Psychopharm Lecture 3

Front 1

neurobiology of depression: reduced ____ volume commong among depressed patients and directly correlates w/ freuqnecy and length of depressive episodes

Back 1

hippocampal

Front 2

neurobiology of depression: ___ & ___ areas demonstrate differential metabolic rates, reflecting aberrant neural activity thought to contribute to depressive symptomatology

Back 2

prefrontal; limbic

Front 3

Neurobiology of depression: reduced GM volume noted in the ___-___ regions and functional alterations in the temporal regions and cerebellym in patients w/ MDD

Back 3

parietal; temporal

Front 4

The Monoamine Hypothesis: The structure and function of these brain regions are modulated by ___ ___

Back 4

monoaminergic neurotransmission

Front 5

Monoaminergic neurotransmission is the neural basis for what 5 things?

Back 5

Mood, reward, pleasure, motivation, and executive functions

Front 6

The Monoamine hypothesis: 3 neurotransmitters associated w/ the hypothesis?

Back 6

serotnonin, norepinephrine, dopamine

Front 7

What neurotransmitters associated with motivation and deficits in EF?

Back 7

DA and NE

Front 8

Impaired neurotransmitter ___ associated with anhedonia, guilt, and similar negative affects of depression

Back 8

5HT (serotonin)

Front 9

Serotonin and norepinephrine have descending ___ pathways.

Back 9

Spinal

Front 10

Descending spinal pathways of 5HT and NE mediate ___ and related ___ sx.

Back 10

Physical fatigue; somatic

Front 11

What 3 behavioral sxs is serotonin involved in?

Back 11

appetite & weight changes; guilt and feelings of worthlessness; SI

Front 12

What 3 things are dopamine and norepinephrine involved in?

Back 12

apathy, EF deficits, fatigue

Front 13

What 3 sxs are serotonin, dopamine, and norepinephrine involved in?

Back 13

depressed mood, sleep disturbances, psychomotor disturbances

Front 14

6 types of SSRIs?

Back 14

Citalopram, Escitalopram, Fluoxetine, Fluvoxemine, Paroxetine, Sertraline

Hint 14

Consumer Electrical Show for Final Fantasy People

Front 15

SSRI: SSRI works by preventing the reuptake of serotnin back into the ___ nerve. This results in ___ sertonin being available in the synapse and thus an amplified transmission

Back 15

presynaptic; more

Front 16

The action of antidepressants in neurotransmission is almost ___, but clinical response is usually more gradual. Patient's may see clinical improvements witin ___ weeks, with further improvements in symptoms over several weeks

Back 16

immediate; 2

Front 17

Common side effects of SSRIs: 4 main areas?

Back 17

Gastrointestinal, psychomotor agitation, sleep changes, sexual side effects

Front 18

SSRI common side effects for gastrointestinal? Sleep? psychomotor agitation/retardation?

Back 18

nausea, vomiting, indigestion, diarrhea; insomnia or fatigue; jitteriness, nervouness, excessive sweating, headaches

Front 19

SSRI common side effects for sexual side effects?

Back 19

decreased libido, ejaculatory disturbance, ED, difficulty achieving orgasm.

Front 20

SSRIs can trigger a ___ episode in patients with bipolar disorder

Back 20

manic

Front 21

2 other adverse reactions to SSRI?

Back 21

Serotonin syndrome; Syndrome of inappropriate antiuretic hormone secretion (SIADH)

Front 22

serotonin syndrome: always a risk when multiple ___ medications are combined

Back 22

serotonergic

Front 23

Serotonin syndrome: occurs due to ___ serotonin in CNS

Back 23

excessive

Front 24

serotonin syndrome: can be ___-___; must STOP offending medications immediately and go to ED

Back 24

life-threatening

Front 25

Symptoms of Serotonin Syndrome: 7

Back 25

lethargy, confusion, restlessness, flushing, profuse sweating, tremor, and uncontrollable muscular twitching/ jerking

Hint 25

Lee Could Really Flex Strong Tree Tops

Front 26

What happens if sertonin syndrome is untreated? 7 step process?

Back 26

elevated temperature and blood pressure, excessive muscle tension, muscle breakdown, kidney failure, coma, death

Hint 26

Tell BP not to be Tense, can lead to muscle tension, breakdown, KF, coma, and death

Front 27

SIADH: what are the 5 steps?

Back 27

Front 28

SIADH: Antiduetic hormone is released by the ___ and stored where?

Back 28

hypothalamus, posterior pituitary

Front 29

When is ADH released?

Back 29

Changes in blood volume (dehydration)

Front 30

What does ADH react on?

Back 30

Kidneys, leads to retain/reabsorb more water.

Front 31

When blood volume returns to equilibirium, this is sensed by the ___, which then decreases secretion of ADH

Back 31

hypothalamus

Front 32

SIADH: ___ and other meds can induce excessive release of ADH leading to excessive reabsorption and rention of water by the kidneys

Back 32

citalopram

Front 33

Excessive release od ADH can lead to higher blood volume (___)

Back 33

hypervolemia

Front 34

SIADH: having excess water can also lead to a dilutional lowering of the blood's volume concentration (___).

Back 34

hypoatremia

Front 35

SIADH: sxs associated w/ mild vs. severe hypoatremia?

Back 35

mild: loss of appetite, headache, nausea, vomiting, muscle weakness, fatigue, cramps; severe: irritability, restlessness, confusions, seizures, LOC, coma, death

Front 36

Hypoatremia signs and sxs?

Back 36

Hint 36

SALTLOSS

Front 37

SSRIs: if discontinuing, the medication should NOT be stopped abruptly, as this will result in ____ ___

Back 37

discontinuation syndrome

Front 38

Withdrawals sxs from SSRIs

Back 38

headaches, nausea, vomiting, diarrhea, insomnia, tremors, paresthesia

Hint 38

HINT, it's not DVP

Front 39

antidepressants may increase risk SI and behavior in children and adolescnce

Back 39

SI

Front 40

SSRIs: Babies exposed to SSRI antidepressants late in ___ trimester of pregnancy may develop complications after birth. What sxs affected by it?

Back 40

third; respiratory distress, cyanosis (bluish skin tone from lack of oxygen), irritability, tremors, constant crying, feeding difficultty).

Front 41

SSRIs w/ pregnancy and breast feeding: may be caused by toxicity of the antidepressant or may be a manifestation of ___ sxs following materal exposure in utero

Back 41

discontinuation

Front 42

SSRIs pregnancy/breast feeding: SSRIs pass into ___ ___,

Back 42

breast milk, if patient cannot stop emdication, breast-feeding should not be started

Front 43

SSRIS: potential drug interactions: ___ and the antibiotic ___ are contraindicated

Back 43

MAOIs; linezolide

Front 44

The ____ actions of MAOIs and the antibiotic linezolide greatly increase the risk of what?

Back 44

serotonergic; serotonin syndrome

Front 45

How long does washout period last for potential drug interaction

Back 45

14

Front 46

What are other sertonergic drugs that may interaction w/ SSRIs?

Back 46

triptans used for migraines, tramadol, tricyclics

Hint 46

Mr. Triple T

Front 47

Citalopram: Brand name?

Back 47

Celexa

Front 48

Citalopram FDA approved for ___

Back 48

depression

Front 49

Off-label use Citalopram for what? 6 dxs

Back 49

OCD, panic dx, GAD, SAD, PTSD, premenstrual dysphoric dx

Front 50

potential drug interactions of citalopram? (3)

Back 50

oral antifungals; anti-HIV drugs, some antibiotics

Front 51

citalopram metabolized in the ___; dose may need to be decreased to prevent ___

Back 51

liver; toxicity

Front 52

citalopram: safer than ___ & ___. (TRUE FOR ALL SSRIs)

Back 52

tricyclics and MAOIs.

Front 53

fatalities are ___ w/ SSRIs, most cases of fatalaties result from combining w/ other drugs. Effects of overdose depends on ___. TRUE FOR ALL SSRIs

Back 53

rare; amount

Front 54

___ is purified form of citalopram (celexa)

Back 54

escitalopram

Front 55

Escitalopram brand name?

Back 55

Lexapro?

Front 56

Escitalopram FDA approved what what?

Back 56

Depression and Anxiety

Front 57

Offlabel use of escitalopram? 5 dx

Back 57

OCD, Panic dx, SAD, PTSD, premenstrual dysphoric dx

Front 58

escitalopram; approved for what special group / age?

Back 58

children, ages 12 - 17

Front 59

Fluoxetine: Brand names? (3)

Back 59

Prozac, Prozac Weekly, and Sarafem

Front 60

Fluoxetine FDA indicated for what? 6 dx

Back 60

depression, OCD, panic dx, eating dx (bulimia), premenstrual dysphoric dx, depressive episodes w/ bipolar I dx

Front 61

Off-label use for fluoxetine: 5 dx

Back 61

anxiety dxs, PTSD, fibromyalgia, diabetic neuropathy, postherpetic nerve pain

Front 62

Side effects of fluoxetine?

Back 62

decreases appetite, may led to weight loss

Front 63

Fluoxetine is one of the more ___ SSRIs

Back 63

activating

Front 64

4 medications that can interfere with breakdown of fluoxetine in the liver?

Back 64

Bupropion, duloxetine, quinidine, and cimetidine

Front 65

Fluoxetine can also inhibit the metabolism of what other 3 drugs?

Back 65

antipsychotics, tricyclic antidepressants, beta-blockers

Front 66

Fluoxetine has a ___duration of action; an overdose may involve ___ serious complications than with other SSRIs

Back 66

long; more

Front 67

Sxs of fluoxetine overdose?

Back 67

somnolence, confusion, nausea, vomiting, rapid heart rate, and seizures. In severe cases, serotonin syndrome, mania, arrhythmia, low blood pressure, elevated temperature, and coma

Front 68

FDA approval for Fluvoxemine?

Back 68

OCD

Front 69

Off-label use of Fluvoxemine?

Back 69

depressive dx, panic dx, anxiety dx, PTSD, and eating disorders (bulimia)

Front 70

Brand name for Fluvoxemine?

Back 70

Luvox

Front 71

Fluvoxemine can inhibit breakdowns of what 7 other medications?

Back 71

tricyclic antidepressants, clozapine, theophylline, propranolol, alprazolam, diazepam, and warfarin

Front 72

Paroxetine brand names (4)

Back 72

Paxil, Paxil CR, Brisdelle, Pexeva

Front 73

What is Paroxetine FDA approved for (6)?

Back 73

MDD, OCD, panic dx, PTSD, premestrual dysphoric dx, and SAD

Front 74

Off-label use for Paroxetine?

Back 74

OCD and Anxiety dx in peds; aggression after TBI

Front 75

Paroxetine is one of the more ___ SSRIs.

Back 75

activating

Front 76

Use of paroxetine in first trimester of pregnancy associated with increased risk of what?

Back 76

Teratogenicity (congenital malformations)

Front 77

Paroxetine w/ other drug metabolisms? (4)

Back 77

tricyclic antidepressants, antiarrhytmic drugs, antipsychotics, beta-blockers

Front 78

Sertraline brand name?

Back 78

Zoloft

Front 79

Sertraline FDA approved for what 6 things?

Back 79

Depression, OCD, SAD, panic dx, PTSD, premenstrual dysphoric dx

Front 80

sertraline is approved for ___ in children 6 years or older

Back 80

OCD

Front 81

Off-label use of sertraline? (4)

Back 81

GAD, aggression in TBI, smoking cessation, children w/ depression

Front 82

Sertraline: patients who are taking what may be predisposed to risk of bleeding?

Back 82

Warfarin (Coumadin)

Front 83

3 broad categories of Mixed Action Antidepressants?

Back 83

SNRIs (Serotonin, Norepinephrine, Reuptake Inhibitors), Atypical Agents, and Serotonin Modulators

Front 84

4 types of SNRIs?

Back 84

Desvenlafaxine, Duloxetine, Levomilnacipran, Venlafaxine

Front 85

2 types of atypical agents?

Back 85

bupropion; mirtazapine

Front 86

3 types of serotonin modulators?

Back 86

trazadone; vilazodone; vortioxetine

Front 87

SNRIs: work by preventuing reuptake of ____ & ___ back into the presynaptic nerve

Back 87

serotnin; norepinephrine

Front 88

SNRIs: this results in more serotonin and norepinephrine being available in the synapse and thus an ___ transmission

Back 88

amplified

Front 89

Babies exposed to SNRIs late in the ___ trimester may develop complications at birth

Back 89

third

Front 90

Drug interactions: ____ and the antibiotic ___ are CONTRAINDICATED

Back 90

MAIOs and linezolide