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.Final Exam: NR546/ NR 546 (NEW Update
2024/ 2025) Psychopharmacology for the
Psychiatric-Mental Health Nurse
Practitioner Review |Weeks 5-8 | Questions
and Verified Answers| 100% CorrectChamberlain
QUESTION
Tricyclic antidepressants (TCAs)
Answer:
Tricyclic antidepressants (TCAs) possess both SRI and NRI properties, but they also block other
receptors, including α1-adrenergic, histamine-1, and muscarinic cholinergic receptors. TCAs are
not used first-line because of the high incidence of adverse effects and the risk of potential
overdose and death due to overdose
QUESTION
Tricyclic antidepressants (TCAs)
Answer:
Drugs:
· amitriptyline (Elavil)
· desipramine (Norpramin)
· doxepin (Sinequan)
· imipramine (Tofranil)
· nortriptyline (Pamelor)
QUESTION
Tricyclic antidepressants (TCAs)
Answer:

Common adverse effects of TCAs
Alpha-1 adrenergic effects-Orthostatic hypotension
Histamine effects-Sedation
Histamine effects-Weight gain
Anticholinergic effects-Blurred vision
Anticholinergic effects-Urinary retention
Anticholinergic effects-Constipation
Anticholinergic effects-Dry mouth
QUESTION
MAOIs
Answer:
Last choice medication class for depression due to the many potential, serious side effects.
MAOIs have specific dietary restrictions that when ignored, may be very uncomfortable or very
serious for clients.
QUESTION
MAOIs
Answer:
Drugs:
· phenelzine (Nardil)
· selegiline (Emsam) - MAOI-B
· tranylcypromine (Parnate)
· isocarboxazid (Marplan)
QUESTION
MAOI's Key Points
Answer:
· Clients taking MAOIs are at high risk for hypertensive crisis if tyramine is ingested.
· Do not prescribe any serotonergic agents within 2 weeks of MAOI discontinuation due to an
increased risk of serotonin syndrome.
Wait at least 5 half-lives after discontinuing a serotonergic medication before initiating an
MAIO.

QUESTION
Foods to Avoid When Taking MAO-A Medications
Answer:
· Red wine (Avoid)
· Sauerkraut (Avoid)
· Cheese (Avoid)
· Soy (Avoid)
· Smoked meats (Avoid)
QUESTION
Foods to Avoid When Taking MAO-A Medications
Answer:
Rationale: Limiting the consumption of tyramine is necessary for orally available MAOIs due to
inhibition of MAO-A in the gut. Dietary restrictions are not required for the transdermal
formulation of selegiline.
Tyramine is present in many aged or preserved foods including aged cheeses, tap and nonpasteurized beers, aged or smoked meat or fish, sauerkraut, kimchee, soy products, and tofu.
Foods to be avoided when taking MAO-A medications include wine, meats, sauerkraut, cheese,
and soy.
QUESTION
Newer Treatments for Resistant Depression
Answer:
· The goal of antidepressant treatment is the remission of symptoms; however, the current
treatment response of clients with mood disorders varies widely and is often unsatisfactory.
· For example, in clients with MDD, the treatment efficacy of selective serotonin reuptake
inhibitors (SSRIs), the most used first-line pharmacological agent is between 48 and 64% with
reported remission rates as low as 23.5%.
· Treatment-resistant depression occurs when depression persists after the client has adequately
trialed at least two antidepressant therapies.

QUESTION
Newer Treatments for Resistant Depression
Answer:
Esketamine (Spravato)-N-methyl-D-aspartate (NMDA) receptor inhibitor
Dextromethorphan/quinidine (Nuedexta)-under investigation for Resistant depression
QUESTION
Esketamine (Spravato)-N-methyl-D-aspartate (NMDA) receptor inhibitor
Answer:
Nasal spray for the treatment of major depressive disorder (MDD) with acute suicidal ideation or
behavior.
Esketamine reaches peak onset in the body in between 20-40 minutes.
Due to the risk of adverse outcomes due to sedation and dissociation, esketamine must be
administered in a supervised healthcare setting
QUESTION
Initiating Medication
Answer:
· Start patients on a single drug for 4-8 weeks to assess efficacy
· Start with the lowest recommended dose to reduce side effects
· If not achieving efficacy follow the process below:
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
If not achieving efficacy for MDD follow the process below:
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