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