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Systems Screening II > Affective disorders > Flashcards

Affective disorders Flashcards

1
Q

What is the big difference between TCAs and second generation antidepressants?

A

2nd gen are more specific for receptors

  • TCAs have a more global effect (bind to cholinergic receptors throughout body)
  • 2nd gen have more tolerable side effects and better long term management
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2
Q

What are the types of SSRIs?

A
  1. Fluoxetine (Prozac)
  2. Fluvoxamine (Luvox)
  3. Sertraline (Zoloft)
  4. Paroxetine (Paxil)
  5. Citalopram (Celexa) - purest SSRI
    - SSRIs current drug of choice
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3
Q

What are the types of 2nd sen antidepressants?

A

SSRI
SNRI- Venlafaxine (Effexor)
NERI -Reboxetine
DRI - Bupropion (Wellbutrin, Zyban)

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4
Q

What are ADRs characteristics of TCAs?

A
  1. Sedation
  2. Seizures -Due to increased neurotransmitter activity in brain
  3. Highest potential for fatal overdose - due to risk of suicide
  4. Central - delirium/confusion
  5. Peripheral Anticholinergic effects - Dry mouth; Constipation; Urinary retention; Tachycardia; Arrhythmias; Orthostatic hypotension
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5
Q

ADRs: Tend to produce CNS excitation (Restlessness, Irritability, Agitation, Sleep loss); Some central and peripheral anticholinergic effects; Because of systemic MAO inhibition, excess activity at peripheral adrenergic sympathetic may cause hypertensive crisis (tyramines released)

A

MAO-I

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6
Q

What can cause serotonin syndrome?

  • confusion, shivering, agitation, tremor, fever, ataxia, sweating, diarrhea
  • can lead to seizures, coma, arrhythmia, renal failure and death
A

MAO-I and SSRI drugs

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7
Q

What antidepressant may cause movement disorders?

  • Severe restlessness (akathisia)
  • Tardive dyskinesia
  • Pseudoparkinsonism
  • Dystonias
  • Dyskinesias
  • sexual dysfunction
A

Second gen
Advantages:
- less sedation, ACh actions, cardiovascular effects
- more GI problems and insomnia

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8
Q

What drug is sometimes used during rehab from stroke?

A

SSRIs

  • Unlikely to hinder treatment
  • Mitigate deleterious effects of depression
  • Increased energy and motivation
  • Improved concentration
  • May enhance reparative processes (recovery/ neuroplasticity)
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9
Q

How may SSRIs inhibit rehab?

A
  1. Insomnia
  2. Restlessness
  3. Agitation
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10
Q

Why might suicide risk increase transiently after any antidepressant is started?

A
  • Patient has more energy

- May act on underlying suicidal impulses

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11
Q

Why would you give patients with chronic pain antidepressants?

A
  • May treat depression which is underlying the chronic pain
  • Also work when depression is not apparent
  • May correct alterations in sleep patterns
  • May affect serotonin and other monoamines which are important in regulation of pain pathways
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12
Q

What is the main drug for bipolar disorder?

A

Lithium

- makes the system more stable and prevents overexcitation

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13
Q

What is the main problems with lithium?

A

Not metabolized, only excreted

- builds up in body to toxic levels

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14
Q

What are the antiseizure medications?

A
  1. Carbamazepine
  2. Valproic acid
  3. Gabapentin (Neurontin)
  4. Lamotrigine
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15
Q

What are some antipsychotic medications?

A
  1. Clozapine

2. Risperidone

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16
Q

What are the pharmacokinetics of 2nd gen antidepressants?

A

A: Usually administered orally
D: Target of the drugs is the brain
M: Liver; Metabolites of some drugs have antidepressant activity
E: biotransformation and renal excretion

17
Q

What are the types of drugs used to treat bipolar disorder other than lithium?

A
  1. Antiseizure medications
  2. Antipsychotic medications
    - Both act to prevent neuronal excitability
    - Both can be started with lithium, then tapered off
    - Valproic acid or carbamazepine may be used with or instead of lithium to prevent relapses
18
Q

What are some side effects of drugs that treat bipolar disorder that may interfere or limit PT intervention?

A
  1. Sedation
  2. Lethargy
  3. Muscle weakness
  4. Nausea and/or vomiting
19
Q

What drug class is orthostatic hypotension most common?

A

TCA drugs

  • can cause syncope
  • risk of injury during falls
20
Q

What drug class is a hypertensive crisis most common with? what should you do as a therapist to prevent this?

A
  • MAO-I drugs

- Monitor blood pressure regularly, particularly during activities that increase blood pressure

21
Q

A pt has a history of HTN and is taking beta-blockers. After an accident, pt becomes depressed and begins taking Trofanil. What should your concerns be with this patient?

A

Trofanil = TCA

  • Postural hypotension, Particularly during early stages of drug administration
  • Beta-blockers will limit the ability of the body to increase cardiac output - Start on tilt table, Parallel bars
  • Limit standing early in therapy
  • OBSERVE CAREFULLY
22
Q

In the original amine hypothesis of depression, it was thought there is a decrease in neural transmission of _______

A

monoaminergic neurotransmitters

- affects limbic system

23
Q

What is the modified amine hypotesis

A
  • depression caused by increased sensitivity of beta-adrenergic receptor
  • antidepressants increase monoaminergic transmission, but overall action is aimed at decreasing the sensitivity of postsynaptic beta-adrenorecptor (serotonin may have biggest role in this)
24
Q

MOA: Block reuptake of monoamines into presynaptic terminals; Released monoamines remain in the cleft longer and stimulate the receptors more; Extended activation of receptors leads to decrease in receptor sensitivity

A

TCA

  • for melancholy depression
  • side effects limit overall use (cholinergic receptor binding)
25
Q

What are the different TCA drugs?

A
  1. Imipramine (Tofranil, Tipramine)
  2. Desipramine (Norpramin, Pertrofane)
  3. Nortryptiline (Aventyl, Pamelor)
  4. Amitryptiline (Elavil, Endep, others)
  5. Trimipramine (Surmontil)
  6. Clomipramine (Anafranil)
    - end in “-amine” or “-tryptiline”
26
Q

First category of antidepressants; first used as a Tuberculosis drug

A

MAO-I

  • MAO-A: Important for actions as antidepressant
  • MAO-B: Dopamine – PD
  • non-selective

Systems Screening II (27 decks)

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