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44 Cards in this Set
- Front
- Back
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What is major symptom of depression?
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depressed mood, and loss of pleasure or interst in all or nearly all of one' susual activiteis and pastimes, insomnia, weight loss, feelings of guilt or worthlessness - need to be present everyday for at least 2 weeks
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Name antidepressant categories of drugs?
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Tricyclic antidepressants, SSRIs, Serotonin/Norepinephrine reuptake inhibitors (SNRI), Monoamine oxidase inhibitors and atypical antidepressatns
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What is first choice for anti-depressants?
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Tricyclic Antidepressants (TCA's)
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What is the effect of TCA's
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prevent reuptake of neurotransmittors therefore making them more readily available
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Why is dosing difficultt with TCA's?
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Half life varies so individualized dosing is required to maintian adequate levels of the drug
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What are side effects of TCA's
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hypotension, sedation and anti-cholernergic effects
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What are drug interactions with TCA's
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MAO inhibitors can lead to severe hypertension, pototntiate epi and dopamine, decrease effects of ephedrien and amphetamine, intensifly anticholenergic meds like antihistamines, increase CNS depression
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Waht is the difference between TCA"s?
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mainly side effects - 9 are available for use and most similar except side effects
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What is the benefit of SSRI's instead of TCAs?
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SSRI do not cause hypotension, sedation or anti-cholernergic activites
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What is mech of action for SSRI's?
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inhibits 5-HT reuptake and intesifies trasmisison at serotonergic synapes.
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What are SSRI's used for
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depression, obsessive-compulsive disorder and panic disorder
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How long does it take to produce a steady plasma drug levels with SSRI's
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4 weeks to obtain & 4 weeks til gone after stop taking
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Adverse effects with Fluoxetine (SSRI)
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safer than TCA or MAO's most common side effect is sexual dysfunction, nausea and HA
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Are SSRI's safe with pregnancy?
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yes
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How should one stop taking SSRI's
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Never aburptly as an cuae dizziness, HA, nausea, sensory disturbances, tremor and anxiety - need to taper dosage
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How to reduce risk of overdose with TCA'
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8 times dose of TCA's can be toxic so patients should initially only be given 1 week dose at a time
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How to dose TCA's
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start dose low to minimize adverse reactions and improve adherance 50 mg then go up to 100-200mg/day
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Why are SSRI's prescribed more than TCA's
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less side effects - do not give late in pregnancy
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What is most prescribed antidpressant in USA?
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Fluoxetine - Prozac or SArafem
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What other drugs are SSRI's
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citalopram (Celexa), escitoloprma (Lexapro, fluvoxamine ( Luvox), paroxetine (Paxil) and sertraline (Zoloft)
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Name 3 Serotonit/norepinephrine reuptake inhibitors (SNRIs)
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Venlafaxien (Effexor XR), Desvenlafaxien (Pristiq ) & duloxetine (Cymbalta)
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What is mechanism of action for SNRI's
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blocks NE and 5-HT uptake allowing more available in the body - SSRI probably safer than SNRI's
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Adverse side effects with SNRI
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nausea, HA, anorexia, nervousness
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When would a MAO inhibitor be used?
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2nd or 3rd choice after failed iwth other options
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Why are MAO's not used?
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They are more dangerous can trigger hypertensive crisis - drug of choice for atypical depression
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Adverse effects of MAO inhibitors?
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CNS stimulation, orthostatic hypotension, hypertensive crise from dietary tyramine - cheeses, smoked foods, alcohol, avocados, bananas, sausages, yeast extract, protien suppliements
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Bupriopion (Wellbutrin) actions & uses
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has stimulant properties,and suppresses appetitie think it block dopamine uptake
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How is bi-polar disorder treated?
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with lithium and valproic acid and some a sntipsychoitce and antidepressant - lifelong treatment
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What mood episodes do people with bi-polar experience?
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pure manic episode - persistenlty heightened mood , overactivity, 2) Hypomanic episode - mild form of mania 3) major depressive epidsode - depressed mood and loss of pleasure 4) mixed episode - mania and depressio mixed
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How do mood episodes vary with bi-polar disease?
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up and down with some normal moods inbetween mania can last months and depression episodes can last 6 months many have at least 4 episode w/i 10 years
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What types of drugs are used to treat BPD?
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mood stabilizers, antipsychotics and antidepressants
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Which antidepressants are used with mood stabliizers in BPD
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Wellbutrin, effexor and SSRI like Prozac or Zoloft
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What vitamin can help decrease effects of BPD?
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Fish Oil
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What is the drug of choice in treating BPD?
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Lithium for controling manic episodes and long-term prophylaxis
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How is lithium excreted?
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short half life - rapid renal excretion - highly toxic
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What adverse effects can happen with excessive lithium levels?
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plasma levels over 1.5, persistent GI upset, course hand tremors, confusion, sedation, incoordination, giddiness, tinnitus, blurred vision, stupor, clonic movements
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What adverse effects can happen with therapeutice levels?
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nausea, diarhea, thrist polyuria, lethargy slurred speach, muscle weakness, fine hand tremor, renal toxicity with long term use,
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What pregnancy category is Lithium?
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D - do not use in 1st trimester of pregnancy
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NSAIDS increase lithium levels in teh blood T or F
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true do not use ibuprofen, or naproxen - ASA OK to use
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How is lithium given?
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must be given at least twice a day, cannot do once a day dosing as peak levels woudl be excessive. Best taken 3-4x day 300 mg per dose for twice a day dosing
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How does Valproic Acid help with BPD?
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originally an anti-seizure drug, controls mania episodes, has a higher therapuetic index and less side effects of lithium
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Serious side effects of Valproic Acid?
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thrombocytopenia, liver failure and pancreatitis -
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What is pregnancy category of valproic acid
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X
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When is carbamazepine indicated for BPD?
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mixed mania or rapid-cycline BPD. reduces symptoms during manic and depressive episodes
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