TABLE OF CONTENTS - NR 546 / NR546 Bundle Weeks 5 to 8 Notes Advanc...

Chamberlain University

NR 546 / NR546

Bundle Weeks 5 to 8 Notes Advanced Psychopharmacology

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TABLE OF CONTENTS

Week 5 – Mood Disorders

Week 6 – Substance Use Disorders (SUD)

Week 7 – ADHD & Pharmacologic Management

Week 8 – Alzheimer’s Disease & Treatment 2 / 4

NR 546 Week 5: Mood Disorders

Mood disorders are abnormalities of mood, which include depression, mania, or both. These disorders occur across a spectrum and a�ect between 10-20% of the population. 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. Pervasive symptoms a�ect 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 US.The role of the PMHNP is to determine the malfunctioning brain circuit responsible for the client's presenting symptoms and select the appropriate medication that targets the associated neurotransmitter(s).Unipolar depression, or major depressive disorder (MDD), is one of the most common mental disorders. Approximately 7.1% of adults in the U.S. have experienced at least one major depressive episode in the last year, with prevalence highest (13.1%) among individuals aged 18-

• Common symptoms of MDD include a depressed mood or los s of interest or pleasure in daily

activities, irritability, withdrawal, and problems with sleep, eating, energy, concentration, or self- worth. Clients with severe depression may experience thoughts of suicide or psychotic symptoms.Medication Management for Depression First-line Treatment Selective Serotonin Reuptake Inhibitors (SSRIs)

oMOA:

inhibit 5-HT reuptake

oAdverse E�ects:

diarrhea, headache, weight gain, sexual side e�ects oPrescribing Pearls citalopram (Celexa) mild antihistamine e�ects escitalopram (Lexapro) no known drug interactions �uoxetine (Prozac) longest half-life paroxetine (Paxil) also treats social anxiety and insomnia �uvoxamine (Luvox) treats anxious depression, smokers require an increased dose sertraline (Zoloft) also treats social anxiety and hypersomnolence oClient Education Most adverse e�ects will subside after 4-5 days, once the body adjusts to increased serotonin levels.Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

oMOA:

inhibit 5-HT reuptake inhibit NE reuptake (increase energy, focus) increase DA in prefrontal cortex (increase cognition)

oAdverse E�ects:

elevated blood pressure, anxiety, insomnia, constipation oPrescribing Pearls venlafaxine (E�exor) treats both depression and anxiety disorders, ensure trial of higher dose before switching to a di�erent medication  Downloaded by Benjamin Luca ([email protected]) lOMoARcPSD|51648332 3 / 4

desvenlafaxine (Pristiq) e�ective for perimenopausal vasomotor symptoms duloxetine (Cymbalta) e�ective for atypical pain at higher doses; appropriate for clients who present with somatic symptoms of depression; e�ective for atypical pain, such as �bromyalgia and diabetic neuropathy oClient Education Medications should not be abruptly stopped to avoid discontinuation symptoms.NE e�ects of the medication may increase anxiety in some clients. Report worsening anxiety to the provider.Norepinephrine Dopamine Reuptake Inhibitors (NDRI)

oMOA:

inhibit NE reuptake (increase energy) inhibit DA reuptake (increase alertness, motivation)

oAdverse E�ects:

Agitation, headache, dry mouth, constipation, weight loss oPrescribing Pearls bupropion (Wellbutrin) may improve energy, alertness, and motivation; not �rst-line treatment for anxiety; contraindicated in clients with a history of seizures oClient Education Take medication in the morning.Stop taking medication if seizures occur.Stop taking medication if anxiety is noted.Serotonin Antagonist and Reuptake Inhibitors (SARIs)

oMOA:

Potently block 5-HT2A and 5HT2C receptors, which allow more 5-HT to interact at postsynaptic 5-HT 1A sites Serotonin blockade and reuptake inhibition is present at higher doses.Trazodone, the most common SARI, also blocks histaminergic and α- adrenergic receptors.

oAdverse E�ects:

Sedation, drowsiness, blurred vision, constipation, dry mouth

Serious adverse e�ect: priapism

oPrescribing Pearls Trazodone causes signi�cant sedation, but has a short half-life; because of these features, low-dose trazodone may be used as an adjunctive treatment for clients with major depression who report continued di�culty falling or staying asleep.

O�-label uses: Insomnia, anxiety

oClient Education Potential side e�ects should be discussed at the initiation of treatment.Because of sedative e�ects, take medication at bedtime.Male clients should be warned of the risk of priapism which is a medical emergency.  Client Education Downloaded by Benjamin Luca ([email protected]) lOMoARcPSD|51648332

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