ExamI2:INURSI660/INURS660I(New
Update)IPsychopharmacologyIandI
AdvancedIMentalIHealthIGuideIwithIQsI&I
As|I100%ICorrect|IGradeIAI(VerifiedI
Answers)-IMaryville
QUESTION
SNRIsI(serotonin-norepinephrineIreuptakeIinhibitors)
Answer:
-BoostsIneurotransmittersIserotonin,Inorepinephrine/noradrenaline,IandIdopamine
-
BlocksIserotoninIreuptakeIpumpI(serotoninItransporter),IpresumablyIincreasingIserotonergicIne
urotransmission
-
BlocksInorepinephrineIreuptakeIpumpI(norepinephrineItransporter),IpresumablyIincreasingInor
adrenergicIneurotransmission
-PresumablyIdesensitizesIbothIserotoninI1AIreceptorsIandIbetaIadrenergicIreceptors
-HaveIworseIdiscontinuationIthanISSRIs
-
SE:IRareIszs,IrareIhypomania,IrareIactivationIofIsuicidalIideation/behavior,Iconstipation,Iincrea
seIinIHRI&IBP
-DrugIinteractions:IMAOIs-
IserotoninIsyndrome,IdoInotIuseItogether/waitI14IdaysIbeforeIstartingIMAOI
-LessIlikelyItoIhaveIwtIgain,ImayIincreaseIBP,IurinaryIretention,Isweating
QUESTION
DuloxetineI(Cymbalta)
Answer:
SNRI
,-AvoidIinIptsIwithIliverIproblems
-SE:INausea,Idiarrhea,IdecreasedIappetite,IdryImouth,IconstipationI(dose-
dependent)IInsomnia,Isedation,Idizziness,Isweating,IincreasesIBP,IurinaryIretention
-UsefulIforIpainI
-horribleIdiscontinuation
-
DrugIinteractions:ICanIincreaseITCAIlevels;IuseIwithIcautionIwithITCAs/IwhenIswitchingIfro
mIaITCAItoIduloxetine
InhibitorsIofICYP450I1A2,IsuchIasIfluvoxamine,IincreaseIplasmaIlevelsIofIduloxetineIandIma
yIrequireIaIdosageIreductionIofIduloxetine
-
CigaretteIsmokingIinducesICYP450I1A2IandImayIreduceIplasmaIlevelsIofIduloxetine,IbutIdos
ageImodificationsIareInotIrecommendedIforIsmokers
-
InhibitorsIofICYP450I2D6,IsuchIasIparoxetine,Ifluoxetine,IandIquinidine,ImayIincreaseIplasma
IlevelsIofIduloxetineIandIrequireIaIdosageIreductionIofIduloxetine
QUESTION
VenlafaxineI(Effexor)
Answer:
SNRI
-GreatIforIptsIw/IlackIofIenergy,IdecreasedIinterest,IandIimpairedIconcentration
-
MOA:IWeaklyIblocksIdopamineIreuptakeIpumpI(dopamineItransporter),IandImayIincreaseIdop
amineIneurotransmission
-
SE:IhigherIdosesIcanIcauseIQTIprolongation,IH/A,Inervousness,Iinsomnia,Isedation,Inausea,Idi
arrhea,IdecreasedIappetite,IsexualIdysfunction,IAsthenia,Isweating,IriskIofIdevelopingIHTN
SIADH,IHyponatremiaIDose-
dependentIincreaseIinIbloodIpressure,IpossibleIweightIloss,IespeciallyIshort-term
AdverseIreactions:IQTIprolongation,IwithdrawalIsymptomsIwithIdiscontinuationIsyndrome
-Drug-
drugIinteractions:IConcomitantIuseIwithIcimetidineImayIreduceIclearanceIofIvenlafaxineIandIr
aiseIvenlafaxineIlevels,IcouldIinterfereIwithItheIanalgesicIactionsIofIcodeineIorIpossiblyIwithI
otherItriptans.
, QUESTION
CarbamazepineI(Tegretol)
Answer:
Anticonvulsant/ImoodIstabilizer
-FirstIlineIforIacuteImania,ImaniaIprophylaxis
-indicatedIforIrapidIcyclersIandImixedIpatientsI(superiorItoIlithiumIinIthisIaspect)
-drugIofIchoiceIinIpartialIseizuresIandItonic-clonicIseizures
-
MOA:IBlockadeIofIvoltageIdependentIsodiumIchannelsI(decreasesIcellIexcitability,IsuppressesI
neuronalIfiring)
-AlphaIsubunitIofIvoltageIsensitiveIsodiumIchannel
-EnhancesIinhibitoryIactionsIofIgaba
-AttenuatesIglutamateI(excitatory)
-VERYIPOTENTICYP450Iinducer
Warfarin,Ilamotrigine,Itheophylline,Idepakote,IandIphenytoinIareImetabolizedIfasterIbecauseIof
Ithis
-ReducesIeffectivenessIofIbirthcontrolIpills
QUESTION
CarbamazepineISE/IAdverseIReactions
Answer:
-SE:IRegularIrash-
mostIcommonIsideIeffect,ILowIriskIforISJS,IN/V/D,Itransaminitis,Isedation,Idizziness,Iataxia,I
confusion,IAVIconductionIdelays
WaterIretentionId/tIvasopressinIlikeIeffectIwhichIcanIresultIinIhyponatremia
-
AR:IcardiacISE,IcanIcauseISIADH,IAplasticIanemiaIandIagranulocytosisI(<0.002%),IlowersIpl
atelets,IrashIinIasianIpopulationsI(mustIcheckIforIpresenceIHLAI(humanIleukocyteIantigen)-
ifIthisIisIpresent,ItheyIareImoreIlikelyItoIdevelopISJSIorItoxicIepidermalInecrolysisI(TEN)
-Food/DrugIinteractions:IMAOIsIandItyramineI(smoked,Iaged,IpickledIfoods)
-Labs/tests:IPriorItoIstartingImed:IbaselineILFTs,ICBC,IandIEKG
Monitoring:IsteadyIstateIachievedIafterI5Idays.ICheckI12IhoursIafterIlastIdoseIandIrepeatICBC
IandILFTs
Goal:ITargetIlevelIofI4-12mcg/ml
