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Pharmacology > CNS Meds: Depression & Psychosis > Flashcards

CNS Meds: Depression & Psychosis Flashcards

1
Q

Describe the 4 treatment modalities for depression

A
  1. pharmacotherapy
  2. Cognitive behavioral therapy
  3. Electroconvulsive therapy (ECT)
    when drugs & psychotherapy have not worked
  4. Vagus nerve stimulation
    only after treatment with at least 4 drugs has failed
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2
Q

Name 6 examples of SSRIs

A
  1. Paxil – Paroxetine
  2. Celexa – Citalopram
  3. Prozac – Fluoxetine
  4. Zoloft – Sertraline
  5. Luvox – Fluvoxamine
  6. Lexapro – Escitalopram
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3
Q

What are the indications of SSRIs?

A

Depression

Other mental disorders: OCD, PTSD, social anxiety disorder, panic disorder, eating disorder

PMS

Enuresis (involuntary urination)

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4
Q

Recognize the time that selective serotonin reuptake inhibitors (SSRIs) take to show their effects

A

Effects take 10-21 days

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5
Q

Specify 2 precautions that patients on SSRIs must take

A
  1. If they want to stop taking the medication, they should wean gradually.
  2. Take SSRIs with food at bedtime!
    - We want to minimize anticholinergic effects (dry mouth, constipation, urinary retention, dilated pupils, blurred vision, increased HR)
  • Take at bedtime unless sleep is disturbed
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6
Q

List 9 side effects of selective serotonin reuptake inhibitors (SSRIs)

A
  1. insomnia
  2. anxiety
  3. nervousness
  4. headache
  5. weight gain
  6. nausea
  7. GI distress
  8. dry mouth
  9. sexual dysfunction
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7
Q

Describe serotonin syndrome and identify the clinical features of serotonin syndrome

A

It is a rare adverse effect of SSRIs due to autonomic “instability”

Can be life threatening

Sweating, agitation, confusion, hyperreflexia, fever, tremor hallucination, seizures, coma

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8
Q

Name 2 alternative antidepressant drugs to SSRIs

A
  1. SNRIs (serotonin-norepinephrine)
    Venlafaxine – Effexor
  2. NDRIs (norepinephrine-dopamine)
    Bupropion – Wellbutrin

***Bupropion is also used for smoking cessation!

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9
Q

Describe the mechanism of action of tricyclic antidepressants (TCAs)

A

TCAs block the neuronal reuptake of 2 monoamine transmitters:

NE and serotonin

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10
Q

Name 5 examples of TCAs

A

Amitriptyline – Elavil
Imipramine – Tofranil
Clomipramine – Anafranil
Nortriptyline – Aventyl
Amoxapine –Asendin

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11
Q

List 2 indications of TCAs

A

Depression
***Chronic pain: fibromyalgia, migraine, severe depression

TCAs can have sedative/hypnotic effect

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12
Q

List 10 side effects of tricyclic antidepressants (TCAs)

A

Sedation & Confusion
Orthostatic hypotension

Arrhythmias, cardiac toxicity

Weight gain

Anti-cholinergic effect

**especially for the elderly
**Take at bedtime to minimize side effects

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13
Q

Name 4 examples of monoamine oxidase inhibitors (MAOIs)

A

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Selegiline (Emsam)

Tips to remember:
“Take Pride in Shanghai” lol

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14
Q

List 3 examples of monoamine neurotransmitters

A

Norepinephrine

Serotonin

Dopamine

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15
Q

Discuss the effect of a patient consuming tyramine-rich foods while being treated with a monoamine oxidase inhibitor (MAOI)

A

MAOIs inhibit monoamine oxidase, so the body cannot get rid itself of excess NE

–> Raised level of NE

–> Hypertensive crisis (life-threatening increase in BP)

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16
Q

List the classic examples of tyramine-rich foods

A

Tyramine is commonly found in foods that are aged

  • cheese
  • smoked fish
  • tofu
  • protein extracts
  • sauerkraut
  • miso

There are more!!!

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17
Q

List 3 drug classes that are likely to lead to serotonin syndrome

A

SSRIs

MAOIs

MDMA (phenylethylamines)

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18
Q

List 2 drug interactions that will also cause serotonin syndrome

A

combine MAOIs with:

  1. opioids like meperidine
  2. tricyclic antidepressants (TCA)
19
Q

List 4 indications of monoamine oxidase inhibitors (MAOIs)

A
  1. Depression
  2. Bulimia nervosa (eating disorder)
  3. Obsession-compulsive disorder
  4. Panic attacks

We do not see MAOIs often in practice, but MAOIs can work effectively for some patients with depression.

20
Q

Recall the disorders for which mood stabilizers are indicated

A

They are often used in bipolar disorder, borderline personality disorder (Luka Yamano!!) , and schizophrenia.

21
Q

List two types of mood stabilizers

A
  1. Lithium
  2. Anticonvulsants – treat epilepsy but can also act as mood stabilizers
22
Q

Describe how lithium benefits patients with bipolar disorder

A

We use lithium to treat acute mania OR prevent future mania/depression

23
Q

Recall how long lithium might take to exert a therapeutic effect

A

Onset of the effects to kick in: 5 - 7 days
Peak: 2-3 weeks after

24
Q

Describe characteristics of borderline personality disorder and explain the role of lithium in the treatment

A

Borderline personality disorder: characterized by mood swings, impulsiveness, and intense fear of abandonment (getting alone)

25
Q

The therapeutic ranges for lithium therapy

A

Normal: 0.6 - 1.2 mEq/L

Toxic: greater than 1.5 mEq/L

Can cause death: greater than 2.5 mEq/L

26
Q

Describe mild, moderate, and severe signs of lithium toxicity

A

Mild: nausea, vomiting, and fatigue

Moderate: confusion, agitation, delirium,

Severe: coma, seizures

27
Q

Explain how a low serum sodium level can affect lithium levels

A

Low serum Na can increase the risk of Li toxicity

(kidney wants to hold on Na –> body cannot distinguish Na and Li –> Li is also retained)

28
Q

Risk factors for low Na

A

Diet, diarrhea, and diuretics

29
Q

Review 7 common side effects of Li early in the treatment

A

GI distress

Since Li can mess up electrolyte balance of the body, it can cause:

fatigue
headache, muscle weakness, confusion, memory impairment
polyuria & thirst (Li blocks the effect of ADH)

30
Q

List the classic side effects associated with chronic lithium therapy

A
  1. May cause degenerative changes to the kidney
  2. May cause goiter OR hypothyroidism
31
Q

Recall common indications for antipsychotic medications

A

Used mostly in:
Schizophrenia (primary use)
Bipolar disorder (in manic phase)

Delusional disorders, depressive psychoses, and drug-induced psychoses

*** Note: psychosis = a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.

32
Q

Identify which age group should not be administered antipsychotics

A

Antipsychotics should not be used to treat dementia-related psychoses in the elderly (as they increase the risk of mortality)

33
Q

Differentiate between 1st- and 2nd-generation antipsychotic medications

A

1st: “conventional antipsychotics”
2nd: “atypical antipsychotics”

equally effective but differ in side effects

34
Q

List 3 common 1st-generation antipsychotics (FGAs)

A

Chlorpromazine
Fluphenazine
Haloperidol

35
Q

Recall how FGAs are classified

A

classified by potency (=the size of the daily dose needed)

Low: chlorpromazine
Medium: fluphenazine
High: haloperidol

36
Q

Describe why FGAs have a higher risk of causing extrapyramidal symptoms (EPS)

A

FGA blocks dopamine receptors in the CNS
–> could develop motor issues
(just like Parkinson’s patients do not have enough dopamine)

Note: EPS are often IRREVERSIBLE !!!

37
Q

List 4 examples of EPS

A

Early reactions (first 3)
1. Dystonia (twisting movement, may respond to anticholinergic medications like benztropine)
2. Parkinsonism
3. Akathisia (motor restlessness)

More common with high potent drug!

Late reactions
4. Tardive dyskinesia (abnormal movement of face and limbs)

38
Q

List common other side effects associated with chlorpromazine and haloperidol

A

Chlorpromazine and haloperidol can cause prolonged QT interval.

They can also mess up hormonal balance –> galactorrhea, gynecomastia (men develop breast) and mensural irregularities.

39
Q

Describe the signs and symptoms of neuroleptic malignant syndrome (NMS)

A

Life-threatening adverse effects of FGAs:

  1. rigidity (back is arched = opisthotonos)
  2. high fever
  3. abnormal BP, cardiac dysrhythmias)
40
Q

List medications used to counteract the effects of NMS

A

Dantrolene: relaxant for rigidity and high fever

Bromocriptine: dopamine receptor agonist to relieve CNS toxicity

41
Q

List 3 commonly used 2nd-generation antipsychotics (SGAs)

A

Clozapine
Olanzapine
Risperidone

**moderately block dopamine and strongly block serotonin receptors –> low risk of EPS

Review slide 18 for FGA vs SGA side effects difference!

42
Q

Describe how SGAs may affect metabolism

A

SGAs can cause metabolic problems like weight gain, diabetes, and dyslipidemia –> increase cardiovascular risk

43
Q

List a concerning side effect of clozapine that makes it a less-optimal SGA choice compared with other SGAs

A

Clozapine has a unique risk: agranulocytosis (low WBC count)
–> could lead to sepsis

Pharmacology (20 decks)

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