Term
| occurs in response to grief, illness, loss |
|
Definition
reactive (secondary) depression
60% |
|
|
Term
| treatment for reactive (secondary) depression |
|
Definition
| psychotherapy or acute therapeutics |
|
|
Term
| Genetic - inability to experience ordinary pleasure, cope with daily life |
|
Definition
major (endogenous) depression
25% |
|
|
Term
| treatment for major (endogenous) depression |
|
Definition
|
|
Term
| characterized by cyclic periods of mania |
|
Definition
bipolar disorders (manic-depressive)
10-15% |
|
|
Term
| bipolar disorders are treated with |
|
Definition
| lithium in combo w/ antidepressants and/or antipsychotic agents |
|
|
Term
| Feelings of sadness, hopelessness, despair, and inability to experience pleasure in daily activities |
|
Definition
|
|
Term
| depression is due to a deficiency of NE and serotonin in key sites in the brain (monamines) |
|
Definition
| biogenic amine theory for depression |
|
|
Term
| ethusiasm, rapid though and speech, extreme self-confidence and impaired judgement |
|
Definition
|
|
Term
| mania is caused by an overproduction of NE, dopamine, and serotonin |
|
Definition
| biogenic amine theory for mania |
|
|
Term
| Most common psychiatric disorder in adults |
|
Definition
|
|
Term
| 13-20% of the population have symptoms |
|
Definition
major depression
males - 5-12% lifetime prevalence
females - 9-26% lifetime prevalence |
|
|
Term
| onset for major depression is most common in.. |
|
Definition
| late 20s but this varies widely |
|
|
Term
| comparable incidence between older adults and the general population |
|
Definition
|
|
Term
|
Definition
lost interest (anhedonia)
sleep disturbance
appetite changes
depressed mood (dysthymia)
concentration problems
activity diminished
guilt
energy diminished
suicidal ideation |
|
|
Term
| Manic symptoms are thought to be due to.. |
|
Definition
| neurotransmitter overactivity |
|
|
Term
|
Definition
inflated self esteem/grandiosity
irritability
pressured speech
distractibility
impaired judgement
psychomotor agitation |
|
|
Term
| mild to moderate depression psychotherapy is comparable to... |
|
Definition
| pharmacologic intervention |
|
|
Term
| Recommended for treatment resistant depression, vegetative depression, and psychotic depression |
|
Definition
| electroconvulsive therapy |
|
|
Term
| unlike drugs this shows a therapeutic response within 1-2 weeks |
|
Definition
| electroconvulsive therapy |
|
|
Term
| classes of drugs for treatment of depression |
|
Definition
TCA's
SSRI
SNRI
Atypical antidepressants
MAOI
antimanics |
|
|
Term
| all potentiate, either directly or indirectly, NE, 5HT |
|
Definition
| classes of drugs for treatment of depression |
|
|
Term
| Drugs used to treat depression are all... |
|
Definition
| equally effective with about a 50-70% response rate |
|
|
Term
|
Definition
ADDIN
amitriptyline
desipramine
doxepin
imipramine
nortriptyline |
|
|
Term
|
Definition
|
|
Term
| Could be considered third generation TCA's |
|
Definition
|
|
Term
block the reuptake of NE and serotonin in the presynpatic neurons
block alpha adrenergic, histamine & muscarinic receptors |
|
Definition
|
|
Term
|
Definition
elevate mood
improve mental alertness
increase physical activity
reduce morbid preoccupation |
|
|
Term
| therapeutic uses for TCA's |
|
Definition
moderate to severe depression
some panic disorders |
|
|
Term
| What is used to treat bed wetting (enuresis) |
|
Definition
not until the child is older than 6
imipramine (its a TCA) |
|
|
Term
|
Definition
|
|
Term
| Pharmacokinetics of TCA's |
|
Definition
oral but inconsistent bioavailability- dosage adjustment required
lipophilic -MEOS & glucuronidated in liver |
|
|
Term
| Weight gain, antihistaminic, anticholinergic, block alpha receptors, cardiovascular |
|
Definition
|
|
Term
| Antihistaminic effect of TCAs |
|
Definition
|
|
Term
| dry mouth (xerostomia), urinary retention, constipation, blurred vision, glaucoma |
|
Definition
| anticholinergic side effects of TCA |
|
|
Term
| orthostatic hypotension, reflex tachycardia |
|
Definition
block alpha receptors
side effects of TCA |
|
|
Term
|
Definition
| cardiovascular effects of TCA's |
|
|
Term
| Cautions/warnings of TCA's |
|
Definition
narrow therapeutic index
manic-depressive patients
suicidal patients |
|
|
Term
drug interactions of TCA's
|
|
Definition
| ethanol and other CNS depressants - toxic depression |
|
|
Term
|
Definition
celexa
lexapro
prozac, sarafem
luvox
paxil
zoloft |
|
|
Term
| selective inhibition of serotonin reuptake |
|
Definition
|
|
Term
fewer anticholinergic (muscarinic) effects
less cardiotoxicty
less weight gain
no orthostatic hypotension |
|
Definition
|
|
Term
|
Definition
major depression
OCD
bulimia/anorexia nervosa
panic disorder
premenstrual dysphoric disorder (PMS)
postmenopausal syndrome
generalized anxiety??? |
|
|
Term
| which SSRI is used to treat OCD |
|
Definition
|
|
Term
| what is the point of slide 18?? |
|
Definition
|
|
Term
| pharmacokinetics of SSRI's |
|
Definition
takes 2-4 weeks to see effect
slowly cleared from body
steady state achieved after several weeks |
|
|
Term
|
Definition
|
|
Term
| fluoxetine has an extra half life |
|
Definition
50 hours
because of norfluoxetine active metabolite (t1/2 =10 days) |
|
|
Term
| drug interactions of SSRI's |
|
Definition
potent inhibitors of P 450 (CYP2D6)
7% caucasian population lack this isoenzyme |
|
|
Term
nausea
sleep disturbances
sexual dysfunction
GI, anorexia
weight loss
children/teenagers --> suicidal ideation
hallucinations |
|
Definition
| adverse reactions of SSRI's |
|
|
Term
| Sexual dysfunction associated with SSRI's |
|
Definition
loss of libido
delayed ejaculation
anorgasmia
incidence is 30-50% more common males |
|
|
Term
| If a depressed person cannot sleep you should give them.. |
|
Definition
|
|
Term
| if a depressed person has insomnia you should give them |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Safer than TCA's in overdoses
unique mechanism of action, used when SSRI's have failed
not as activating as fluoxetine |
|
Definition
|
|
Term
Depression associated w/ neuropathic pain
(backache & muscle ache) |
|
Definition
|
|
Term
Unlike TCA's
no adrenergic, muscarinic, histaminergic receptor blockade
fewer adverse effects |
|
Definition
|
|
Term
| Nausea, headache, dry mouth, somnolence, sexual dysfunction |
|
Definition
|
|
Term
|
Definition
buproprion (wellbutrin)
mirtazapine (Remeron)
trazodone
nefazodone |
|
|
Term
Weak NE/DA reuptake inhibitor
no anticholinergic/antihistamine/alpha blockade |
|
Definition
|
|
Term
| ______ has a low incidence of sexual dysfunction therfore alternative for SSRI's |
|
Definition
|
|
Term
| has been used in "SR" form for smoking cessation |
|
Definition
|
|
Term
| xerostomia, sweating, nervousness, tremor, lowers seizure threshold |
|
Definition
|
|
Term
alpha 2 antagonist
serotonin receptor antagonist
increases 5HT and NE neurotransmission |
|
Definition
|
|
Term
|
Definition
|
|
Term
increased appetite, weight gain
no anticholinergic
little sexual dysfunction
minimal drug-drug interactions |
|
Definition
|
|
Term
5HT2A antagonists
weak 5HT reuptake inhibitors |
|
Definition
|
|
Term
| desensitizes 5HT1A presynaptic receptors = |
|
Definition
|
|
Term
| low incidence of sexual dysfunction but with trazadone may see.. |
|
Definition
|
|
Term
| fewer anticholinergic side effects than TCA's |
|
Definition
|
|
Term
hepatotoxicity
pulled in Canada and USA
only generics remain available |
|
Definition
|
|
Term
|
Definition
|
|
Term
| only inhibits MAO- B so only for dopamine |
|
Definition
|
|
Term
inhibit monoamine oxidase
increase stores of intraneuronal NE, dopamine, & serotonin |
|
Definition
|
|
Term
| food-drug interactions are seen with? |
|
Definition
MAOI
inhibition of MAO in the GI tract = increased tyramine |
|
|
Term
| Tyramine will release stored EPI/NE causing... |
|
Definition
hypertension
tachycardia
nausea
arrhythmias
stroke
hypertensive crisis induced by MAOI's med emergency |
|
|
Term
only used today in patients refractory or hypersensitive to other antidepressants
strong anxiety, phobic states |
|
Definition
|
|
Term
labile mood
rejection sensitivity
appetite disorders |
|
Definition
|
|
Term
| drowsiness, orthostatic hypotension, blurred vision, xerostomia, constipation/urinary retention |
|
Definition
|
|
Term
| adverse effects of tyramine |
|
Definition
| headache, hypertension, stroke |
|
|
Term
| dietary restriction of MAOI |
|
Definition
avoid use w/ aged cheeses, wine, beer, organ meats, sausage, seafood, avocados
this limits therapy |
|
|
Term
| the full effects of these drugs is delayed several weeks |
|
Definition
|
|
Term
the effects are also continued several weeks after discontued
need to wait @ least 2 weeks after d/c to start new drug |
|
Definition
|
|
Term
Do not use with SSRI's (wait 6 weeks)
could cause serotonin syndrome |
|
Definition
|
|
Term
| potentially fatal interaction cause by the combination of 2 or more drugs that enhance serotonin transmission |
|
Definition
|
|
Term
anxiety, shivering, tremor, diaphoresis
death has been attributed to malignant hyperthermia |
|
Definition
| serotonin syndrome symptoms |
|
|
Term
| If someone has a mild case of serotonin syndrome then you should...... |
|
Definition
| discontinue serotonergic antagonists and symptoms should resolve in 1-2 days |
|
|
Term
| If someone is having a severe serotonin syndrome reaction then.... |
|
Definition
| serotonergic antagonists such as methysergide and propranolol have been used |
|
|
Term
| most cases of serotonin syndrome are due to.. |
|
Definition
|
|
Term
| other problem combinations that cause serotonin syndrome include |
|
Definition
| meperidine, TCA, dextromethorphan, lithium, triptans, and St. John's wort |
|
|
Term
|
Definition
|
|
Term
| drug selection in depression is based on |
|
Definition
patient history
safety in overdose
adverse effects
patients age
ease of admin
possible interactions |
|
|
Term
| drug specific adverse effects to consider when selecting a drug for depression |
|
Definition
TCA's are more sedating than SSRI
TCA's cause more anti-cholinergic side effects |
|
|
Term
| patient specific things to consider when considering drug selection in depression |
|
Definition
TCA's can cause weight gain so avoid in obese pt's
wellbutrin will lower seizure threshold so avoid in epilepsy
best not to use antidepressants during pregnancy |
|
|
Term
considered the most deadly psychiatric illness due to the suicide rate in patients
10-15% suicide rate if left untreated |
|
Definition
|
|
Term
| Both characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood |
|
Definition
| manic and hypomanic epidodes |
|
|
Term
| ethusiasm, rapid thought and speech, extreme self confidence |
|
Definition
| manic and hypomanic episodes |
|
|
Term
| the difference between manic and hypomanic is that manic episodes are... |
|
Definition
severe enough to impair functioning
(self-care, work, or social functioning) |
|
|
Term
used in the treatment of manic-depressive illnesses
standard of therapy for decades (60-80% effective) |
|
Definition
|
|
Term
preventitive for manic/depressive symptoms
not used for acute mania as delayed drug effect |
|
Definition
|
|
Term
MOA : unknown, may work by altering the cellular concentration of inositol triphosphate
(2nd messenger) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| may be necessary to use benzodiazepines (clonazepam) or antipsychotics until onset |
|
Definition
|
|
Term
| Lithium salts are a toxic drug with.. |
|
Definition
a narrow therapeutic index
requires monitoring |
|
|
Term
| This drug is a potential teratogen |
|
Definition
|
|
Term
| Adverse effects - tremors, weight gain, confusion, convulsions |
|
Definition
|
|
Term
| Many _______ will increase lithium due to an enhanced reabsorption of sodium and lithium secondary to inhibition of prostaglandin therapy |
|
Definition
|
|
Term
| New treatment for bipolar disorder |
|
Definition
pyrexia + prozac
atypical antipsychotic + SSRI antidepressant
combo of pyrexia + prozac = symbyax
Anticonvulsants : mood stabilizers |
|
|
Term
|
Definition
carbamazepine (tegretol)
valproic acid (Depakote)
Lamictal |
|
|
Term
|
Definition
|
|
