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44 Cards in this Set
- Front
- Back
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What are the neurotransmitters that make up the neurobiological changes associated with depression? |
DEPLETION or DEFICIENCY Serotonin Norepinephrine Dopamine |
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What is the basis of pharmacological treatment of depression? |
Manage the relationship between the synaptic levels of neurotransmitters Serotonin Norepinephrine Dopamine |
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What changes in the hypothalamus may lead to depression? |
Pituitary - Adrenal axis dyregulation Increased levels of corticotrophin releasing factor and cortisol |
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For a PHQ-9 score of >20, what is the treatment recommendation? Dx: Major Depression, severe |
Antidepressant and Psychotherapy |
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For a PHQ-9 score of 15-19, what is the treatment recommendation? Dx: Major Depression, moderately severe |
Antidepressant Or Psychotherapy |
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For a PHQ-9 score of 10-14, what is the treatment recommendation? Dx: Minor Depression, Dysthymia, Major depression mild |
Support, watchful waiting antidepressant or pyschotherapy |
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For a PHQ-9 score of 5-9, what is the treatment recommendation? Dx: Minimal symptoms |
Support educate to call if worse return in 1 month |
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Which patient populations are referred for management of depression? |
SUICIDAL PATIENTS PREGNANT PATIENTS TREATMENT FAILURES |
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For the management of depression, what medical causes need to be ruled out? |
- HYPOTHYROID
- HYPOXIA - HYPO-PARATHYROIDISM - B12 DEFICIENCY - DEMENTIA - HYPO-ADRENOCORTICISM - MEDICATION EFFECT |
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LIST SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) |
FLUOXETINE (PROZAC) PAROXETINE (PAXIL) SERTRALINE (ZOLOFT) CITALOPRAM (CELEXA) ESCITALOPRAM (LEXAPRO) $$$ |
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SEROTONIN REUPTAKE INHIBITORS (SSRIS) ADVERSE REACTIONS |
GI EFFECTS SWEATING NERVOUSNESS INSOMNIA SEXUAL DYSFUNCTION |
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WHAT IS AN ALERT FOR PRESCRIBING FLUOXETINE (PROZAC)? |
WEEKLY PROZAC IF STABLE USE CAUTIOUSLY IN ELDERLY -- RENAL ELIMINATION |
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LIST TRICYCLIC ANTIDEPRESSANTS (TCA) |
DESIPRAMINE (NORPRAMIN) NORTIPTYLINE (PAMELOR) AMITRIPTYLINE (ELAVIL) DOXEPIN (SINEQUIN) IMIPRAMINE (TOFRANIL) |
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LIST TRICYCLIC ANTIDEPRESSANTS (TCA) ADVERSE REACTIONS |
- ANTICHOLINERGIC EFFECTS - DRYNESS - CONSTIPATION - URINARY RETENTION - TACHYCARDIA - WEIGHT GAIN |
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What is a norepinephrine & dopamine reuptake inhibitor? |
Bupropion (Wellbutrin) |
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Bupropion (Wellbutrin) alerts? |
Not prescribed with a history of: seizures CNS lesions recent head trauma |
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What are serotonin & norepinephrine reuptake inhibitors? |
Venlafaxine (Effexor) Desvenlafixine (Pristiq) Duloxetine |
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What is an alert for venlafaxine (effexor)? |
may increase BP monitor BP |
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What are serotonin & norepinephrine antagonists? |
Mirtazapine (Remeron) |
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What is the length of pharmacological intervention in depression? |
Minimum 9-12 months therapy |
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What is the goal of pharmacological intervention in depression? |
MEDICATE DURING ACUTE PHASE BRING SYMPTOMS UNDER CONTROL REMISSION LASTS UP TO 3 MONTHS |
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How long should depression medications be continued? |
continue medication for a minimum of 6 months after depression remission achieved |
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When is the most likely time of relapse? |
first 2 months after discontinuation of therapy greater than 2 episodes, 80% relapse in 1 year without treatment |
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Would you switch a bipolar patient with depressive symptoms to an SSRI? |
NO. Avoid switch from depressive to manic episode Medicate with mood stabilizers LITHIUM |
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What is the best management for bipolar disorder? |
-address safety -manage presenting symptoms -avoid SSRI, use mood stabilizers or anti-psychotics -refer to psychiatry |
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What are important diagnoses to rule out before an anxiety disorder diagnosis? |
Thyrotoxicosis Alcohol withdrawal Abuse of sympathomimetic drugs (caffeine, amphetamines, cocaine) Hypoglycemia |
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What diagnostic testing would be done before a diagnosis of anxiety disorder? |
HADS (Hospital Anxiety and Depression Scale) Labs: TSH, EKG |
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What minim length of time is required for anxiety management medications? |
*9 month treatment phase* initial 3 month acute phase 6 to 12 month maintenance period includes: education, counseling, self-management techniques |
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LIST BENZODIAZEPINES |
LORAZEPAM (ATIVAN) DIAZEPAM (VALIUM) ALPRAZOLAM (XANAX) CLONAZEPAM (KLONOPIN) |
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What is the correct method to medicate with benzodiazepines? |
supplement with SSRIs consider abuse potential taper slowly to discontinue (reduce by 25% per week)
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What is the correct benzodiazepines dosing to medicate elderly? |
use meds with shorter half-life due to increased risk of confusion and falls i.e. ativan (lorazepam) |
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LORAZEPAM (ATIVAN) ONSET EFFICACY |
SLOWER GOOD THERAPEUTIC EFFECT SHORT ACTING |
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DIAZEPAM (VALIUM) ONSET EFFICACY |
INITIAL RAPID ONSET
CAN BE INTOXICATING RELATIVELY SUSTAINED EFFECT |
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ALPRAZOLAM (XANAX) ONSET EFFICACY |
SLOW ONSET RELATIVELY SUSTAINED EFFECT |
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CLONAZEPAM (KLONOPIN) ONSET EFFICACY |
SLOW ONSET HIGHLY SUSTAINED EFFECT |
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What is the first line therapy for anxiety? |
SSRIs: Paroxetine (Paxil) Citalopram (Celexa) avoid fluoxetine (Prozac) for panic |
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What is the best way to prescribe SSRI and when do patients begin to see results? |
start low, go slow 3-5 week initial period before med is effective need to be tapered or can cause withdrawal |
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LIST 5-HT RECEPTOR SITE AGONIST |
Buspirone (BuSpar) slow onset of action >7days approved for GAD little abuse potential may exacerbate symptoms of depression |
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LIST TRICYCLIC ANTIDEPRESSANTS |
Imipramine (Tofranil) Clomipramine (Anafranil) |
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What beta blocker is commonly used in anxiety management to diminish arousal symptoms? |
Propranolol |
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What lab diagnostics may be seen with alcohol abuse? |
CBC - MCV elevation / impaired folate levels LFT - rise in ALT and AST = ratio AST:ALT >1 GGT - returns to normal after 3 wks sober (abstinence tracker) |
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What is pharmacotherapy used in motivated patients who want to quit ETOH? |
Naltrexone (ReVia): opioid antagonist >decreases cravings Acamprosate (Campral) >reduces cravings Disulfiram (Antabuse) >not recommended |
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For alcohol withdrawal, if a patient has adequate liver function which benzodiazepines are prescribed? |
Chlordiazepoxide (Librium) Diazepam (Valium) |
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For alcohol withdrawal, if a patient has impaired liver function which benzodiazepines are prescribed?
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Lorazepam (short acting) |
