Directions
Answer the following study guide quesons to help guide you in your learning for this week’s topic(s).
Your answers must be written in your own words, paraphrasing what you have learned from your
research. Include in-text citaons with each response and then full references at the boom in current
APA professional paper format.

1. What blood values should be monitored with carbamazepine?
2. What are the pharmacodynamics of carbamazepine?
3. What should families be taught regarding the monitoring of seizure acvity?
4. What electrolyte imbalance is noted with the administraon of topiramate?
5. What are the pregnancy precauons for valproate?
6. What instrucons will you provide to a woman who wants to get pregnant and has a seizure
   disorder controlled with valproate?
7. What are the precauons and contraindicaons for tricyclic andepressants?
8. Phenelzine (Nardil) is an MAO inhibitor. What are the cauons and contraindicaons? How is it
   used to treat recalcitrant depression?
9. What are the symptoms of hypertensive crisis?
10. How long does it take for selecve serotonin reuptake inhibitors to produce an eect in paents
    with depression?
11. When are buspirone (Buspar) and an SSRI combined?
12. What type of diet is recommended with the administraon of lithium?
13. What are the main side eects of each of the classes of andepressants?
14. What receptors do andepressants and ananxiety medicaons act on?
    What to Submit
    (https://maryville.instructure.com/courses/74477/modules/items/6232684)
    Submit
    Assignment
    (https://maryville.instructure.co
    8/28/23, 9:47 AM Assignment 4.1: Study Guide Questions
    https://maryville.instructure.com/courses/74477/assignments/1912030?module_item_id=6232691 2/3
    Choose a submission type
    Your answers in a MicrosoWord or PDF document
    In-text citations and full citaons on a reference page
    If you use a textbook, include the page number or numbers you consulted to respond to the
    question. This will allow you to easily locate the informaon later.
    If you copy and paste references from the course into your assignment, be sure to conrm current APA
    professional paper formatting (hps://lmscontent.embanet.com/MVU/Syllabus/APA_Style.html) before
    submitting.
    Similarity Score
    After submitting your assignment, select Submission Details to view your similarity score.
    Your similarity score will appear as a percentage next to your submied le.
    It may take up to 24 hours for your similarity score to appear.

SAMPLE ANSWER

Study Guide Questions 4

Blood Values to be Monitored for carbamazepine

Blood values to be monitored for carbamazepine include complete blood cell counts and
electrolyte tests.

Pharmacodynamics of Carbamazepine

Carbamazepine is an anticonvulsant and mood-stabilizing drug that works by inhibiting
voltage-gated sodium channels. The inhibition of the sodium channels leads to a reduction in
neuronal excitability and the prevention of repetitive firing of action potentials, thus preventing
convulsions. There is also some action of the drug on calcium and potassium ion channels that
contribute to the treatment of various disorders, including epilepsy and bipolar disorder.

Family Monitoring on Seizure Activity

It is important to teach family members to monitor the patient’s body movements, such as
intense shaking. It is also important for the family to know some of the actions they should take
when a seizure occurs. For example, protecting the patient from self-injury like tongue-biting
during convulsions.

Electrolyte Imbalance Associated with Topiramate

Although rare, the drug may cause metabolic acidosis, which is mostly susceptible to
patients with renal disease, severe respiratory disease, chronic diarrhea, or other medical
conditions. The imbalances caused by the medication can lead to acute hypernatremia (Muaddi et
al., 2021)

STUDY GUIDE QUESTIONS 3

Pregnancy Precautions for Valproate

The medication has a high risk of congenital malformation and should be avoided by
pregnant women unless all other medications have been proven ineffective (Macfarlane &
Greenhalgh, 2018).

Pregnancy and Controlled Seizure Disorder

The patient should be encouraged to continue with the seizure medications as prescribed.
It is also good to consult with the prescribing physician whether there is a need for dose
adjustment to ensure that safe levels of the medication are taken without risk to the patient or the
unborn child.

Precautions and Contraindications for Tricyclic Antidepressants
Tricyclic antidepressants are contraindicated for patients with a family history of sudden
cardiac death. The medication should also not be administered concurrently with monoamine
oxidase inhibitors (Vos et al., 2022). Other precautions and contraindications include patients
with angle-closure glaucoma, patients with a history of seizures, and patients with hepatic
impairment. 

How Phenelzine Treats Recalcitrant Depression and Contraindications
Being a potent nonselective monoamine oxidase inhibitor, phenelzine prevents serotonin,
norepinephrine, and dopamine from being broken down, thus enhancing the neurotransmitters to
have a more prolonged effect on their target receptors (Cookey, 2021). Like other MAOI
inhibitors, the contraindications for the drug include patients with pheochromocytoma,
congestive heart failure, and renal or hepatic impairment.

STUDY GUIDE QUESTIONS 4

Symptoms of Hypersensitive Crisis

Hypersensitivity crisis is usually characterized by chest tightness and pain, blurred vision,
seizures, nausea and vomiting, confusion and anxiety, and severe headaches.
Duration Before Action for SSRI for Patients with Depression
In most cases, SSRIs take 2 to 4 weeks before their impact on a patient’s symptoms is
felt.

Combination of Buspirone and SSRI

The combination of the two medications has been found more effective in treating
depression, panic disorder, and anxiety compared to buspirone alone (Park, 2020)

Diet Recommended for Lithium

Patients under lithium should take diets with appropriate sodium levels and adequate
amounts of water to prevent lithium toxicity (Enderle et al., 2020).
Side Effects of Antidepressants

The main side effects of SSRIs and SNRIs include feeling agitated, loss of appetite,
weight loss, dizziness, and indigestion. For SNRIs, there is also excessive sweating (diaphoresis)
and sexual dysfunction. The same side effects are also present for TCAs with the addition of
problems in passing urine. Side effects for MAOIs include dry mouth, headache, drowsiness,
insomnia, dizziness, nausea, constipation or diarrhea, and skin reaction at the patch site. The side
effects of NMDA receptor antagonists include confusion, dizziness, headache, cough
hypertension, backache, and pain.

Receptors Targeted for Antidepressants and Antianxiety Medications
Most anti-depressants and antianxiety drugs target serotonin and 5-HT 1A receptors

STUDY GUIDE QUESTIONS 5

References

Cookey J. (2021). Use of MAOIs in severe treatment-resistant depression: back to the old
school. Journal of Psychiatry & Neuroscience: JPN, 46(4), E427–E428.
https://doi.org/10.1503/jpn.200214
Enderle, J., Klink, U., di Giuseppe, R., Koch, M., Seidel, U., Weber, K., & Lieb, W. (2020).
Plasma lithium levels in the general population: a cross-sectional analysis of metabolic
and dietary correlates. Nutrients, 12(8), 2489. https://doi.org/10.3390/nu12082489
Macfarlane, A., & Greenhalgh, T. (2018). Sodium valproate in pregnancy: what are the risks and
should we use a shared decision-making approach?. BMC Pregnancy and
Childbirth, 18(1), 200. https://doi.org/10.1186/s12884-018-1842-x
Muaddi, L., Osman, O., & Clark, B. (2021). Topiramate-induced severe electrolyte abnormalities
and hypernatremia leading to central pontine myelinolysis. BMJ Case Reports, 14(11),
e245870. https://doi.org/10.1136/bcr-2021-245870
Park Y. M. (2020). The hypothesis on the prediction of treatment response with buspirone
augmentation along with serotonergic antidepressant in patients with major depressive
disorder using loudness dependence of auditory evoked potentials: Two cases and review
of the literature for evidence. Psychiatry Investigation, 17(3), 222–224.
https://doi.org/10.30773/pi.2019.0293
Vos, C. F., Aarnoutse, R. E., Op de Coul, M. J., Spijker, J., Groothedde-Kuyvenhoven, M. M.,
Mihaescu, R., & Janzing, J. G. (2021). Tricyclic antidepressants for major depressive
disorder: a comprehensive evaluation of current practice in the Netherlands. BMC
Psychiatry, 21(1), 1-11. https://doi.org/10.1186/s12888-021-03490-x