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Pharmacology II Quiz 6 > Depression > Flashcards

Depression Flashcards

1
Q

CNS Neurotransmitters

A 
Acetylcholine
Gamma-aminobutyric acid
Dopamine
Glutamate
Norepinephrine
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2
Q

PNS Neurotransmitters

A

Acetylcholine

Norepinephrine

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3
Q

Sympathetic System

A

Acetylcholine
Dopamine
Epinephrine
Norepinephrine

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4
Q

PNS Neurotransmitters

A

Acetylcholine

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5
Q

Depression Prevalence

A

Affects up to 19 million Americans
-31 million adults report having had at least one episode of major depression in their lifetime

Annual costs of $43 billion equal to the annual health care costs for coronary heart disease

Can affect all age groups

 - Women 2 to 3 times more likely to develop depression than men
 - If left untreated, 15% of adult patients will commit suicide
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6
Q

Diagnosis of Depression

A

Depressed mood or loss of interest/pleasure in activities for at least two weeks

plus

At least four of the following seven factors in the same two week period

  • Change in sleep pattern
  • Change in appetite/weight
  • Fatigue
  • Psychomotor agitation or retardation
  • Feelings of worthlessness/guilt
  • Difficulty thinking, concentrating or indecisiveness
  • Recurrent thoughts of death, suicidal ideation, plans, attempts
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7
Q

Premenstrual Dysphoric Disorder Diagnosis

A 
Five or more of the following occuring during the final week before the onset of menses:
Marked affective lability
Markedly depressed mood
Decreased interest
Lethargy
Sleep pattern change
Marked irritability
Marked anxiety
Difficulty concentrating
Change in appetite
Physical symptoms
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8
Q

Monoamine Oxidase Inhibitors

A

Tranylcypromine
Isocarboxazid
Phenelzine
Selegeline

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9
Q

Childhood Bipolar Disorder is now

A

Disruptive Mood Dysregulation Disorder

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10
Q

New Depression diagnoses in DSM-V

A

Disruptive Mood Dysregulation Disorder

Premenstrual Dysphoric Disorder

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11
Q

Tricyclic Depressants

A

Secondary Amines
Tertiary Amines
Tertracyclic Amine

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12
Q

Tetracyclic Amine

A

Maprotiline

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13
Q

Tertiary Amines

A 
Amitriptyline
Clomipramine
Doxepin
Imipramine
Trimipramine
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14
Q

Selegeline mechanism of administration

A

Topical patch

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15
Q

Secondary Amines

A

Nortriptyline

Desipramine

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16
Q

MOA MOIs

A

Effects the enzyme monoamine oxidase so the body loses its ability to breakdown monoamines which increases the levels of NE in the body.

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17
Q

Nobody uses

A

MOIs

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18
Q

Indications for Phenelzine

A

Symptomatic treatment of atypical, nonendogenous, or neurotic depression

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19
Q

Dosage forms of Phenelzine

A

Tablet

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20
Q

Dosing of Phenelzine

A

Oncea day or every 2 days

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21
Q

Selegeline indications

A

Treatment of major depressive disorder.

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22
Q

Dosage form of Selegeline

A

Topical Patch

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23
Q

Dosing of Selegeline

A

Once a Day

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24
Q

Black Box Warning of MOIs

A

Suicidal Thinking/ Behavior

-Age groupings

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25
Q

If on an MOI consult your physician if:

A

MAO Inhibitors may not play well with others!

Doesn’t play well with certain foods.

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26
Q

MOI ADRs

A 
Dizziness
Lightheadedness
Drowsiness
Fatigue
Weakness
Blood pressure effects
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27
Q

Food interactions of MOI

A 
Tyromine-containing foods:
Pizza
Cheeses
Duff Beer
Mountain Dew
Fava Beans
Chocolate chip cookies
Yogurt
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28
Q

Metabolic Effect of MOIs

A

Hypoglycemic possible

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29
Q

Class Drug of MOIs

A

Phenelzine

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30
Q

Phenelzine

A

Phenelzine
15 mg
Once daily

-Maintenance Dose

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31
Q

Selective Seratonin Reuptake Inhibitors Class Drug

A

Sertraline

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32
Q

Sertraline

A

Sertraline
100 mg
Once daily

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33
Q

Indications for Duloxetine

A

Acute and maintenance treatment of major depressive disorder
Generalized anxiety disorder
Management of diabetic peripheral neuropathic pain
Management of fibromyalgia
Chronic musculoskeletal pain (e.g., chronic low back pain, osteoarthritis)

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34
Q

Beginning Dosing of Phenelzine

A

60 mg

Titrate down to 15 mg per day.

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35
Q

Tricyclic Antidepressants to know

A

Nortriptyline

Amitriptyline

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36
Q

MOA Tricyclic Antidepressants

A 
Block receptor sites:
Seratonin
Adrenergic
Histamine
Muscarinic acetylcholine
Acetylcholine
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37
Q

Older patients do not tolerate ________well.

A

Tricyclic Antidrepressants

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38
Q

If you have to use a tricyclic antidepressant in an older patient use:

A

Secondary Amines

  • Nortriptyline
  • Desipramine
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39
Q

Do plasma levels correlate with therapeutic effect of tricyclic antidepressants?

A

Plasma levels don’t directly correlate to therapeutic effect

Dosing is based on observation, side effects and clinical response

40
Q

Dosing of Antidepressants

A

Once a day versus multiple doses per day- once a day is fine.

Most such as amitriptyline, nortriptyline, imipramine can be effective with a single bedtime dose that equals the total daily recommended dose

Put the doses together and take at night.

41
Q

ADRs of Tricyclic Antidepressants

A

Histamine receptor blockade - Sedation

Alpha adrenergic blockade - Postural hypotension

Anticholinergic effect - Blurred vision, dry mouth, constipation

Cardiac - Arrhythmias, sinus tachycardia, prolongation of conduction time

42
Q

Tricyclic Antidepressants Class Drug

A

Amitriptyline

43
Q

Amitriptyline

A

Amitriptyline
150 mg
Once a day at bedtime

44
Q

Selective Seratonin Reuptake Inhibitors

A 
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine - Paxil
Sertraline - Zoloft
Vilazodone - Viibrid
Vortioxetine - Brintelix
45
Q

Indications for Sertraline

A 
Major depression
Obsessive-compulsive disorder
Panic disorder
Premenstrual dysphoric disorder 
Post-traumatic stress disorder 
Social anxiety disorder
46
Q

Serotonin/ NE Reuptake Inhibitors Class Drug

A

Cymbalta

47
Q

Cymbalta

A

Cymbalta
60 mg
Once Daily

48
Q

SSRI MOI

A

Blocks 5-HT re-uptake transporter to prevent reuptake of seratonin increasing seratonin levels in the body.

49
Q

Depression is due to low levels of

A

Norepinephrine

50
Q

SSRIs also treat

A

anxiety disorders

51
Q

Side effects of SSRIs

A

Sexual Dysfunction

52
Q

Paxil is especially bad due to …

A

erectile dysfunction side effect.

53
Q

Often times the SSRI is picked based off of their…

A

side effect profile.

54
Q

Kinetics of SSRIs

A

Organ Dysfunction

Renal impairment adjustments generally not needed.

Hepatic impairment may result in increased levels.

55
Q

SSRI Drug Interactions

A

MOI - BAD

Addictive effect to result in serotonin syndrome - BAD!

Watch with St.John’s Wart

56
Q

ADRs of SSRIs

A

Increased fall risk

Lower bone mineral density

Sexual dysfunction

Decreased libido, ejaculation failure

SIADH - Syndrome of inappropriate antidiuretic hormone. Check sodium levels.

Constipation, diarrhea, nausea, dizziness, headache, insomnia, etc., etc., etc.

57
Q

SIADH with SSRIs are often seen with…

A

older patients.

Check their sodium levels. Dilutional effect - treat with a diuretic.

58
Q

SSRI Class Drug

A

Sertraline

59
Q

Sertraline

A

Sertraline
100 mg
Once daily

60
Q

How long until you see changes in depression?

A

1-3 weeks

61
Q

Selective Serotonin Norpinephrine Reuptake Inhibitors

A 
Desvenlafaxine
Duloxetine
Levomilnacipran
Milnacipran
Venlafaxine (Flexor)
62
Q

SSRIs

A 
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Vilazodone
Vortioxetine
63
Q

SNERI Side Effects

A

Vary greatly within category.

64
Q

Issues with Venlafaxine

A

At higher doses, raises blood pressure

Higher rate of treatment-emergent mania than other agents

More “activating” than others

Dose-dependent weight loss

65
Q

Differences in Side Effects between Duloxetine and Venlafaxine seen with

A

Headaches (Venlafaxine higher)
Insomnia (Venlafaxine higher)
Agitation (Same)
HTN (Same)

66
Q

Side Effects of S/NERIs

A 
Somnolence
Headache
Nausea
Fatigue
Palpitation
Insomnia
Agitation
Abnormal Dreams
Anxiety
HTN
67
Q

Withdrawal Issues

A

SSRIs and SNRIs are not addictive but abrupt cessation can cause withdrawal-type symptoms

68
Q

Withdrawal-type symptoms

A 
Nausea
Headache
Dizziness
Lethargy
Flu-like symptoms
69
Q

When do withdrawal symptoms occur?

A

2-3 days post-discontinuation

70
Q

High risk drugs for withdrawal like symptoms

A

Paroxetine

Venlafaxine

71
Q

Bupropion is a

A

Norepinephrine/Dopamine Reuptake Inhibitor

72
Q

Buproprion Forms and Names

A

Immediate release, sustained release, extended release, Zyban™ versus Wellbutrin™

73
Q

ADRs of Bupropion

A

Seizure threshold lowering so…

Anaphylactic reactions

74
Q

One factor to note when prescribing Buproprion is

A

Shorter time of onset of action.

75
Q

Bupropion works at

A

nicotinic receptor site.

76
Q

Mirtazapine (Remeron) is a

A

Serotonin Antagonist

77
Q

MOA of Mirtazapine

A

Blocks multiple receptors accounting for therapeutic effects and side effects.

78
Q

Onset of activity in Mirtazapine…

A

… may be faster.

79
Q

Is Mirtazapine tolerated in the elderly?

A

Maybe?

80
Q

Adverse Side Effects of Mirtazapine

A

Appetite Increase
Drowsiness
Cholesterol Increase

81
Q

People sometimes use Remeron in elderly people to…

A

increase appetite.

82
Q

Serotonin Modulators

A

Trazodone
Vilazodone
Nefazodone

83
Q

Seratonin modulators are associated with…

A

… hepatotoxicity.

Illegal in all other countries.

84
Q

ADRs of seratonin modulators

A

Drowsiness
Hypertension
Weight gain

85
Q

Trazodone side effect

A

Incredible Drowsiness

86
Q

What can be used as an add on therapy to an SSRI?

A

Trazodone

Augmentation therapy which is done by a psychiatrist.

87
Q

Are all antidepressants equally effective?

A

YES!!

88
Q

Which antidepressant do you choose?

A

Lower incidence of adverse events with newer agents has been seen as an advantage

89
Q

Overall efficacy of antidepressants

A

Overall efficacy

60% to 70% response rate

Improvement may be seen in 1 to 2 weeks with maximum effect seen in 4 to 6 weeks

90
Q

What can be seen with all antidepressants?

A

Increased risk of suicidal thoughts and behaviors in children, adolescents and young adults

Covers all antidepressants that were or will be on the U.S. market agents

Study in latter 2006 showed that antidepressant use may protect against completed suicide in children and adolescents

Higher rates of SSRI prescriptions associated with lower rates of suicide (ages 5 through 12)

91
Q

Depression in the Elderly

A

7 million of the nation’s seniors have depression and 1 million suffer with major depressive disorder

In women 1% prevalence; men 0.4%

Minor depression in the elderly is more prevalent than MDD

15-25% of minor depressions evolve into a major depressive episode within 2 years

Suicide risk in the elderly

92
Q

Preferred antidepressant agents in the elderly

A

Sertraline

Bupropion (extended release)

Citalopram - The agents help avoid many of the common problematic drug interactions

93
Q

Results of antidepressant therapy in the elderly

A

Partial treatment effect within 3 to 4 weeks; full therapeutic response may take months

94
Q

Select antidepressant based on

A 
Past treatment history
Likelihood of adverse effects
Patient preference
Overdose toxicity
Cost
95
Q

What do you do when you have therapeutic failure with an antidepressant?

A

Try an agent in same or different class
-Up to 50% response rate to second agent possible
Combination therapy

96
Q

Theories of why antidepressants work

A

You get the edge needed to help for mild depression.

Give drugs to those with severe depression.

Give it a shot!!

Pharmacology II Quiz 6 (5 decks)

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