Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Exam #1 > Antidepressant Agents > Flashcards

Antidepressant Agents Flashcards

1
Q

What are the signs and symptoms of depression?

A
  • Low energy
  • Sleep disturbances
  • Altered appetite
  • Altered libido
  • Inability to perform activites of daily living
  • Overwhelming feelings of sadness, despair, hopelessness, and disorganization
  • Altered affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the
Biogenic Theory of Depression?

A
  • Depression results from a deficiency of norepinephrine (NE), dopamine, and serotonin (5HT)
  • Monamine oxidase may break them down to be recycled or restored in the neuron
  • Rapid fire of neurons may lead to their depletion
  • The # or sensitivity of receptors may increase, depleting neurotransmitter levels.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antidepressant Therapy
Mechanisms of Action

A
  • Inhibit the effects of MAO => increased NE or 5HT in the synaptic cleft
  • BLOCK reuptake by the releasing nerve => increased neurotransmitters in the synaptic cleft
  • Regulate receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in the synaptic cleft
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of Antidepressants

A
  • Triclycic antidepressants (TCAs)
  • MAO inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin neorepinephrine inhibitors (SNRIs)
  • Others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Considerations for use of antidepressants
in Children

A
  • Rule out medical reasons first
  • First choice: SSRIs and SNRIs
  • Response is unpredictable
  • Possible long term effects
  • Studies have not proven efficacy
  • Many black box warnings r/t increased sucidal ideation/behavior
  • Avoid MAOIs d/t drug-food interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Considerations for use of antidepressants
in Adults

A
  • Rule out medical reasons first
  • Effects may not be seen for 4 weeks or more
  • Caution during pregnancy/lactation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Considerations for use of antidepressants
in Older Adults

A
  • Rule out medical reasons first
  • More susceptible to adv. effects (especially CNS effects)
  • Renal and hepatic impairment: Start LOW and Go SLOW
  • TCAs can worsen Benign Prostatic Hyperplasia (BPH) because they decrease bladder contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TCAs
Mechanism of Action

A

Reduces the reuptake of 5HT AND NE into the nerves => increase in the synaptic cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TCAs
Indications

A
  • Depression
  • Sleep disorders
  • Enuresis (nightime bedwetting)
  • Anxiety
  • Chronic Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TCAs
Drug Names

A

“-triptyline”
* Amitriptyline
* Nortriptyline

“-pramine”
* Clomipramine
* Despramine
* Imipramine
* Trimipramine

Doxepin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TCAs
Contraindications

A

Absolute:
* Allergy

Relative:
* Recent MI (can cause it to worsen or reoccur)

Cautions:
* CV disease
* Anticholinergic conditions (BPH, glaucoma, urinary retention)
* Manic-depression/ bipolar (can shift into manic phase)
* Seizure disorders (can lower the threshold for seizures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TCAs
Adverse Effects

A
  • CNS: sedation, sleep disturbances, fatigue, hallucinations, ataxia (lack of voluntary muscle control)
  • GI: Dry mouth, constipation, n&v, anorexia, decreased salivation
  • CV: tachycardia, hypertension, arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TCAs
Drug Interactions

A
  • MAOIs
  • Cimetidine (Histamine-2 antagonist)
  • Fluoxetine (SSRI)

Risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

TCAs
Assessment

A

History:
* Cardiac dysfunction/disease

Labs:
* ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TCAs
Implementation/Patient Teaching

A
  • Limit drug access if pt is suicidal (dec. risk of overdose)
  • Parenteral form only if Oral is not feasible
  • Reduce dose if minor adv. effects occur
  • Discontinue slowly if major adv. effects occur
  • Take at bedtime if drowsiness occurs
  • Void before meds if urinary retention occurs
  • sugarless lozenges for dry mouth
  • small meals/take with meal for GI upset
  • Takes 4 weeks to take effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MAOIs
Mechanism of Action

A

Irreversibly inhibits monoamine oxidase
Allows NE, 5HT, and dopamine to accumulate in the synaptic cleft

NOT 1st line/1st choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MAOIs
Indications

A

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MAOIs
Drug Names

A

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline (transdermal)

19
Q

MAOIs
Contraindications

A

Absolute:
* Allergy
* Pheochromocytoma (adrenal gland tumor)

Relative: (made worse)
* CV disease
* Headaches
* Renal or Hepatic impairment

Cautions:
* Bipolar disease (can lead to mania)
* Seizure disorder (lowers the threshold for seizures)
* Hyperthyroidism (made worse)

20
Q

MAOIs
Adverse Effects

A

CNS: dizziness, diaphoresis, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation
CV: Hypertension, tachycardia, arrhythmia
Black Box warning: suicidal ideation and behavior (especially in children and young adults)

21
Q

MAOIs
Drug Interactions

A

Drug:
* Other antidepressants: Hypertensive crisis, coma, convulsions, serotonin syndrome
* Sympathomimetics: CV effects increase
* Antidiabetic agents: Increased risk of HYPOglycemia

Food:
* Tyramine: Increase in BP, possible hypertensive crisis
* Foods high in tyramine: aged cheeses and meats, red wine, soy sauce

22
Q

MAOIs
Assessment

A

History:
* Cardiac dysfunction, seizure disorders, pheochromocytoma, headaches, hyperthryoidism

Labs:
* ECG

23
Q

MAOIs
Implementation/Patient Teaching

A
  • Limit drug access (potential overdose)
  • Monitor BP and Ortho BP
  • Discontinue drug at any complaint of severe headache (potential hypertensive crisis)
  • Have phentolamine or adrenergic blocker on standby (antidote)
  • Void before admin if at risk of urinary retention
  • take with food for GI upset
  • Patient Teaching - what to report to provider, follow up appts., emergency services for SI
24
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Mechanism of Action

A

Specifically blocks the reuptake of 5HT, with little to no known effect on NE

25
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Adverse Effects

A
  • Not many because there is no effect on norepinephrine

Related to increase in 5HT:
* CNS: Headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation
* GU: Painful menstruation, sexual dysfunction, impotence, urgency
* Serotonin Syndrome

26
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Indications

A
  • Depression
  • OCD
  • Panic attacks
  • bulimia
  • PMDD
  • post-traumatic stress disorders
  • social phobias
  • social anxiety disorders
27
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Drug names

A

“-italopram”
* Citalopram
* Escitalopram

“-oxetine”
* Fluoxetine
* Paroxetine

Sertraline

28
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Drug Interactions

A

Drug: (Increases risk of serotonin syndrome)
* MAOIs
* TCAs
* SNRIs
* St. John’s Wort

29
Q

Selective Serotonin Reuptake Inhibitors

SSRIs
Contraindications

A

Absolute:
* Allergy

Cautions:
* impaired renal or hepatic function
* Pregnancy/lactation —> congenital abnormalities in animal studies

30
Q

What is Serotonin Syndrome?

A

agitation, confusion, diaphoresis, increased BP, increased HR, diarrhea, headache, high fever, muscle rigidity, death

31
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Mechanism of Action

A

Decreases neuronal reuptake of both serotonin and norepinephrine and more weakly inhibit dopamine reuptake

32
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Indications

A
  • Depression
  • Neuropathic pain
  • Fibromyalgia
  • Anxiety (generalized and social)
33
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Drug Names

A
  • Desvenlafaxine
  • Duloxetine
  • Venlafaxine
34
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Contraindications

A

Absolute:
* Allergy
* MAOIs use (increases risk of hypertenisve crisis and serotonin syndrome)

Cautions:
* Severe depression, suicidality (black box warning)
* Bipolar disorder (manic phase)
* Seizure disorder (lowers threshold)

35
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Adverse effects

A
  • Hyperhidrosis
  • Erectile Dysfunction
  • Cardiac: tachycardia, palpitations, hypertension
  • abnormal bleeding
  • anticholinergic: glaucoma, urinary retention, BHP
  • Serotonin Syndrome
36
Q

Serotonin Norepinephrine Reuptake Inhibitors

SNRIs
Drug Interactions

A
  • MAOIs
  • SSRIs, TCAs, serotonergic drugs (including St. John’s Wort)
  • Anything that increases serotonin
37
Q

SSRIs and SNRIs
Interventions/Patient Teaching

A
  • Establish suicide precautions for severely depressed patients
  • Limit the access to drugs (overdose risk)
  • Administer the drug once a day, in the morning to achieve optimal Therapeutic effect (unless pt does better with the sedative effect at night)
  • If severe GI effects, dose can be divided
  • Can take 4 weeks to work
  • Void before taking
  • Risk of HT crisis, serotonin syndrome
38
Q

Bupropion

A

Other antidepressant
Low doses: smoking cessation
Available in ER and SR formulas

39
Q

Mirtazapine

A

Other Antidepressant
Atypical antidepressant
MANY anticholinergic effects

40
Q

Trazadone

A

Other antidepressant
MANY CNS effects
Black Box warning for suicidality, hypotension, and priapism

41
Q

Esketamine

A

Other Antidepressant
Nasal spray is approved for depression
CNS effects and increased BP

42
Q

Antidepressants
General Nursing Assessment

A

History:
* Allergy, severe depression and suicidality, bipolar disorder, contraindications and cautions for specific drug class, impaired liver or kidney function, pregnancy/lactation

Physical:
* Vital signs and weight
* CNS, including vision
* Abdomen (GI issues)

Labs:
* Renal and hepatic
* EKG (for MAOIs and TCAs)

43
Q

Antidepressants
General Nursing Conclusions

A
  • Impaired comfort (r/t adverse effects)
  • Altered thought process and sensory perception (r/t CNS effects)
  • Malnutrition risk (r/t GI effects)
  • Knowledge deficit

Pharmacology Exam #1 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions