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80 Cards in this Set

  • Front
  • Back
Depression can be treated with what four modalities?
2)Depression-specific psychotherapy
4)Vagus nerve stimulation
Which type of antidepressant is the first choice due to being inexpensive, effective, safe, and easy to administer?
Why would you choose a SSRI?
less SE
When would a pt receive an MAOI?

They are the drug of choice for?
When not responding to TCAs or SSRIs

Canidates for ECT...
1)severely depressed, suicidal
2)elderly pts at risk for
starving becuase depression
induced lack of appetite
3)Pts not responding to
antidepressant drugs
blocks norepinephrine and serotonin
With TCAs
Will see initial responses in...

Maximal response in...
1 to 3 weeks

1 to 2 months
TCA's help with:
major depression, bipolar, neuropathic pain, chronic insomnia, ADHD, Panic d/o, OCD
Major Adverse Effects of TCA's

Most serious one
orthostatic hypotension, sedation, anticholinergic effects

T or F
TCA's lower seizure threshold?
When taken with MAOI's can lead to
Potential hypertensive crisis
OD can be life threatening. The lethal dose is
8 times the avg dose!
S/S of TCA OD.
hyperthermia, flushing, dry mouth, and dilaton of pupils
Early responses: confusion, agitation, and hallucinations. Coma & death to follow.
Treatment for OD of TCAs
gasstric lavage followed by ingestion of activated charcoal
Common SE of SSRI's
nausea, insomnia, wt gain, sexual dysfunction
Protoype of SSRI's
Fluuoxetine (Prozac) is used to treat:
Major depression, bulimia nervosa, and premenstrual dysphoric disorder.
Ways to manage sexual dysfunction with Fluuoxetine (Prozac):
1)reduction in dose
2)drug holiday
3)Add a drug that can over-come the problem
Fluuoxetine (Prozac)initially causes wt loss due to medication induced:

After initial period pt starts to
nausea and vomiting.

gain wt
The most common EPS caused by Fluuoxetine (Prozac) isL:
Fluuoxetine (Prozac) also can have SE of:
Bruxism, bleeding d/o's, hyponatremia, dizziness and fatigue, severe rash, diarrhea and excessive sweating
Why shouldn't Fluuoxetine (Prozac) be given with MAOI's?
Increases risk for serotonin syndrome.
What does Fluuoxetine (Prozac) do to TCA's and Lithium?
elevates plasma levels of them.
SSRI's with the exception of Luvox, cause CNS
With most SSRI's they must be withdrawn ____ days before starting a MAOI?
Its possible that Paroxetine (Paxil)may cause:
ventral septal defects and other cardiac anomalities
With CR tablets, the CR doesn't means that:
A) They last longer
B) Dissolve in lower intestines
B) Dissolve in lower intestines
Two drugs block neuronal reuptake of serotonin and norepinephrine.
Effexor & Cymbalta
Serotonin symdrom usually beings ___ to ___ hours after initiation of treatment and usually when a ____ is combined with a _____.
2 to 72 hours
S/S of serotonin syndrome:
altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration) as well as incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.
With Venlafaxine (Effexor) you must monitor the BP for:
dose-related sustained diastolic hypertension
Duloxetine (Cymbalta) is used to treat:
diabetic peripheral neuropathy
With Duloxetine (Cymbalta), there is a higher risk of ___ damage
Avoid use of ETOH with it
The major danger with MAOI's is the risk of triggering a
hypertensive crisis
MAOI's cause direct CNS _____

Excessive stimulation can produce:

anxiety, agitation, hypomania, and even mania.
Adverse effects of MAOI's
CNS stimulation, orthostatic hypotension, hypertensive crisis from dietary tyramine
Symptoms of hypertensive crisis:
headache, tachycardia, palpitations, nausea, and vomiting
BP can be lowered with:
IV phentolamine or sublingual nifedipine

Hypertensive Crisis

Serotonin Syndrome
Antihypertensives + MAOI =
Excessively low BP
Demerol + MAOI =
Bupropion (Wellbutrin), Nefazodone, Mertazapine (Remeron), Amoxapine (Asendin), Reboxetine (Vestra), and Trazodone (Desyrel) are ________ antidepressants.
Bupropion (Wellbutrin)has what kind of action?
Stimulant. Supresses appetite too.
Bupropion (Wellbutrin) doesn't cause ____ or ____.
Wt gain or sexual dysfunction
An adverse effect of Bupropion (Wellbutrin)
Mirtazapine (Remeron) must be given:
Amoxapine (Asending) isn't used long term because of the risk of:
EPS Tarditive dyskinesia
Trazadone (Desyrel) shares most of the same SE of TCA's execpt:
it has minimal anticholinergic actions and isn't cardiotoxic. May cause priapism
With hypomania, symptoms are not severe enough to cause marked impairment in ____ or ___.
social or occupational functioning or to require hospitalization. Psychotic symptoms are absent.
Bipolar d/o is treated with 3 major groups of drugs:
1)Mood stablilzers
Lithium has a LOW or HIGH therapeutic index.
Lithium is excreted by the:

Renal excretion is affected by blood levels of :

When sodium levels are low, lithium excretion isL
Use caution in pts with kideny problems.


Lithium levels must be kept below
1.5 mEq/L
For initial therapy of a manic epidose, lithium levels should range from
0.8 to 1.4 mEq/L
The maintenance level of lithium should be
0.4 to 1.0 mEq/L
When should lithium levels be checked?
In the morning, 12 hours after the last dose.
The most common casue of lithim accumulation is:
sodium depletion
At the beginning of treatment with Lithium levels should be checked:
During maintence therapy:
Every 2 to 3 days

Every 1 to 3 months
Treatment of OD of lithium??

If level greater than 2.5 mEq/L consider?
No antidote; primarily supportive.

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
2.0 to 2.5 mEq/L
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.
1.5 to 2.0 mEq/L
At what lithium level would you expect to see the following: Symptoms may progress rapidly to generalized convulsions, oliguria, and death
Above 2.5 mEq/L
Before initiating lithium thrapy what should be ruled out?
Drug interactions with lithium:
diuretic - sodium loss
NSAIDS - increase levels
Anticholinergics - urinary hesitancy
How can you reduce the risk for GI upset with lithium?
Adminsiter with food or milk.
Can lithium be administered in a daily dose? Why or why not?
No. Peak levels would be excessive.
This drug is so effective that it has replaced lithium as the drug of choice for BPD.
Valproic acid. Which is an antiepileptic drug.
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
3 areas of concern with valproic acid:
thrombocytopenia, pancreatitis, and liver failure
True or False:\
Valproic acid has no effect during pregnancy.
What is the trough plasma level for valproic acid?
50 to 120 mcg/mL.
What is the trough plasma level for Carbamazepine?
4 to 12 mcg/mL
Which is better for mixed mania or rapid-cycling BPD?
B)Valproic acid
C. Carbamazepine
2 bad SE from Lamotrigine (Lamictal) are:
Stevens-Johnson Syndrome and toxic epidermal necrolysis
Which is antipsychotic is prefered?
Atypical ones.

Zyprexa, Seroquel, Risperdal, Abilify, Geodon

Clozaril-agranulocytosis watch for it.
Common SE of lithium at a therapeutic level are:
tremor, goiter, and polyuria
Lithium levels can be increased by:
Diuretics and NSAIDS
Why are antipsychotics given with BPD?
To help control Sx during sever manic episodes, even if psychotic Sx are absent
___ ____ can stabilize mood in people with bipolar d/o.
Fish oil.
A nurse gives a med that inhibits MAO. How would this drug affect autonomic activity?
Sympathetic activity would increase.