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Pharmacology Sem 3 > Antidepressive > Flashcards

Antidepressive Flashcards

1
Q

Feverfew herb interfere with

A

SSRI antidepressant like fluoxetine Prozac

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2
Q

St. John’s wort herb interfere with (x), causing s/s

A

SSRI antidepressant, causing serotonin syndrome (HA, dizziness, sweating, agitation)

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3
Q

what herbs leads to palpitation, heart attack, and HTN crisis when taken with which type antidepressants?

A

Ginseng, ephedra, ma-huang, and St. John’s wort when taken with Monoamine Oxidase Inhibitors (MAOIs)

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4
Q

why do pts use herbal remedies

A

pt want to self-treat

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5
Q

is there a need for collaboration when taking herbal remedies?

A

yes, colloborate between herbalist, MD, accupuncturist to treat the anxiety (not the actual mood d/o)

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6
Q

list 4 types of antidepressants?

A

monoamine oxidase inhibitors (MAOIs), tricyclic antidepressant (TCA), selective serotonin reuptake inhibitors (SSRI), non-selective serotonin reuptake inhibitor (NSRI)

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7
Q

Action of monoaminie oxidase inhibitor (MAOI)

A

monoamine oxidase usually inactivate norepinephrine, dopamine, epinephrine, and serotonin. So you MAOIs block that, so neurotransmitters increase in level.

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8
Q

Monoamine oxidase enzymes are found

A

in liver and brain

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9
Q

what are types of monoamine oxidase enzymes?

A

MAO-A and MAO-B enzymes

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10
Q

what is the difference between MAO-A and MAO-B enzymes?

A

MAO-A enzyme typically inactivate dopamine in brain. MAO-B enzyme typically inactivate norepinephrine and serotonin.

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11
Q

are MAOI agents selective or nonselective to MAO-A or MAO-B

A

nope. The agent works on both enzymes

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12
Q

when do you prescribe MAOI agents?

A

for Atypical Depression not responding to other treatment

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13
Q

List 3 types of MAOIs

A

phenelzine sulfate Nardil, isocarboxazid Marplan, tranylcypromine sulfate Parnate

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14
Q

what foods cause HTN crisis with MAOIs

A

Cheese (cheddar, swiss, bleu), bananas, raisins, pickled foods, red wine, beer, cream, yogurt, chocolate, coffee, italian green beans, liver, yeast, soy sauce, pickled herring, sausage, pepperoni

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15
Q

what effect do contraindicated food have with MAOIs?

A

sweating, tremors, bounding HR, high BP, high temp.

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16
Q

what sort of drugs caust HTN crisis with MAOIs?

A

CNS stimulants or sympathomimetics (vasoconstrictors and cold medication containing phenylephrine and pseudoephedrine); diet pills, meth, DEXTROMETHOPRHAN, other antidepressants, Meperidine demorol d/t dopamine

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17
Q

What chemical in foods cause HTN crisis with MAOIs?

A

tyramine

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18
Q

why do you avoid tyramine containing foods with MAOIs?

A

it has sympathomimetic-like effects that can cause HTN crisis

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19
Q

S/E of MAOIs

A

CNS stimulation: agitation, restlessness, insomnia, orthostatic hypotension, and anticholinergic effects

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20
Q

St. John’s wort herb does what?

A

decrease reuptake of neurotransmitters serotonin, norepinephrine, dopamine

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21
Q

When do you stop taking herbal supplements?

A

1-2 weeks before surgery.

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22
Q

how to eat tyramine containing foods with MAOIs?

A

if high, avoid. If moderate, eat occasionally. If low, eat in limited quantities.

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23
Q

What do you do in a HTN crisis?

A

VS, cooling measure, ice pack/bath, bear hug

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24
Q

What are collaborative invervention for HTN crisis?

A

IV fluids, benzodiazipine for muscle rigidity, short acting antiHTN meds

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25
Q

TCA or Lithium should be decreased in what type of pt

A

Asian pt, and all antidepressant should be decreased for Hispanic pt.

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26
Q

if taking herbal remedies with antidepressant,

A

antidepressive dose may need to be modified or herb needs to be d/c’d

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27
Q

herbal remedies interact with antidepressants, especially

A

MAOIs and SSRI

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28
Q

tricyclic antidepressants (TCA) action

A

block reuptake of norepinephrine and serotonin; also block histamine receptors

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29
Q

S/E of TCA

A

anticholinergic effect, orthostatic hypotension (rise slowly), sedation, cardiac toxicity, seizures

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30
Q

See effect of TCA in

A

2-4 weeks

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31
Q

if TCA does not work

A

slowly w/d and prescribe another antidepressant

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32
Q

TCA treats

A

major depression, neuralgia, pruritic, bulemic, cataplectic, narcoleptic adjunct, enuretic, panic, ulcer, OCD

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33
Q

TCA should do this

A

elevate mood, increase interest in ADLs, decrease insomnia

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34
Q

TCA has a (x) action

A

sedative action

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35
Q

W/D s/s of TCA with stopped abruptly

A

n/v, anxiety, akathisia (inability to be still)

36
Q

half life of TCA

A

up to 10-50 hrs; look for cumulative drug effect

37
Q

A/E of TCA

A

cardiac toxicity/dysrhythmia. blood dyscrasias: leukopenia, thrombocytopenia, and agranulocytosis

38
Q

anticholinergic effect s/s

A

tachycardia, urinary retention, constipation, dry mouth, and blurred vision.

39
Q

allergic reaction to TCA s/s

A

skin rash, pruritus, petechiae, sexual dysfunction, impotence, amenorrhea

40
Q

which TCA cause Extrapyramidal S/s

A

Amitriptyline Elavil

41
Q

which TCA cause neuroleptic malignant syndrome

A

Clomipramine Anafranil

42
Q

TCA (x) seizure threshold, so do what?

A

decrease seizure threshold. Adjust TCA dose.

43
Q

TCA serum range should be

A

100-200 ng/mL

44
Q

TCA interact with what drugs

A

ETOH, hypnotics, sedatives, barbituates potentiate CNS depression,

45
Q

What happens when you take TCA amitriptyline with MAOIs?

A

cardiovascular instability and toxic psychosis.

46
Q

TCA amitriptyline with antithyroid meds does what?

A

increase risk of dysrhythmia

47
Q

What to do if pt has TCA toxicity

A

ABC (airway), GI decontamination (can’t lavage), ECG abn tx with sodium bicarbonate drip (increase blood alk which slow Na influx when acidic to decrease dysrhythmia); control agitation/fever; controvertial admin of physostigmine (blocks acetylcholine)

48
Q

what is polydrug therapy? Should you do this?

A

giving several antidepressants or antipsychotics together. Avoid doing this.

49
Q

Mrs Teal said to learn which TCA

A

imipramine Tofranil

50
Q

Imipramil tofranil treats

A

major depression

51
Q

what kind of antidepressant is imipramil tofranil

A

TCA

52
Q

Nursing Consideration with imipramil tofranil

A

take at HS to decrease danger from sedative effect. Take with food to decrease GI irritation. Avoid taking with ETOH or other CNS depressants.

53
Q

Common s/e of imiprmine tofranil

A

drowsiness, dry mouth, hypotension, delayed micturition (delayed peeing when you want to pee).

54
Q

therapeatuic range of imipramil tofranil

A

150-250 ng/mL

55
Q

Imipramil tofranil max for elderly

A

150 mg/d

56
Q

Imipramil tofranil max for adults

A

300 mg/d

57
Q

anticholinergic mnemonic

A

dry as a bone (poor skin turgor; dry mucous membrane), blind as a bat (dilated), hot as a hare (high temp), red as a beet (flushed), mad as a hatter (confused/psychotic)

58
Q

anticholinergic syndrome

A

inhibition of muscarinic cholinergic neurotransmission (acetocholine receptors blocked)

59
Q

s/s of anticholingergic syndrome

A

sinus tachycardia, ileus, urinary retention, HTN, tremulousness, myoclonic jerking

60
Q

what cause anticholinergic syndrome

A

anti: cholinergics, histamines, psychotics, spasmotics; cyclic antidepressants, mydraitics to dilate pupils, plants like datura

61
Q

what kinds of plants cause anticholinergic syndrome?

A

datura, morning glory seeds, jimson weed, loco week , georgia o’keeffe

62
Q

Selective serotonin reuptake inhibitor action

A

block reuptake of serotonin into the nerve terminal of CNS; so enhancing its transmission at serotonergic synapse

63
Q

SSRI treats

A

major depressive d/o and anxiety d/o such as OCD, panic, phobias, PTSD; eating d/o, drug abuse, decrease premenstrual tension syndrome, preventing migraine HA, decrease aggressive behavior in boderline personality d/o.

64
Q

SSRI are used more than (x) to treat depression

A

TCA

65
Q

SSRI are (x) expensive than TCA

A

SSRI are less expensive than TCA

66
Q

SSRI does not block

A

dopamine, norepinephrine, cholinergic and alpha1-adrenergic receptors.

67
Q

List 3 SSRIs

A

Fluoxetine Prozac, fluvoxamine Luvox, sertraline zoloft

68
Q

SSRI s/e to teach

A

sexual dysfunction (men will stop taking this d/t decrease sexual arousal; or women will become anorgasmic); these s/e cease over 2-4 weeks; there’s also weight gain in some pts

69
Q

ssri s/e

A

dry mouth, blurred vision, insomnia, HA, nervousness, anorexia, nausea, diarrhea, suicidal ideation, GI distress, restlessness.

70
Q

who should not take SSRI

A

pt with suicidal ideation

71
Q

which SSRI shoud OCD take

A

fluvoxamine luvox,

72
Q

most prescribed SSRI

A

sertraline zoloft

73
Q

FDA approved (x) dose of fluoxetine prozac

A

90 mg/wk

74
Q

SSRI interact with which food? What happens?

A

grapefruit leads to toxicity

75
Q

List an Atypical (heterocyclic) antidepressant?

A

bupropion Wellbutrin

76
Q

You should not take MAOIs with (or p 14 days of)

A

atypicial (heterocyclic) antidepressants like bupropion Wellbutrin

77
Q

Do not take atypical heterocyclic antidepressant bupropion Wellbutrin with (or p 14 days of)

A

MAOI

78
Q

another name for atypical antidepressant?

A

heterocyclic antidepressant

79
Q

cost of SSRI

A

Expensive!

80
Q

SSRI has (x) of safety

A

wide margin; get GI pain, not die

81
Q

SSRI does what in children

A

increase suicide rate in children

82
Q

SSRI fluoxetine prozac therapeautic range

A

90-300 ng/mL

83
Q

SSRI a/e

A

seizures, hyponatremia, palpitations, chest pain

84
Q

SSRI fluoxetine prozac + ETOH does this

A

more CNS/respiratory depression, hypotension

85
Q

SSRI starts to work in

A

1-2 weeks; at 2 weeks, pt may commit suicide.

Pharmacology Sem 3 (26 decks)

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