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Pharmacology Test 2 > Depression > Flashcards

Depression Flashcards

1
Q

Depression

A
  1. Symptoms associated w/ depression include:
    - Sad, despondent mood, lack of energy
    - sleep disturbances, abnormal eating pattern
    - feelings of despair, guilt, hopelessness
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2
Q

Postpartum Depression

A

Intense mood changes associated w/ hormonal changes

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3
Q

Seasonal Affective Disorder (SAD)

A

Enhanced release of melatonin due to lower light levels

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4
Q

Psychotic Depression

A

Intense mood shifts; unusual behaviors

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5
Q

Major Depressive Disorder

-Dx

A

In order to dx depression, there must be a depressed affect + 5 of the following symptoms for a minimum of 2 weeks:

  1. difficulty sleeping or sleeping too much
  2. Extremely tired; w/out energy
  3. Vague physical symptoms
  4. Inability to concentrate or make decisions
  5. Feelings of despair, guilt, misery; lack of self worth
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6
Q

Treatment of Depression

A

Severe depressive illness requires both

MEDICATION & PSYCHOTHERAPY

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7
Q

Role of the Nurse

-Depression

A
  1. Rule out medical and neurologic causes
  2. Ask about alcohol and drug use; suicidal ideation
  3. Obtain family hx of depressive illness
  4. Obtain drug hx
  5. Obtain V/S, liver & renal function tests, cardiovascular status, body weight
  6. Monitor therapeutic blood levels
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8
Q

Anti-Depressant Drugs

-General Points

A

Depression is a chemical imbalance involving: Serotonin, Dopamine, Norepinephrine

  1. Avoid alcohol w/ meds
  2. Takes 1 to 4 weeks for therapeutic effect
  3. NEVER discontinue abruptly
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9
Q

Anti-depressants

-What to monitor??

A
  1. V/S
  2. Neuro and cardio status
  3. Underlying psychoses
  4. Liver function and hematologic status
  5. Pt safety
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10
Q

Foods Containing Tyramine

A
  1. Avocados, Bananas, Raisins
  2. Cheese
  3. Beer & wine
  4. Beef or chicken liver, Pepperoni
  5. Fava Beans
  6. Soy Sauce & Yeast
  7. CHOCOLATE
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11
Q

Tricyclic Antidepressants

-Mechanism of Action

A
  1. Decrease reabsorption of norepinephrine and serotonin
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12
Q

Tricyclic Anti-depressants

-Used For:

A
  1. Major depressive episodes
  2. Panic disorders
  3. OCD
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13
Q

Tricyclic Anti-depressants

-Examples

A
  1. amitriptyline (Elavil)

2. doxepin (Sinequan)

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14
Q

Tricyclic Anti-depressants

-Contraindications

A
  1. Severe coronary artery disease CAD
  2. Cardiac dysrhythmias
  3. BPH
  4. Narrow Angle Glaucoma
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15
Q

Tricyclic Antidepressants

-Adverse effects

A

OVERDOSE IS USUALLY LETHAL
(Sympathetic Effects)
1. Dry mouth, tremors, headache, weight gain
2. Urinary difficulty, constipation, blurred vision
3. Seizures

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16
Q

Tricyclic Anti-depressants

-Patient Teaching

A
  1. Takes 2-4 weeks to achieve therapeutic effect
  2. Orthostatic hypotension
  3. SUCK ON CANDY OR CHEW GUM FOR DRY MOUTH
  4. Administer at bed time
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17
Q

SSRI

A 
Selective Serotonin Reuptake Inhibitors 
(1st line medication)
1. Decreases REM sleep
2. Potentiates opioid analgesics 
3. Inhibit appetite 
4. DO NOT USE W/ MAOI's
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18
Q

SSRI

-Examples

A

Tolerated by Elderly due to fewer side effects

Prozac
Paxil
Zoloft
Celexa
Lexapro
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19
Q

SSRI

-Adverse effects

A

Very few undesirable effects

-Agitation, anxiousness, overstimulation, insomnia, jitteriness

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20
Q

SSRI

-Patient Teaching

A
  1. Do not start w/in 2 weeks of MAOIs
  2. Avoid use of alcohol, OTC, and herbs
  3. Monitor liver function and seizure disorders
  4. Takes 1-4 weeks to achieve therapeutic effect
21
Q

MAOI

A

Monoamine Oxidase Inhibitor
1. Very effective (Second line agents)

  1. Main drawback is HYPERTENSIVE CRISIS
22
Q

MAOI

-contraindications

A
  1. Impaired Renal or Hepatic function
  2. CAD, CHF
  3. Hypertension
  4. Foods containing TYRAMINE & CAFFEINE
  5. Pregnancy and lactation
23
Q

MAOI

-Adverse effects

A
  1. Orthostatic hypotension
  2. Weight gain, Edema
  3. Sexual dysfunction
  4. Foods high in TYRAMINE & CAFFEINE can lead to HYPERTENSIVE CRISIS
24
Q

MAOI

-Patient Teaching

A
  1. Monitor for Suicidal Ideation
  2. Monitor for Hypertensive crisis
  3. Avoid foods high in tyramine and limit caffeine
  4. Avoid alcohol
  5. Change position slowly
  6. Takes 1-4 weeks to achieve therapeutic effect
25
Q

Wellbutrin, Effexor

-Indications

A
  1. Inhibits the reuptake of dopamine

2. Blocks serotonin and norepinephrine reuptake

26
Q

Wellbutrin, Effexor

-Contraindications

A
  1. Hx of head trauma & CNS tumor
  2. Seizure disorder
  3. Heart attack or unstable angina
  4. Hepatic or renal insufficiency
  5. Pregnancy and Lactation
27
Q

Wellbutrin, Effexor

-Adverse Effects

A
  1. Nausea, decreased appetite, dry mouth, weight loss
  2. Agitation and anxiety (CNS stimulation)
  3. SEIZURE ACTIVITY
  4. Headache, tremor, insomnia
28
Q

Wellbutrin, Effexor

-Pt Teaching

A
  1. Monitor for suicidal ideation

2. Monitor for hypertensive crisis

29
Q

Anxiolytics

A
  1. Drugs having ability to relieve anxiety

2. Used when anxiety begins to significantly affect daily activities

30
Q

Classes of Med’s used to treat:

-Anxiety & Sleep Disorders

A
  1. Antidepressants
  2. Benzodiazepines
  3. Barbiturates
  4. Nonbenzodiazepine/nonbarbiturate CNS depressants
31
Q

CNS Agents used to treat Anxiety and Insomnia

A

2 Major Classes:

  • Benzodiazepines
  • Barbiturates
32
Q

Sedatives

A

Ability to sedate or relax a patient

33
Q

Hypnotics

A

ability to induce sleep

34
Q

Sedative-hypnotic:

A

Calming effect at lower doses and sleep at higher doses

35
Q

Anti-anxiety medication

-Cautions

A
  1. Elderly
  2. Suicidal Potential
  3. Impaired renal or liver function
36
Q

Insomnia

A

Acts of sleeping and waking synchronized to many different bodily functions
Insomnia sometimes associated with anxiety

37
Q

Short-term Insomnia

A
  1. Short term or behavioral insomnia sometimes attributed to stress
38
Q

Long-Term Insomnia

A
  1. Long-term insomnia often caused by depression, manic disorders, chronic pain
  2. NONPHARMACOLOGIC means should be attempted prior to drug therapy
39
Q

Rebound Insomnia

A
  • Caused by discontinuation of long-used sedative drug

- Older pt’s more likely to experience medication-related sleep problems

40
Q

Electroencephalogram (EEG)

A

Tool used for Dxing sleep disorders, seizure activity, depression, and dementia

Identifies two types of sleep:

  1. NREM
  2. REM
41
Q

Normal Sleep Pattern

A

Involves REM and NREM

  1. Occur every 90 minutes
  2. NREM sleep 4 stages
  3. REM sleep follows NREM sleep
  4. Dreams occur in REM sleep
42
Q

NREM Stage 1

A
  1. Stage of drowsiness lasts between 1 and 7 min

2. Pt can be easily awakened

43
Q

NREM stage 2

A

Pt can still be easily awakened

45% to 55% of total sleep time

44
Q

Stage 3 NREM

A

Move into or out of deeper sleep

  1. Heart rate and BP fall
  2. GI activity rises
45
Q

NREM Stage 4

A
  1. Deepest stage of sleep
  2. Nightmares occur in children
  3. Sleepwalking is also common in this stage
  4. HR and BP remain LOW. GI activity remains high
46
Q

REM Sleep

A
  1. Characterized by eye movement and loss of muscle tone
  2. Dreaming takes place
  3. Mind is very active and resembles a normal waking state
47
Q

Stage 4 NREM

-Sleep Deprivation

A
  1. Pt’s deprived of stage 4 NREM sleep experience depression, apathy and fatigue
48
Q

REM sleep deprivation

A

Lack of REM sleep causes Sleep debt

-Pt becomes frightened, irritable, paranoid, and even emotionally disturbed

Pharmacology Test 2 (10 decks)

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