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Kol- Pharm 323 Spring > Antidepressant/ Bipolar > Flashcards

Antidepressant/ Bipolar Flashcards

1
Q

5 classes of antidepressant!

A
  1. Selective serotonin reuptake inhibitors (SSRIs)
  2. Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
  3. Tricyclic antidepressants (TCA)
  4. Monoamine oxidase inhibitors (MAOIs)
  5. Atypical antidepressants
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2
Q

Antidepressant (general) nursing considerations

A
  • Slow onset (1-3 weeks for sxs change/12 weeks maximal effect)
  • Wean off
  • *No PRN use
  • Start slow and titrate up
  • continue drug even when sxs free and 4-9 months after sxs approve
  • Better response: drugs+ psychotherapy
  • Relapses
  • Suicide risk can increase initially: more common in <25 yrs
  • —>energy levels increase and have energy to carry out suicide plan without transition in brain to get rid of suicidal thoughts
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3
Q

3 monoamine NT that are linked to depression - why do I care?

A
  1. Norepinephrine
  2. Dopamine
  3. Serotonin

*all antidepressants increase 1 or more of these monoamine NT

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4
Q

3 theories on how antidepressant treatment works (i doubt she will ask about this)

A
  1. If increase amt of NT –> post synaptic receptors decrease/desensitize = downregulation
    - -> downregulation is what actually has an effect on the brain and doesn’t have effect until 4-6 weeks
  2. brains adaptation to NT
  3. New synaptic formations have to form in order for mood/behavior to change
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5
Q

SSRI prototype

A

fluoxetine (Prozac)

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6
Q

which antidepressant has the best safety profile and it a first line choice?

A

fluoxetine (Prozac) (SSRI)

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7
Q

how does fluoxetine (Prozac) fxn?

A

Slow the reuptake of serotonin (5-HT) into presynaptic nerve terminals (accumulation of serotonin in synapse)

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8
Q

Side effects of fluoxetine (Prozac)

A

sexual dysfunction, nausea, headaches, nervousness, insomnia, anxiety, weight gain

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9
Q

onset of fluoxetine

A

May take up to 5 weeks to work

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10
Q

admin for fluoxetine (Prozac)- timing?

A

give in morning b/c of insomnia

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11
Q

can we use SSRI like fluoxetine in preg?

A

not in LATE preg

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12
Q

____ risk with SSRI (think about population)

A

Bleeding risk in elderly/someone w/ GI predisposition

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13
Q

Serotonin Syndrome (SES)- onset?

A

2-72 hours after treatment start

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14
Q

Serotonin Syndrome (SES) treatment?

A

stop the SSRI, break b/w drugs when transitioning to new med

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15
Q

sxs of Serotonin Syndrome (SES)

A

mental status changes, hypertension, tremors, fever and sweats, hyperpyrexia, or ataxia

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16
Q

Serotonin Withdrawal Syndrome sxs?

A

Dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria

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17
Q

Serotonin Withdrawal Syndrome duration?

A

Persists 1-3 weeks

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18
Q

Serotonin Withdrawal Syndrome prevention

A

slowly tapering drug

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19
Q

prototype for Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)

A

venlafaxine (Effexor)

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20
Q

how does venlafaxine (Effexor) fxn?

A

Block the uptake of both serotonin and norepinephrine

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21
Q

how are Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) similar to SSRI?

A

sexual dysfunction, sustained myandriasis, serotonin syndrome, neonates, withdrawal symptoms

22
Q

Side effects of venlafaxine (Effexor)

A

sexual dysfxn, Nausea, HA, anorexia, nervousness, sweating, somnolence and insomnia, HTN

23
Q

prototype for Tricyclic Antidepressants

A

imipramine (Tofranil)

24
Q

how does imipramine (Tofranil) fxn?

A

inhibit the reuptake of both NE and serotonin into presynaptic nerve terminals.
>To varying degrees-block AcH receptors and/or histamine

25
Q

Side effects of imipramine (Tofranil)

A

Sedation common initially–> after several weeks tolerance of the sedation develops

  • Anticholinergic effects are common, less so if drug is gradually increased over 2-3 weeks
  • Orthostatic hypotension : blocks alpha 1 adrenergic receptors on blood vessels
26
Q

imipramine (Tofranil) admin?

A

give @ bed time (sedation)

27
Q

imipramine (Tofranil) serious risk of

A

OVERDOSE

lethal (❤️), 8X regular dose

  • do not give to suicidal patients.
  • acute depression –> give only 1 week Rx @ a time
28
Q

drug drug interactions w/ imipramine (Tofranil)

A

> MOAI, sympathomimetic drugs, anticholinergic drugs

>Additive effect with other CNS depressants= sedation

29
Q

prototypes for Monoamine Oxidase Inhibitors

A

Selegiline (EMSAM) MAO-B at low dose and MAO-A at high doses
Phenelzine (Nardil)
isocarboxiazide (Marplan)
Tranylcypromine (Parnate)

(SPIT)

30
Q

how do Monoamine Oxidase Inhibitors fxn?

A

Inhibit the breakdown of NE, dopamine and serotonin in CNS neurons

31
Q

Whats up with MOA and MOB?

A
  • -MOA –> inactivates norepi and serotonin = inhibiting it keeps norepi/serotonin active for life of enzyme (2 weeks!)
  • -MOB –> inactivates dopamine –> parkinson’s (celleduline)
32
Q

what up with tyramine? what does it cause? who is it not playing nicely with?

A

(type of monoamine that is not broken down on MOA inhibitor ) if not broken down causes vasoconstriction –> hypertensive crisis

33
Q

who is our most dangerous antidepressant?

A

MAOI

34
Q

onset of MAOI

A

4-8 weeks

35
Q

MAOI interacts with

A
  • meperidine (Demerol)= hyperpyrexia
  • antidepressant or sympathomimetic = hypertensive crisis
  • antihypertensive = excessive hypotension
  • diabetic drugs = hypoglycemia

MAAD

Me Peri make me hot
Antidepress= increase BP
Antihypertensive = hypotens (more of the same)
Diabeet= hypoglyc (more of the same)

36
Q

Must be a ____ interval between the use of MAOI and MAAD drugs

A

14 day

37
Q

MAOI + tyramine =

A

hypertensive crisis

38
Q

foods with tyramine

A

Avocados, bananas, raisins, papaya, meat tenderizers, canned figs, fava beans, cheese, sour cream, yogurt, soy sauce, beer, wine-especially red, yeast/yeast extracts, beef or chicken liver, pate, meat extracts, pickled or kippered hearing, pepperoni, salami, sausage, bologna/hot dogs, chocolate

39
Q

Who is our atypical antidepressant with an unknown mechanism of action?

A

Bupropion (Wellbutrin)

40
Q

Benefits of Bupropion (Wellbutrin) compared to other antidepressants?

A

No weight gain or sexual dysfunction –> increase sexual desire

(stay skinny and get laid!!!)

41
Q

Side effects of Bupropion (Wellbutrin)

A

seizures, agitation, HA….psychotic symptoms

42
Q

what else is Bupropion (Wellbutrin) used for?

A

smoking cessation

43
Q

drug for bipolar disease

A

Lithium

44
Q

Lets talk ranges for Lithium

safe? best? increase adverse effects? dialysis? toxic?

A

0.4-1 mEq/L = safe
0.4 - 0.8 = best
–>0.8-1 = increase adverse effects
1.5 = toxic
>2.5 = dialysis

45
Q

how does lithium treat bipolar disorder

A

no one knows… #science, but here are some theories

  • reduce glutamate
  • ion w/ + charge –> effects electrical conduction of nerves
46
Q

whats up with salt and lithium?

A

When Na is low (hyponatremia); body holds on to lithium in an attempt to compensate

summer sweating + lithium = Lithium toxicity

47
Q

s/s of toxicity of lithium

A

-N/V, tremors, polyuria, muscle weakness, ataxia, EKG changes, convulsions, coma and death

48
Q

prototype for antidote for lithium?

A

no antidote! only give symptom management

>2.5 = dialysis

49
Q

how do we admin lithium?

A

take 2/day or w/ food to prevent gi upset

50
Q

adverse effects of Lithium

A 
GI
Hypothyroidism & Goiter --> check TSH, T3, T4 before/during therapy
Tremors 
Renal damage
Increases risk for toxicity 
Polyuria 
Birth defects
51
Q

drug interactions with lithium?

A

NSAIDS

Diuretics

Kol- Pharm 323 Spring (41 decks)

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