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depression Flashcards

1
Q

what are the nerve cells of the brain

A

neurons and glial cells

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2
Q

dienacephalon

A

made up of thalmus and hypothalmus

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3
Q

medulla oblongata

A

regulates cardiovasculature, digestive tract, and respiratory tract

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4
Q

cerebellum

A

coordinates motor stimulations and controls posture

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5
Q

limbic system

A

pre frontal cortex,thalmus, hypothalmus, temporal lobe, and these structures: amygdala, hypocampus, nucleus acumbens: regulates emotional responses

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6
Q

amygdala

A

emotions (example, hipocampus decides what emotions will go with what situations)

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7
Q

hipocampus

A

learning and memory consolidations (feeds into the amygdala what is remembered from past experiences with situations)

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8
Q

nucleus accumbens

A

reinforcement of behaviors

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9
Q

what occurs in the post synaptic membrane

A

receptor binding

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10
Q

what neurotransmitters are monoamines

A

DA,NE, epinephrine, seritonin (from trytophan) , histamine

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11
Q

what neurotransmitters are catacholamines

A

DA and NE from tryosine

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12
Q

what kind of receptor is 5-HT, D, and adrenergic

A

G coupled, increase cAMP or Ca (excitatory)

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13
Q

un-coupling

A

kinase on the G receptor is phosphorylated so that G proteins can’t be activated

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14
Q

receptor down regulation

A

receptor is endocytosed and degraded

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15
Q

monoamine theory

A

a decrease in available monoamines causes synaptic connections to be rerouted or lost, this is supported because drugs that increase the amount of monoamines in the cleft help reverse depression

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16
Q

HPA theory

A

increased cortisol and CRH. increased cortisol damages hipocampus so it can’t inhibit CRH so more CRH and more cortisol is made.CRH can inhibit an emotional response in the amygdala and nucleus accumbans. This plus repeated stress causes depression

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17
Q

effect of long term reuptake inhibition

A

autoreceptor signaling is decreased, biosynthesis of monoamines is increased, and post synaptic receptor are down regulated

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18
Q

whats the biggest sign of depression in kids

A

anhedonia, loss of interest

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19
Q

what are the diagnostic symptoms of depression

A

Depression, Interest, Guilt, Energy, Sleep, Concentration, Appetite, Suicidal ideation (5+ symptoms with at least one being depression or loss of interest)

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20
Q

goals of acute phase

A

remession, 3 weeks without depression and no more than 3 symptoms

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21
Q

goals of continuation phase

A

prevent relapse

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22
Q

goals of maintenence phase

A

prevent new episode or reoccurence

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23
Q

vortioxetine

A

SSRI

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24
Q

tranylcypromine

A

MAOI

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25
Q

levomilnacipran

A

SNRI

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26
Q

Imapramine

A

TCA

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27
Q

Which of the following has the most severe side effects:

Paroxitine, vortoxitine, levomilnacipran, desimapramine

A

desimapramine

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28
Q

which can’t be taken with hard cheese: selgeline, levomilnacipran, imapramine, vortioxetine, vilazadone

A

selgeline

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29
Q

what’s the Pgp do?

A

pumps things, like drugs, back out of the brain

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30
Q

what are the secondary ways that reuptake inhibitors may help depression

A

increase cAMP thus increasing growth of neurons, increase BDNF, down regulating post synaptic receptors

31
Q

what is known about antidepresents mechanisms

A

they increase amount of monoanimes in the post synaptic cleft and they cause secondary effects that help

32
Q

what causes a greater chance of withdrawl in antipsychotic drugs

A

shorter half lives

33
Q

anxiety, crying spells, insomina, nausea, vomitting, parasethias, and flu like symptoms (FINISH)are what

A

seratonin withdrawl symptoms

34
Q

this SSRI is an enatmerically pure form of another SSRI

A

ecitalopram

35
Q

at low doses this SNRI is an SSRI

A

venlefaxine

36
Q

which class of drugs can increase BP

A

SNRI

37
Q

BK has narrow-angle glaucoma, which drug can he not take

A

levomilacipran

38
Q

which TCA’s have a higher affinity for serotonin

A

amytriptylan and imapramine

39
Q

which TCA’s have a higher affinity for NE

A

nortryptylan and desimapramine

40
Q

which drugs should not be taken if patient has cardiovascular problem

A

TCA’s, MAOI’s, mirtazapine and duloxetine

41
Q

if BK is having suicidal thoughts what main drug type should he stay away from and why

A

TCA, has a smaller therapeutic window then others

42
Q

what is mertazapines mechanism of action

A

5-HT and adrenergic antagonist, potent H1 inhibitor, low muscarinic effect

43
Q

weight gain is probably from antagonizing which receptor

A

H1

44
Q

which antipsychotic can be used for nicotine cessation

A

buproprion

45
Q

what is buproprions mechanism

A

unknown but appears to block reuptake

46
Q

which medication should be avoided with seizures

A

buproprion

47
Q

which med should be avoided in alcohol withdrawl, or eating disorders

A

buproprion

48
Q

what are the phenylpipridines

A

nefazadone, vilaxadone

49
Q

what is the triazlopropridine

A

trazdone

50
Q

what is the mechanism of trazadone and nefazadone

A

they block 5 ht

51
Q

what is the mechanism of vilaxadone

A

it is an agonist at 5 ht

52
Q

MAOI’s ______ inhibit MAO

A

irreversibly

53
Q

when switching from selgeline to amytriptaline how long should you wait

A

2 weeks

54
Q

when switching from paroxitine to tranycloprimine you should wait

A

2 weeks

55
Q

when switching from fluoxetine to phenelizine you should wait

A

5 weeks

56
Q

which SNRI is metabolized by the kidney

A

levomilnacipran

57
Q

which drugs go through glucoronidation

A

SNRI’s, TCA’s, and mirtazapine

58
Q

what does 2B6 metabolize

A

buproprion and MAOI’s

59
Q

which drugs would need to be decreased or avoided if a patient is a poor metabolizer?

A

SNRI, TCA, and mirtazapine

60
Q

who are the major 2D6 inhibitors

A

Vortioxetine, fluoxetine, paraxetine, duloxetine, buproprion

61
Q

who are the major 2C ihibitors

A

Sertraline

62
Q

why can’t MAOI’s be taken with tryamine foods (hard cheese, pickled foods, wines)

A

tryamine is a precourser to catalcholamines so it would cause serotonin syndrome, worst with MAO-A

63
Q

best meds for insomnia and depresssion

A

TCA and mirtazapine

64
Q

what med is best for migraines

A

amtriptalyn

65
Q

what med is best for pain

A

duloxitine

66
Q

which med is use adjuctively for insomnia

A

trazadone

67
Q

what meds can be used as add on

A

alpipramine, olonzapine, quatrapine, buprorion, mirtazapine

68
Q

when should patients fill out the rating scale

A

beginning, 6-8 weeks, then periodacly

69
Q

what are symptoms of serotonin syndrome

A

tremor, myoclunus, hyperreflexia, hyperpyrezxia, tachycardia, tachypina, diaphorisis, mydridis, agitation, anxiety, confusion

70
Q

weight gain

A

TCA’s, MAOIs mirtazapine

71
Q

best for not getting sexual dysfunction

A

buproprion, mirtazapine

72
Q

considerations for elderly

A

starting does cut in half, SSRI’s can mess with antiplatelet drugs, can take up to 12-16 weeks to work

73
Q

pregnancy

A

fluoxetine, citalpram, TCA

74
Q

how does vortioxetine work

A

inhibits reuptake of serotonin and is also an agonist, partial agonist, and antagonist at different 5-ht receptors

depression (3 decks)

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