guidelines for Antidepressants 6. Pharmacologic Treatment of Bipolar Disorder a. Lithium b. Anticonvulsants 7. Second generation antipsychotics 8. Management of Acute Agitation 9. Resistant Depression Key Concepts to Study: Major Depressive Disorder (MDD):  Review of the monoamine hypothesis and its implications for prescribing, focusing on how this theory informs the selection of antidepressants based on neurotransmitter targets and symptom profiles The Monoamine Hypothesis of depression suggests that the disorder is linked to a deficiency of certain neurotransmitters, primarily serotonin, norepinephrine, and dopamine , in the brain. This hypothesis informs the development and prescription of antidepressants, guiding choices based on which neurotransmitter the medication targets and the symptom profile of the patient . Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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 SSRIs : o Identify necessary screening prior to prescribing. o Medical History : Check for past or current psychiatric disorders (e.g., bipolar disorder, history of suicide attempts). o Drug interactions : Assess for drugs that may interact with SSRIs (e.g., other antidepressants, anticoagulants, or antiplatelets). o Risk of Serotonin Syndrome : Be mindful of drugs that increase serotonin levels (e.g., other serotonergic drugs). o Liver function : SSRIs are metabolized in the liver, so check liver function tests (especially in the elderly or those with liver disease). o Study age-related risks and which age group requires extra caution . Children & Adolescents: Increased risk of suicidal thoughts and behaviors. SSRIs should be prescribed cautiously and monitored frequently. Elderly: They are at a higher risk for side effects like hyponatremia, sedation, and bleeding. Caution is needed with dosage adjustments due to slower metabolism. Understand which SSRI has the least CYP interactions, best tolerance, and longest half- life. Fluoxetine (Prozac): Has a long half-life (approximately 4-6 days for the parent drug and up to 16 days for its active metabolite, norfluoxetine), reducing the risk of withdrawal symptoms. It has fewer CYP450 enzyme interactions compared to other SSRIs like paroxetine or fluvoxamine. Sertraline (Zoloft): Also known for having a generally well-tolerated side-effect profile with moderate CYP450 interactions, it’s considered one of the better choices when managing side effects. Explore SSRIs associated with discontinuation syndrome, activation, or panic exacerbation. Discontinuation Syndrome: Common in paroxetine (Paxil) and fluvoxamine (Luvox), due to their shorter half-lives. This syndrome can manifest as dizziness, flu-like symptoms, and electric shock sensations. Activation: Fluoxetine (Prozac ) is more likely to cause agitation, insomnia, or anxiety . It’s typically preferred for patients with low energy or psychomotor retardation. Panic Exacerbation: For patients with panic disorder, fluoxetine or sertraline may be better options, though fluoxetine can also lead to activation in certain individuals.  Lithium Interactions : Downloaded by Aisyln Vaughn (samuelkingstone40@gmail.com) lOMoARcPSD|14174986

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