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95 Cards in this Set
- Front
- Back
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What is the most common psychiatric disorder?
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depression
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what % of US will expereince depression?
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30%
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what are the antidepressant groups?
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tricyclic antidepressants
selective serotonin reuptake inhibitors(SSRI) serotononin/norepinephrine reuptake inhibiotors(SNRIs) monoamine oxidase inhibitors(MAOIs) atypical antidepressants |
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how do you clinically diagnosis depression?
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depressed mood
loss of pleasure or interest insomnia/hypersomnia anorexia/hyperphagia mental slowing and loss of concentration feelings of guilt, worthlessness, helplessness thoughts of death and suicide overt suicidal behaviro symptoms must be present most of the day nearly every day for at least 2 weeks |
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what is the pathogenesis of depression?
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genetic
difficult childood chronic low self esteem monoamine hypothesis of depression-depression caused by a functional insufficiency of monoamine neurotransmitters. |
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what are the monoamines?
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dopamine
norepinephrine serotonin |
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what are the treatments for depression?
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pharmacotherapy
depression specific psychotherapy(CBT) electroconvulsive therapy vagus nerve stimulation. |
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when is electroconvulsive therapy used?
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when drugs and therapy have not worked
sever depressed pt suicidal elderaly pt at risk of starving when rapid response is needed |
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when is vagus nerve stim used?
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only after treatment with at least four drugs has failed
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what is a big risk with all antidepressants?
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may increase suicidal tendency early in the treatement
must observe pt closely |
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what precautions are taken to lessen risk of suicidality with antidepressant use?
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observe pt closely for increases in suicidality/worsen mood/changes in behavior
prescribe lowest number of doeses consisten with good pt mangment. pt dosing with inpatient should be directly observed and documented |
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what is the first choice for most pt with major depression?
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tricyclics
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what are the most common adverse effects of tricyclics?
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sedation
othrostatic hypotension anticholinergic effects |
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what is the most dangerouse adverse effect of tricyclics?
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cardiac toxicity
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what drug do many tricyclics resemble chemically?
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phenothiazine antipsychotics
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what is the classic prototypic tricyclic?
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imipramine
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what is the MOA of tricyclics?
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block reuptake of norepinephrine and serotonin
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what is the half-life and dosing of most tricyclics?
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long half life 24-36 hours
usually only given once a day |
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what is difficult about dosing any drug in depression?
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everyone is different in the quality of their symptoms and the way they respond to them so you always have to start low and slowly work your way up
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what is blocked by tricyclics to prevent NE and serotonin reuptake?
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transmitter pumps located in the presynaptic nerve terminal that actively uptake after release.
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what are some of the secondary uses of tricyclics?
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bipolar
neuropathic pain chronic insomnia adhd panic disorder OCD |
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what is the main benificial effect in the secondary uses of tricyclics
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sedation helps all of them
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What are the adverse effects of tricyclics?
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orthostatics hypotension
anticholinergic effects Diaphoresis(sweating) seen in low dose sedation cardiac tox seizures hypomania yawngasm |
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what are the drug interaction with tricyclics?
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MAOIs-increased effects
direct aciting sympathomimetics-additive indirect-acting sympathomimetics-additive anticholinergic agents-additive CNS depressants- this can lead to respiratory depression |
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what is the toxicity of tricyclic
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primary from anticholinergic and cardiotoxic actions
dysrhythmias tachycardia intraventricular blocks complete atrioventreicular block ventricular tachycardia V-fib |
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what are the treatments for tricylic tox
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gastric lavage(rare)
ingestion of activated charcoal(only if not in intestines yet) physostigimine propanolol, lidocaine, or phenytoin-block the arythmic effects |
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what is important with dosing tricyclics?
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takes weeks to months for onset start low and go slow give each amount a long time before assessing its function
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what is used to determine what type of tricyclic you use?
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there are 9 equally effective ones selection is based on side effects.
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what is the most commonly prescribed antidepressant
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SSRIs
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what is the comparison btw SSRIs and tricyclics(TCAs)
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as effecive as TCAs but do not cause hypotension, sedatino or anticholinergic effects, and does not cause cardiac tox
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what is the risk with overdose of SSRIs?
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death by overdose is extremely rare
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what is the most widely prescribed SSRI in the world?
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fluxetine
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what is the MOA of SSRIs?
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acts on serotonin reuptake pumps to inhibit them and keep serotonin in the synapse longer
excitatory effect on CNS |
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What is the main Therapeutic uses of SSRIs
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main use is depression
other uses- OCD,bulimia, premenstrual dysforic disorder. |
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what is serotonin syndrome?
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excessive serotonin response.
it take the normal effects of serotonin and ampilfies them by factor of 10 very rare less than 2% of pt have this response, but it can be life threatening |
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how long after treatment does serotonin syndrome usually occur?
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2-72 hours usually within first 24
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what is the problem with stopping SSRIs?
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you can get withdrawal syndrome, which has aggitation, and behavior changes. only occurs if stopped suddenly not seen if you properly taper down off dose
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what is the neonatal effects of serotonin?
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little risk if given in early pregnancy(may be some risk of teratogenesis, but not well documented)
main risk is when taken in late pregnancy it can lead to babies being born with serotonin syndrome |
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what are the adverse effects of SSRIs?
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serotonin syndrome(2-3%risk)
withdrawal if taken off to fast neonatal effects when used late in preg teratogenesis(only known for sure in animals) extrapyramidal side effect(movement disorders)-seen in high dose and extended use bruxism(clenched teeth) seen in most pt who are on it for long time bleeding disorders sexual dysfunction weight gain |
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what are the drug interactions with SSRIs?
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MAOIs- increased risk of serotonin syndrome
Warfarin-increased bleeding effects TCAs and lithium- elevate levels of SSRIs and can lead to serotonin syndrome as well. |
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what is sertraline?
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SSRI
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what is specail about sertraline?
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blocks uptake of serotonin and dopamine
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what are the uses of sertraline?
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major depression
panic disorder OCD PTSD PMDD social anxiety disorder minimal effects on reducing seizures so not used alone in seizure pt but if seizure pt comes in with depression this could be a good drug to use. |
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what are the adverse effects of sertraline?
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TRANSIENT AND RARE
headache nausea tremor diarrhea insomnia RARE BUT LONGER LASTING weight gain agitation sexual dysfunction when used late in preg can lead to neonatal abstinence syndrome/neonatal pulmonary hypertension can also cause nervousness |
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what are the drug interactions with sertraline?
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MAOIs
pimozide |
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what is fluvoxamine and what is it used for?
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SSRI used in OCD much more often than depression
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what is the pharmacokinetics of fluvoxamine?
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rapidely absorbed from GI tract
half life about 15hours interacts adversely with MAOIs |
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what are the normal SSRI side effects?
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nausea
vomiting constipation weight gain dry mouth headache sexual dysfunction |
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what is a specific adverse effect to fluvoxamine?
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abnormal liver function in long term use
so you need to take regulary liver enzyme tests when on this drug long term. |
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what is the fastest acting SSRI?
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paroxetine
can see effects a week or two instead of several weeks to months |
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what is unique about citalopram?
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it is an SSRI but it does not block recetpros for seotonin, acetlcholine, NE, or histamine.
we don't know how it works but is has simialar side effects including neonatal serotonin withdrawal/syndrome so we call it an SSRI |
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what is escitalopram?
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S-isomer of citalopram
same as citalopram we dont know how it works bc doesnt block any of the reuptakes things main difference btw this and citalopram is that escitalopram is better tolerated the side effects are less severe less common and last less time. |
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what are the SNRIs?
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venlafaxine
duloxetine |
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what is the MOA of the SNRIs?
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block reuptake pumps for both serotonin and NE.
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what are the indications for use of venlafaxine?
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used in major depression, generalized anxiety disorder and social anxiety disorders.
basically its used for depression and anxiety instead of mainly depression like the SSRIs |
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what are the drug interactions of Venlafaxine?
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serious reaction if combined with MAOIs
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what are the side effects seen in venlafaxine?
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same the side effects of the SSRIs exept that they can cause hyponatremia as well mainly in elderly
bc of this you need to run electrolyte panels routinely on pts taken these. |
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what can you see if a pt is hyponatremic due to use of venlafaxine?
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cardiac and neurologic effects
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what is speacial about duloxetine?
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inhibits serotonin and NE and also weakly inhibits dopamine reuptake
this is the first drug so far that causes increase in all these neurtransmitters that are implicated in depression |
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what is a very speacial indication that duloxetine has?
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it is the drug of choice in diabetec peripheral neuropathy.
it is also used in depression and OCD but its frontline in DPN. |
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what are the pharmacokinetics of duloxetine?
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FOOD REDUCES RATE OF ABSORPTION
highly bound to albumin so it can knock off other medicine that bind albumin half life of 12 hours Undergoes mainly liver metabolism |
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what is the adverse effects of duloxetine?
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all the normal SNRI ones
major difference is that most patients will expereince blurred vision as well. |
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what is important about duloxetine and new mothers?
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can cross placental barrier and can also enter breast milk.
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what are the drug interaction of duloxetine>
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alcohol(liver stuff)
MAOi drugs that afftect CYP1A2 or CYP2D6 (liver enzymes bc this is metabolized in liver) |
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when is MAOi used?
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2nd or 3rd choice for antidepressant
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why are MAOIs not used as first line drugs?
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as effective as TCA or SSRIs but more dangerous
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what is the major danger for patients on MAOIs?
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risk of triggering hypertensive crisis if pt eats foods rich in tyramine
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what is MOAIs the drug of choice for?
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atypical depression
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What food is high in tyramine?
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cheese
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What is the MOA of the MAOIs?
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blocks monoamine oxidase from converting NE, dopamine, and serotonine into inactive products
also is responsible for inactivating tyramine and other biogenic amines |
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what are the two forms of MAO in the body?
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type A
Type B |
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what about the MOA of MOAIs makes them so dangerous?
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they are all irreversible inhibitors
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what are the adverse effects of the MAOIs?
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CNS stimulation
othrostatic hypotension hypertensive crisis from dietary tyramine |
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what are the uses of MAOIs?
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can be use in depression, OCD, and anxiety
shouldnt be front line. but can be helpful if refractroy to others |
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How are MAOIs metabolized?
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liver
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what are the drug interactions for MAOIs
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indirect acting sympathomimetics
interactions secondary to inhibiton of hepatic MAO antidepressants:TCAs and SSRIs antihypertensive drugs Meperidine(displaces from albumin) |
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what is a problem with the oral use of antidepressants?
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people tend to abuse them. many of them take a long time to work people who are depresed may feel like they are not working so they take more to see if it will make them feel something.
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where are the two types of MAO located in the body?
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in the brain and in the liver
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which MAO works on tryamine?
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the one in the liver.
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what is selegiline?
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MAOI
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what is speacial about selegiline?
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first transdermal treatment for depression
much lower risk of adverse effects especially hypertensive crisis when administered transdermally adverse effects still exist when using sympathomimetic though |
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what is the MOA in bupropion?
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appears to only work on NE increasing amounts
acts as a stimulant and suppresses appetite |
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what is an advantage to the use of bupropion?
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does not cause weight gain
increases secual desire and pleasure can provide andtidepressant effects in 1 to 3 weeks. |
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what are the adverse effects of bupropion?
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can cause seizures
agitation tremor tachycardia blurred vision dizziness headache insomnia dry mouth GI upset constipation weight loss |
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what are the drug interactions with bupropion?
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MAOIs can increase risk of toxicity
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what are the atypical antidepressants
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bupropion
nefazodone mirtazapine amoxopine reboxetine trazodone |
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what is the main effect of Trazadone
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sedation thought to help deal with depression by improving sleep.
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what are the two types of pt that may be candidates for electroconvulsive therapy?
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those who have failed to respond to medication
severely depressed suicidal patients |
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what are the advantages of electroconvulsive therapy?
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effective
rapid onset can be used to terminate ongoing depressive episodes |
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what is an adverse effect of electroconvulsive therapy?
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can cause memory loss for event immediately surrounding treatment.
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what is usually given along with electroconvulsive therapy?
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some sort of sedative like valium to prevent clenching of teeth and stuff
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what is Vagus nerve stimulation used for?
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long term therapy of treatment resistan depression(TRD)
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what is TRD?
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treatment resistant depression when at least 4 antidepressant meds have failed.
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what is the MOA of vagus nerve stimulation
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an implanted device delivers electrical pules to the vagus nere.
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what are some side effects of vagus nerve stimulation?
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hoarseness
voice alteration caugh dyspnea. |
