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Which SSRI should be prescribed to a client who also suffers from insomnia & social anxiety, but is contraindicated in pregnancy? Paroxetine (Paxil) Which SSRI should be prescribed for a client who suffers from hypersomnolence & social anxiety? Sertraline (Zoloft) Which medication that treat...

Which SSRI should be prescribed to a client who also suffers from insomnia & social anxiety, but is contraindicated in pregnancy? Paroxetine (Paxil) Which SSRI should be prescribed for a client who suffers from hypersomnolence & social anxiety? Sertraline (Zoloft) Which medication that treats anxiety & depression needs to be increased if the client actively smoke? Fluvoxamine (Luvox) Which SSRI can improve the speed of processing & cognitive function? Vortioxetine (Brintellix) Which SSRI is considered the best tolerated with the fewest CYP interactions? Escitalopram What is a dosing considerations for Escitalopram? Start at ½ the dose due to QT prolongation Which SSRI should be avoided if a pt. has a history of falls/fractures? Paroxetine What screens should be completed prior to prescribing SSRIs? CBC, CMP, & thyroid stimulating hormone levels. Which age group is most at risk when prescribed a SSRI? Why?  65 & older due to may not respond as robustly as younger people & children/adults younger than 25 due to risk of death by suicide. Which medications are used as adjuncts?   Antipsychotics Which SSRI has the potential for activation?  Fluoxetine Which SSRI has the potential to increase panic attacks?  Fluoxetine Which medication should be avoided when the client has anxiety because it can exacerbate anxiety?  SSRIs Which medication is pharmacologically similar to the combination of an SRRI and buspirone?   What is the role of L-Methylfolate in depression treatment? It is a cofactor in the production of monoamines serotonin, dopamine, & norepinephrine which are involved in the regulation of mood. What is the method of action of L-Methylfolate? It addresses folate deficiency & supports essential biological processes such as DNA synthesis & cell division. Why is L-Methylfolate recommended as an adjunct?  It enhances the effectiveness of antidepressant medications How do SNRIs work? Work by inhibiting 5HT and NE reuptake and increase DA in the prefrontal cortex. Which NTM are affected in SNRIs? 5HT, NE, & Dopamine What are SE of SNRIs? SE= elevated BP, anxiety, insomnia, and constipation Why should SNRIs not be stopped abruptly? Could cause discontinuation symptoms. Norepinephrine effects of the medication may increase anxiety in some clients which cause worsening of anxiety. Is SNRI safe during breastfeeding? Yes, just monitor for infant irritability. Which SNRI used to treat both depression & anxiety disorders does the PMHHNP want to ensure they’ve tried a higher dose before switching to a different medication? Venlafaxine Which medication is effective for somatic symptoms of depression, atypical pain (fibromyalgia and diabetic neuropathy) at higher doses? Duloxetine (Cymbalta) Which SNR can be prescribed if the patient also suffers from perimenopausal vasomotor symptoms such as sweating or flushing? Desvenlafaxine (Pristiq).