Anti-Depressant Medication: Exam 3

Question 1

_________________ is the most common psychiatric illness. About 17% of americans will experience it at some point in their lives.

Answer 1

Depression

Question 2

What is the oldest type of antidepressants?

Answer 2

Monoamine Oxidase Inhibitors (MAOIs)

Question 3

What are the 4 MAOIs?

Answer 3

1. Isocarboxazid
2. Phenelzine
3. Selegiline (Transdermal)
4. Tranyclypromise

Question 4

What are the common uses for MAOIs?

Answer 4

MAOIs are effective in treating major depression. They are not a first line medication.

Question 5

What is the MOA for MAOIs?

Answer 5

MAOIs work by blocking monoamine oxidase, which is the enzyme that breaks down SEROTONIN, NOR-EPINEPHRINE, and DOPAMINE.

Question 6

So MAOIs __________ serotonin, nor-epi, and dopamine levels in the synapses. That can elevate a clients mood and energize them.

Answer 6

Increase

Question 7

Why are MAOIs not commonly prescribed?

Answer 7

Because when taking them you MUST avoid foods containing tyramine.

Question 8

Clients taking a MAOI must avoid foods containing __________. A good rule of thumb is that these foods tend to be _________ and _________.

Answer 8

Thyramine
Old
Stinky

Question 9

What are examples of thyramine rich foods?

Answer 9

Most cheeses (especially the old, stinky kinds)
Aged, processed meats (bologna, salami, and pepperoni, liver)
So are smoked and picked fish
Overly ripened fruit (figs, avocados, old bananas)
Most beers and wines (aged/fermented)
Sauerkraut (fermented cabbages)
Soy sauce (fermented soybeans)

Question 10

Remember it the _______ process that produces high levels of thyramine in foods.

Answer 10

aging

Question 11

What medications should a client avoid when taking an MAOI?

Answer 11

A person taking a MAOI must avoid other medications that increase the neurotransmitters, serotonin, nor-epi, and dopamine.

Question 12

The medications that should be avoided when taking MAOIs are…

Answer 12

other ANTI-DEPRESSANTS

OTC COLD medications. Particularly, clients need to watch out for sympathomimetic medications such as pseudophedrine or phenylephrine, common nasal decongestants.

Meperidine (a strong pain medication)

Triptans (a class of migraine medications)

Question 13

Excessive amounts of tyramine will cause a clients BP to skyrocket. The same thing would happen if the clients ________________ levels became too high. So remember, to monitor these clients BP. Remember, severe hypertension can manifest as a _____________.

Answer 13

Nor-epinephrine
Headache

Question 14

Excessive amounts of serotonin can cause serotonin syndrome. Serotonin syndrome is characterized by an altered ________ status, high fever, sweating, and clonus. Clonus is an involuntary, ______________ muscle contraction.

Answer 14

Mental
Rhythmic

Question 15

What do many patients on MAOIs experience?

Answer 15

Orthostatic Hypotension

Question 16

What is the name for TCAs?

Answer 16

Tricyclic Anti-depressants

Question 17

What medications fall under TCAs?

Answer 17

1. Amitriptyline
2. Nortriptyline

Question 18

What are the common uses for TCAs?

Answer 18

These drugs help treat major depression. Other uses include neuropathic pain (nerve damage) and anxiety disorders.

Question 19

TCAs work by blocking serotonin and nor-epi ___________ pumps. This, of course ___________ serotonin and nor-epi levels in the synapses.

Answer 19

Re-uptake
Increases

Question 20

TCAs are ____ ____________; they also block muscarinic cholinergic receptors, causing anti-cholinergic effects.

Answer 20

NOT selective

Question 21

______________ _____________ is a common side effect of TCAs.

Answer 21

Orthostatic Hypotension

Question 22

The most serious problem with TCAs is that they can cause fatal heart dysrhythmias when ___________. if the patient is having suicidal thoughts, TCAs probably aren’t the best choice. We also need to make sure TCAs stay out of the hands of kids that like to crawl around and put everything in their mouths. TCAs can also cause _______________ within the GI system.

Answer 22

Overdosed
Constipation

Question 23

What is the most commonly used anti-depressant medication?

Answer 23

Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 24

What are the medications that fall under SSRIs?

Answer 24

1. Escitalopram
2. Fluoxetine
3. Paroxetine
4. Sertraline

Question 25

SSRIs are the first line drug for ____________. They also are very effective at treating ___________.

Answer 25

Depression
Anxiety

Question 26

These drugs, as their name states, are very selective. SSRIs ONLY block serotonin reuptake pumps. Thus, they only increases levels of _____________ in the brain.

Answer 26

Serotonin

Question 27

SSRIs side effects:

Answer 27

Stomach troubles
Slowed metabolism: weight gain
Sexual dysfunction
Suicidal ideation (most common in children under 18)
Sodium levels decreased: a rare adverse effect.

Question 28

Most SSRIs are sedating and probably best taken in the ______________. Fluoxetine, however, can be very “activating” for clients. Thus, we typically recommend clients take fluoxetine in the _____________.

Answer 28

Evening
Morning

Question 29

What does SNRIs mean?

Answer 29

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Question 30

What medications fall under SNRIs?

Answer 30

1. Desvenlafaxine
2. Duloxetine
3. Venlafaxine

Question 31

All SNRIs are prescribed for major _______________. They are also prescribed for ____________ pain and anxiety disorders.

Answer 31

Depression
Neuropathic

Question 32

Venlafaxine and Duloxetine block the reuptake of ___________ and __________. SNRIs are very similar to TCAs. The primary difference is that SNRIs are “____________” – they have much milder anticholinergic and antihistamine effects. (Increases BP)

Answer 32

Serotonin
Nor-Epinephrine
Cleaner

Question 33

SNRIs side effects are similar to SSRIs except they also can cause __________________ – especially if the dose is high.

Answer 33

Hypertension

Question 34

What are some miscellaneous anti-depressants?

Answer 34

1. Bupropion
2. Trazodone

Question 35

Bupropion is prescribed for ______________ and _____________ cessation. It is also used for adults with ___________. Trazodone is approved for depression, but is primarily used for ____________.

Answer 35

Depression
Smoking
ADHD
Insomnia

Question 36

Bupropion increases both _____________ and ______________.

Answer 36

Nor-epi
Dopamine

Question 37

Bupropion inhibits the reuptake of ____________ and ________________. Unlike other anti-depressants, it has no significant effects on ________________. Trazodone is a weak serotonin reuptake inhibitor with strong sedative and ________________ effects.

Answer 37

Nor-epi
Dopamine
Serotonin
Anti-cholinergic

Question 38

Bupropion can actually _________ libido (sexual drive). In addition, Bupropion isn’t likely to cause weight gain. Many clients taking Bupropion typically experience ________ ________.

Answer 38

Increases
Weight Loss

Question 39

The primary adverse effects of Bupropion are anxiety and insomnia. Bupropion is also contraindicated if the client is at risk for _____________.

Answer 39

Seizures

Question 40

Trazodone has a strong sedative and anti-cholinergic effects. In very rare cases it can also cause _____________. (A prolonged, painful erection of the penis)

Answer 40

Priapism

Question 41

It takes up to _______ ________ for anti-depressants to start working. Tell you clients this so they won’t give up taking them too soon!

Answer 41

four weeks

Question 42

Most anti-depressants have a ___________ box warning regarding an increased risk of suicidal thoughts. This risk is greatest when initiating drug therapy and it’s more common with ____________ clients.

Answer 42

Black
Pediatric