NR-546 Advanced Pharmacology Psychopharmacology for the Psychiatric- Mental Health Nurse Practitioner
Final Exam (New Update)
Question:
Adjunct treatment for depression
Answer:
Antipsychotic medications are sometimes prescribed at low doses as adjunctive medications for severe depression
Question:
Newer tx for resistant depression: esketamine (Spravato)
Answer:
nasal spray for the treatment of major depressive disorder (MDD) with acute suicidal ideation or behavior -reaches peak onset in the body in between 20-40 minutes -risk of adverse outcomes due to sedation and dissociation *must be administered in a supervised healthcare setting
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Question:
Newer tx for resistant depression: Ketamine clinics
Answer:
Ketamine is an N-methyl-D-aspartate (NMDA) receptor inhibitor, results in the downstream release of glutamate -high doses, ketamine may cause psychotic symptoms, in low doses, it has a rapid effect on depression -Ketamine clinics have provided intravenous ketamine for treatment- resistant unipolar and bipolar depression *required frequent dosing, inconvenient, expensive
Question:
Newer tx for resistant depression: dextromethorphan/quinidine (Nuedexta)
Answer:
Researchers are investigating, related to NMDA -currently approved by the FDA for the treatment of pseudobulbar affect *combines dextromethorphan and quinidine as an oral treatment
Question:
considered when selecting an antidepressant medication
Answer:
Client preference Prior treatment response 2 / 4
Anticipated adverse effects Comorbidities Half-life and interactions Cost
Question:
Antidepressants: Initiating Medication
Answer:
Start clients on a single drug for 4-8 weeks to assess efficacy. Start with the lowest recommended dose to reduce side effects. If a medication is not
achieving efficacy:
-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 dosing and a minimum of eight weeks of trial.-Add a second medication as an adjunct.
Question:
Antidepressants: Discontinuing Medications
Answer:
Don't suddenly stop or omit doses due to risk of discontinuation syndrome -Paroxetine highest risk due to serotonin transporter inhibition and anticholinergic rebound 3 / 4
-If a treatment course has lasted 8 weeks, discontinuation over 1-2 weeks is safe. Once symptoms are in remission, continue treatment for 4-9 months to reduce the risk of relapse
Question:
Antidepressants Important Prescribing Considerations: Black Box Warning
Answer:
Suicide Risk with Antidepressant Drugs -Clients with depression may consider or attempt suicide -risk for suicide may increase at the start of treatment -Antidepressant-induced suicide is more prevalent in children, adolescents, and adults younger than 25 years.
Question:
Antidepressants Important Prescribing Considerations: Drug-Drug
Interactions
Answer:
Most antidepressant medications have serious drug-drug interactions.Carefully review the client's history and current prescriptions before selecting a medication.
Question:
Antidepressants Important Prescribing Considerations: Serotonin Syndrome
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