Term
| Explain the difference between the term "depression" and "CNS depressant." |
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Definition
"CNS depressant"- means the drug causes confusion, sedation, drowsiness, slowed thought processes.
It does not mean that the drug causes clinical depression |
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Term
| Describe the general onset of action for the anti-depressants in treating depression and anxiety. |
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Definition
Onset of action is slow (3 to 4 weeks for full effects). Indicates some type of re-regulation within the CNS in response to the antidepressant that may be partially responsible for efficacy
(Slow onset can led to less particpation from an individual as well could be the reason why we don't know the cause of depression)
Differs from one person to another and type of antidepressant being used |
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Term
| List the antidepressants that are the drugs of choice to treat depression/anxiety and discuss why. |
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Definition
| First-line: SSRIs, SNRIs, buproprion, or mirtazapine |
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Term
| List the common therapeutic uses of the antidepressants (e.g. depression, anxiety disorders, and neuropathic pain). |
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Definition
-Generalized anxiety disorder
-phobic disorders
-obsessive-compessive disorder (OCD)
-bulima
-Tourette's syndrome
-bipolar disorder
-ADHD
-Neuropatic pain: diabetic peripheral neuropathy pain, post-herpetic neuralgia (shingles pain), and migraine prophylaxis |
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Term
SSRIs
-Mech of Action
-Adverse Effects
-Therapeutic Uses |
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Definition
SSRIs
Mech. of action:
-Inhibit serotonin reuptake into nerve terminals
-Selective: have little effect on norepi or dopamine
-Selective: have low affinity for histaminic, cholinergic, or α-receptors (will have fewer side effects)
Adverse effects:
-Activation: insomnia, agitation, anxiety, nervousness (could be early signs of serotonin syndrome)
-Sexual Dysfunction
-Rarely extrapyramidial side effects (EPSE)
-Serotonin Syndrome-call doctor
-Withdrawl sympoms-depression, rebound depression
-Suicidal thoughts- black box warning
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Term
| List the antidepressants that cause sedation. |
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Definition
-TCAs
-trazodone (induces sleep)
-mirtazapine (induces weight gain, and sleep) |
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Term
| List the antidepressants that can cause CV ADRs. |
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Definition
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Term
| List the antidepressants with the highest rate of anticholinergic side effects. |
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Definition
TCAs
-amitriptyline (higher incidence of ADRs)
First-line TCAs (fewer ADRs)
-desipramine
-nortriptyline |
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Term
Wellbutrin
-Therapeutic Uses
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Definition
FDA approved
Drug of choice in the mgmt. of depression
Same drug as Zyban (nicotene drug for smoking cessation)
Treats depression- the way the drug is marketed
Reported smoking cravings went away
-Does not cause problems w/sedation or sexual dysfunction
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Term
| Serotonin syndrome (early warning signs) |
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Definition
Call ER if you see SE:
-Hypotension or hypertension
-Agitation
-Muscle tightness and twitching
-Hyperthermia, shivering
-Tachycardia and other arrhythmias
-Seizures
-Coma and death |
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Term
benzodiazepines
-Mech of Action
-Therapeutic uses
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Definition
Mech of Action:
Enhances actions and binding of gamma-aminobutyric acid (GABBA)
GABBA levels increase=neuronal activity decreases (brain slows down)
Therapeutic Uses:
-Anxiolytic-Reduces anxiety
-Insomnia, sedative/hypnotic- (sleeping pill)
-Status epilepticus- reduces seizures
-Alcohol withdrawl-alcohol CNS depressant, GABBA agonist (Increase GABBA activity=decrease neural activity)
-Muscle spasm-relax skeletal muscle spasticity by acting on spinal cord |
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Term
| Discuss the association between benzodiazepines and falls in older adults. |
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Definition
Will see more falls in the patients that are on the longer acting agents than the shorter acting agents
Diazepam used commonly- long acting, so may see several falls
LOTTA-short acting
All others-long acting |
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Term
SNRIs
-Mech of Action
-Adverse Effects
-Therapeutic Uses |
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Definition
Mech of Action:
Inhibit reuptake of serotonin and norepi
Adverse Effects:
-All same SE for SSRIs
-Insomnia, agitation, anxiety, headache
-Dry mouth, constipation, nausea, loss of apetitite, urniary retention (due to increase in norepi levels)
-Excessive sweating, mild CV effects, HTN (due to increase in norepi levels)
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Term
TCAs
-Mech of Action
-Adverse effects
-Therapeutic Uses |
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Definition
Mech of Action:
-Inihibit norepi, dopamine, and serotonin reuptake
-Non-selective-cause ADRs thoughout the body
lack of selectivity=increased ADRs
Narrow therapeutic window
Adverse Effects:
-Have SE of SSRIs and SNRIs, and anticholinergic
-Weight gain, seizures
-Anticholinergic SE
-CV SE -increase norepi levels
-Antihistamine SE-bind and block
-α1-blockade-orthostatic hypotension
-Sexual dysfunction, serotonin syndrome, withdrawl symptoms, sucidal thoughts
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Term
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Definition
-Prozac
-Paxil
-Zoloft
-Lovox
-Celexa
-Lexapro |
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Term
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Definition
-Cymbalta (FDA approved for fibromyalgia)
-Effexor
-Pristiq |
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Term
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Definition
1st line (fewer ADRs)
-desipramine
-nortriptyline
Other (higher incidence of ADRs)
-amitriptyline (Elavil) |
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Term
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Definition
-diabetic peripheral neuropathy pain
-post-herpetic neuralgia (shingles pain)
-migraine prophylaxis |
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Term
benzodiazepines
-Adverse Effects |
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Definition
Adverse Effects:
-CNS depression-drowsiness, confusion, hangover feeling
-Respiratory depression- increase GABBA too much for areas of brain stimulating respiration, will slow respiration rate
-Anterograde amnesia-forgetfulness
-Abuse-schedule IV controlled substance
-Physical dependence/Withdrawl symptoms- incl. anxiety, insomnia, panic, sweating, tremors, agitation, HTN, muscle twitching, and fatal seizures
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