Antidepressants And Bipolar Drugs

Front 1

Depression can be treated with what four modalities?

Back 1

1)Pharmacotherapy
2)Depression-specific psychotherapy
3)ECT
4)Vagus nerve stimulation

Front 2

Which type of antidepressant is the first choice due to being inexpensive, effective, safe, and easy to administer?

Back 2

TCA's

Front 3

Why would you choose a SSRI?

Back 3

less SE

Front 4

When would a pt receive an MAOI?

They are the drug of choice for?

Back 4

When not responding to TCAs or SSRIs

Atypical

Front 5

Canidates for ECT...

Back 5

1)severely depressed, suicidal
2)elderly pts at risk for
starving becuase depression
induced lack of appetite
3)Pts not responding to
antidepressant drugs

Front 6

MOA of TCAs

Back 6

blocks norepinephrine and serotonin

Front 7

With TCAs
Will see initial responses in...

Maximal response in...

Back 7

1 to 3 weeks

1 to 2 months

Front 8

TCA's help with:

Back 8

major depression, bipolar, neuropathic pain, chronic insomnia, ADHD, Panic d/o, OCD

Front 9

Major Adverse Effects of TCA's

Most serious one

Back 9

orthostatic hypotension, sedation, anticholinergic effects

Cardiotoxicity

Front 10

T or F
TCA's lower seizure threshold?

Back 10

TRUE

Front 11

When taken with MAOI's can lead to

Back 11

Potential hypertensive crisis

Front 12

OD can be life threatening. The lethal dose is

Back 12

8 times the avg dose!

Front 13

S/S of TCA OD.

Back 13

hyperthermia, flushing, dry mouth, and dilaton of pupils
Early responses: confusion, agitation, and hallucinations. Coma & death to follow.

Front 14

Treatment for OD of TCAs

Back 14

gasstric lavage followed by ingestion of activated charcoal

Front 15

Common SE of SSRI's

Back 15

nausea, insomnia, wt gain, sexual dysfunction

Front 16

Protoype of SSRI's

Back 16

Prozac

Front 17

Fluuoxetine (Prozac) is used to treat:

Back 17

Major depression, bulimia nervosa, and premenstrual dysphoric disorder.

Front 18

Ways to manage sexual dysfunction with Fluuoxetine (Prozac):

Back 18

1)reduction in dose
2)drug holiday
3)Add a drug that can over-come the problem

Front 19

Fluuoxetine (Prozac)initially causes wt loss due to medication induced:

After initial period pt starts to

Back 19

nausea and vomiting.

gain wt

Front 20

The most common EPS caused by Fluuoxetine (Prozac) isL:

Back 20

Akathisia

Front 21

Fluuoxetine (Prozac) also can have SE of:

Back 21

Bruxism, bleeding d/o's, hyponatremia, dizziness and fatigue, severe rash, diarrhea and excessive sweating

Front 22

Why shouldn't Fluuoxetine (Prozac) be given with MAOI's?

Back 22

Increases risk for serotonin syndrome.

Front 23

What does Fluuoxetine (Prozac) do to TCA's and Lithium?

Back 23

elevates plasma levels of them.

Front 24

SSRI's with the exception of Luvox, cause CNS

Back 24

excitation

Front 25

With most SSRI's they must be withdrawn ____ days before starting a MAOI?

Back 25

14

Front 26

Its possible that Paroxetine (Paxil)may cause:

Back 26

ventral septal defects and other cardiac anomalities

Front 27

With CR tablets, the CR doesn't means that:
A) They last longer
B) Dissolve in lower intestines

Back 27

B) Dissolve in lower intestines

Front 28

Two drugs block neuronal reuptake of serotonin and norepinephrine.

Back 28

Effexor & Cymbalta

Front 29

Serotonin symdrom usually beings ___ to ___ hours after initiation of treatment and usually when a ____ is combined with a _____.

Back 29

2 to 72 hours
SSRI and a MAOI

Front 30

S/S of serotonin syndrome:

Back 30

altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration) as well as incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

Front 31

With Venlafaxine (Effexor) you must monitor the BP for:

Back 31

dose-related sustained diastolic hypertension

Front 32

Duloxetine (Cymbalta) is used to treat:

Back 32

diabetic peripheral neuropathy

Front 33

With Duloxetine (Cymbalta), there is a higher risk of ___ damage

Back 33

LIVER
Avoid use of ETOH with it

Front 34

The major danger with MAOI's is the risk of triggering a

Back 34

hypertensive crisis

Front 35

MAOI's cause direct CNS _____

Excessive stimulation can produce:

Back 35

Stimulation

anxiety, agitation, hypomania, and even mania.

Front 36

Adverse effects of MAOI's

Back 36

CNS stimulation, orthostatic hypotension, hypertensive crisis from dietary tyramine

Front 37

Symptoms of hypertensive crisis:

Back 37

headache, tachycardia, palpitations, nausea, and vomiting

Front 38

BP can be lowered with:

Back 38

IV phentolamine or sublingual nifedipine

Front 39

MAOI + TCA =

MAOI + SSRI =

Back 39

Hypertensive Crisis

Serotonin Syndrome

Front 40

Antihypertensives + MAOI =

Back 40

Excessively low BP

Front 41

Demerol + MAOI =

Back 41

Hyperpyrexia

Front 42

Bupropion (Wellbutrin), Nefazodone, Mertazapine (Remeron), Amoxapine (Asendin), Reboxetine (Vestra), and Trazodone (Desyrel) are ________ antidepressants.

Back 42

Atypical.

Front 43

Bupropion (Wellbutrin)has what kind of action?

Back 43

Stimulant. Supresses appetite too.

Front 44

Bupropion (Wellbutrin) doesn't cause ____ or ____.

Back 44

Wt gain or sexual dysfunction

Front 45

An adverse effect of Bupropion (Wellbutrin)

Back 45

seizures

Front 46

Mirtazapine (Remeron) must be given:

Back 46

dry

Front 47

Amoxapine (Asending) isn't used long term because of the risk of:

Back 47

EPS Tarditive dyskinesia

Front 48

Trazadone (Desyrel) shares most of the same SE of TCA's execpt:

Back 48

it has minimal anticholinergic actions and isn't cardiotoxic. May cause priapism

Front 49

With hypomania, symptoms are not severe enough to cause marked impairment in ____ or ___.

Back 49

social or occupational functioning or to require hospitalization. Psychotic symptoms are absent.

Front 50

Bipolar d/o is treated with 3 major groups of drugs:

Back 50

1)Mood stablilzers
2)Antipsychotics
3)Antidepressants

Front 51

Lithium has a LOW or HIGH therapeutic index.

Back 51

Low

Front 52

Lithium is excreted by the:

Renal excretion is affected by blood levels of :

When sodium levels are low, lithium excretion isL

Back 52

kidneys.
Use caution in pts with kideny problems.

Sodium

Reduced

Front 53

Lithium levels must be kept below

Back 53

1.5 mEq/L

Front 54

For initial therapy of a manic epidose, lithium levels should range from

Back 54

0.8 to 1.4 mEq/L

Front 55

The maintenance level of lithium should be

Back 55

0.4 to 1.0 mEq/L

Front 56

When should lithium levels be checked?

Back 56

In the morning, 12 hours after the last dose.

Front 57

The most common casue of lithim accumulation is:

Back 57

sodium depletion

Front 58

At the beginning of treatment with Lithium levels should be checked:
During maintence therapy:

Back 58

Every 2 to 3 days

Every 1 to 3 months

Front 59

Treatment of OD of lithium??

If level greater than 2.5 mEq/L consider?

Back 59

No antidote; primarily supportive.

Hemodialysis

Front 60

At what lithium level would you expect to see the following: Ataxia, giddiness, high output of dilute durine, serious ECG changes, fasciculations, tinnitus, blurred vision, clonic movements, seizures, stupor, severe hypotension, coma, death

Back 60

2.0 to 2.5 mEq/L

Front 61

At what lithium level would you expect to see the following: Persistent GI upset, coarse hand tremor, confusion, hyperirritablitiy of muscles, ECG changes, sedation, incoordination.

Back 61

1.5 to 2.0 mEq/L

Front 62

At what lithium level would you expect to see the following: Symptoms may progress rapidly to generalized convulsions, oliguria, and death

Back 62

Above 2.5 mEq/L

Front 63

Before initiating lithium thrapy what should be ruled out?

Back 63

Pregnancy

Front 64

Drug interactions with lithium:

Back 64

diuretic - sodium loss
NSAIDS - increase levels
Anticholinergics - urinary hesitancy

Front 65

How can you reduce the risk for GI upset with lithium?

Back 65

Adminsiter with food or milk.

Front 66

Can lithium be administered in a daily dose? Why or why not?

Back 66

No. Peak levels would be excessive.

Front 67

This drug is so effective that it has replaced lithium as the drug of choice for BPD.

Back 67

Valproic acid. Which is an antiepileptic drug.

Front 68

True or False:
Valproic acid compare favorably with lithium: both drugs are highly effective, and valproate works faster and has a higher therapeutic index and is more desirable SE profile

Back 68

TRUE

Front 69

3 areas of concern with valproic acid:

Back 69

thrombocytopenia, pancreatitis, and liver failure

Front 70

True or False:\
Valproic acid has no effect during pregnancy.

Back 70

False

Front 71

What is the trough plasma level for valproic acid?

Back 71

50 to 120 mcg/mL.

Front 72

What is the trough plasma level for Carbamazepine?

Back 72

4 to 12 mcg/mL

Front 73

Which is better for mixed mania or rapid-cycling BPD?
A)Lithium
B)Valproic acid
C)Carbamazepine

Back 73

C. Carbamazepine

Front 74

2 bad SE from Lamotrigine (Lamictal) are:

Back 74

Stevens-Johnson Syndrome and toxic epidermal necrolysis

Front 75

Which is antipsychotic is prefered?

Back 75

Atypical ones.

Zyprexa, Seroquel, Risperdal, Abilify, Geodon

Clozaril-agranulocytosis watch for it.

Front 76

Common SE of lithium at a therapeutic level are:

Back 76

tremor, goiter, and polyuria

Front 77

Lithium levels can be increased by:

Back 77

Diuretics and NSAIDS

Front 78

Why are antipsychotics given with BPD?

Back 78

To help control Sx during sever manic episodes, even if psychotic Sx are absent

Front 79

___ ____ can stabilize mood in people with bipolar d/o.

Back 79

Fish oil.

Front 80

A nurse gives a med that inhibits MAO. How would this drug affect autonomic activity?

Back 80

Sympathetic activity would increase.