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Nurs 5225 Psychopharmacology APRN/MHN > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What factors influence medications

A

Neurobiological
Structural Brain Differences
Genetic
Environmental

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2
Q

Other than monoamines what other factors play a role in neurobiological causes of depression

A

neurotrophins or growth factors such as BDNF

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3
Q

Growth factors like BDNF is like

A

miracle grow for the brain. Plays a role in neuroplasticity for the synapse and is critical for the maintence and survival of neurons.

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4
Q

Stress hromones

A

play a role in depression. There is a malfunction of the HPA axis. There is an impaired inhibition of cortosol release and elevated levels of cortosol. This interferes with normal neurogenesis in the hippocampus of the brain. They also impact the function of BDNF.

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5
Q

Inflmmation

A

can be another cause of depression

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6
Q

gut brain axis

A

Functional interplay between brain function and gut microbiota

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7
Q

Structural abnormalities in the brain with people in depression also have these located in the

A

frontal cortex and hippocampus

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8
Q

Antidepressants can be used for

A 
Depressive Disorders
Obsessive-Compulsive Related Disorders
Anxiety Disorders
Phobias
Panic
PTSD and other trauma related disorders
Sleep
Chronic Pain
Migraine Prophylaxis
Others
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9
Q

Selective Serotonin Reuptake Inhibitor (SSRI) - Examples

A 
Fluoxetine
Paroxetine
Sertraline
Escitalopram
Citalopram
Fluvoxamine
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10
Q

SSRI function

A
  • Block reuptake of 5HT (Reuptake Inhibitor)

- Increases synthesis of important proteins (BDNF)

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11
Q

SSRI labs

A

not routinely done. But if there are comorbid factors you might want to check.

Impact on platelets
Electrolytes
Hyponatremia
Vitals
Including weight
LFTs
ECG- QTc prolongation
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12
Q

A lot of serotonin receptors are found in

A

gut

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13
Q

SSRI side effects

A 
Discontinuation syndrome
GI upset, N&V, diarrhea
Headache
Drowsiness, dizziness
Insomnia
Activation, restlessness
Sexual dysfunction
Appetite, weight loss/gain
Black box warning
Serotonin Syndrome
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14
Q

SSRI side effects are often

A

transient. usually resolve in a week or two.

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15
Q

Seronin syndrome

A 
Agitation or restlessness
Insomnia
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
High blood pressure
Muscle rigidity
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumps
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16
Q

Discontinuation syndrome symptoms

A

The mnemonic FINISH summarizes the symptoms of antidepressant discontinuation syndrome: Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating), Insomnia (with vivid dreams or nightmares), Nausea (sometimes vomiting), Imbalance (dizziness, vertigo, light-headedness), Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).

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17
Q

SSRI effect on platelets

A

can decrease platelet activation and aggregation and impar hemostasis. use with caution in people with coagulation disorders

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18
Q

which SSRI has QTC issues

A

most due, but citalopram is the worst.

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19
Q

Serotonin-Norepinephrine Reuptake inhibitor - Examples

A 
Venlafaxine
desvenlafaxine
duloxetine
levomilnacipran
milnacipran
atomoxetine
20
Q

When we inhibit NE it increases

A

DA in the prefrontal cortex

21
Q

SNRI action

A

Serotonin-Norepinephrine Reuptake inhibitor

22
Q

Venlafaxine note

A

serotonin inhibition is really potent at lower doses it isn’t until it gets to higher doses that it starts to impact NE

23
Q

SNRI monitoring

A

LFTs
Electrolytes
Vitals
BP-Dose Dependent

24
Q

Norepinephrine Dopamine Reuptake Inhibitor (ndRI)

A

Bupropion

25
Q

NDRI is not great for

A

anxiety

26
Q

NDRI uses

A
  • Block reuptake of DA and NE
  • Depression
  • ADHD- off label
  • Smoking cessation (Zyban)
  • Sexual dysfunction
27
Q

NDRI side effects

A 
Anxiety, irritability, restlessness
Insomnia
Constipation
Decreased appetite, weight loss
Headache
Increased sweating
28
Q

NDRI Labs

A 
Decreases seizure threshold
Alcohol use
Vitals
LFT, BUN, GFR
ECG
EEG
29
Q

NDRI note

A

Decreases seizure threshold

Alcohol use - also decreases seizure threshold

30
Q

Tricyclic Antidepressant (TCA) - uses and action

A

Block reuptake of NE and 5HT in presynaptic nerve terminals
Migraine prophylaxis
Chronic Pain
Sleep

31
Q

TCA examples

A 
amitriptyline
clomipramine
doxepin
imipramine
nortripamine
desipramine
amoxapine
protriptyline
32
Q

TCA side effects

A 
Anticholinergic SEs - (Dry mouth.
Blurred vision.
Dry eyes.
Constipation.
Urinary retention.
Dizziness due to drop in blood pressure on standing up (postural hypotension)
Cognitive problems (confusion)
Heart rhythm disturbance.)
Orthostatic hypotension
Sexual side effects
Weight loss/gain
Serotonin Syndrome
Overdose potential

POTENTIAL WITH DEATH FROM OVERDOSE WITH TCA AND MAOI

33
Q

TCA labs

A 
TCA level-trough 
ECG- steady state and hx of cardiac problems, toxicity 
Weight 
BP, pulse
Lipids, glucose
34
Q

TCA have action on the

A

sodium level system on the heart and the brain. Can lead to abnormal rhythm brain damage and death.

35
Q

MAOI action and types

A

block action of monoamine oxidase
2 sub types
A- 5HT, NE, DA, Tyramine
B- DA, Tyramine, Phenylethylamine

36
Q

MAOI examples

A

selegiline
isocarboxazid
tranylcypromine
phenelizine

37
Q

MAOI side effects

A 
Drowsiness, dizziness, confusion
Nausea
Headache
Weight gain
Drug-drug, drug-food reactions
Serotonin syndrome
38
Q

MAOI have a lot of

A

drug to drug interactions

39
Q

MAOI what to watch out for and monitor

A 
Overdose potential
Hypertensive crisis
Orthostatic BP and pulse
LFTs
Weight
Glucose, lipid
40
Q

MAOI need to know

A

Tyramine linden food can lead to hypertensive crisis. S/S occipital headache, palpitations, neck stiffness, photophobia, tachy or brady, chest pain

41
Q

Serotonin Partial agonist/reuptake inhibitor (SPARI) - action and note

A

Block reuptake of serotonin
5HT1A Partial agonism
N&V, diarrhea
*Take with food

42
Q

SPARI example

A

vilazodone

43
Q

SARI action and note

A 
Block 5HT2A and 5HT2C	 receptors
H1-histaminergic and ⍺1-adrenergic antagonism
Different actions
Sleep
Depression
ECG
44
Q

SARI examples

A

trazodone

nefazodone

45
Q

Review different 5ht receptors and their actions

A

See alix chart

46
Q

Alpha-2 antagonist/ Noradrenergic specific serotonergic Antidepressant (Nassa) - Action and note

A 
Alpha-2 antagonism
Enhances release of 5HT and NE 
Antagonist 5HT2A, 2C, 3
Antagonist H1 
Weight gain, drowsiness
Less sexual SE, less GI (5HT3)
BUN, creatinine, LFT, Lipid
Agranulocytosis
47
Q

NaSSA examples

A

mirtazapine

mianserin

Nurs 5225 Psychopharmacology APRN/MHN (7 decks)

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