Depression and Anxiety with special topic of Alzheimer's Dementia Flashcards
Explain the pathophysiology of Alzheimer dementia as we know it, including neurofibrillary tangles, amyloid plaques, β amyloid, and the neurotransmitter acetylcholine synthesis.
tangles: these are fibrous proteins (tau protiens) wound around each other in a helical fashion. resist chemical/enzymatic breakdown and persist long after the neuron they came from has gone.
Beta amyloid plaques: deposits of amyloid beta in the brain-BAD. ASK BEGAY
neurotransmitter acetylcholine synthesis: Acetylcholine (ACh), a neurotransmitter essential for processing memory and learning, is decreased in both concentration and function in patients with Alzheimer’s disease.
Differentiate Alzheimer’s from other dementias.
Dementia is the term applied to a group of symptoms that negatively impact memory, but Alzheimer’s is a specific progressive disease of the brain that slowly causes impairment in memory and cognitive function.
vascular=decreased in blood flow to the brain
Parkinson’s=lewy body dementia (build up of lewy body proteins making signals hard to get across neurons, like the plaques)
Frontotemporal dementia is a name used to describe several types of dementia, all with one thing in common: They affect the front and side parts of the brain, which are the areas that control language and behavior.
Mixed dementia refers to a situation where a person has more than one type of dementia. Mixed dementia is very common, and the most common combination is vascular dementia and Alzheimer’s.
List possible risk factors for Alzheimer dementia.
increasing age
family hx–genetics
people with down syndrome because of the change on chromosome 21
List clinical signs of Alzheimer dementia and differentiate these from aging.
loss of short term memory, difficulty with language, and changes in behavior.
aging has some of these changes, but alzheimer’s is a lot more pronounced, and it it’s a lot more inappropriate. Furthermore, the symptoms stay constant over a period of time–eg. constantly forgetting words or etc.
this one is hard to explain, you just kind of have to know.
Define major depression & how it differs from Anxiety Disorder
major depression: loss of interest in previously enjoyed activities, resist attempts to engage in those activities. suicidal thoughts, lack of appetite, inability to concentrate, difficulty/inability to make decisions, feelings of worthlessness.
diagnosing criteria: presence of symptoms most of the day nearly every day on a level significant enough to interfere with normal functioning.
major depression differs from anxiety disorders because while they can coincide,
Explain the Neurophysiology of symptoms in anxiety (see Porth, p.533)
anxiety disorders are thought to be caused by an interaction of multiple biologic and psychosocial factors. the major mediators appear to be GABA, NE, serotonin, and dopamine.
The autonomic system (somatic nervous system) is involved in the stress response.
panic is thought to be related to hyperactive amygdala, limbic, and cortical prefrontal cortex involvement.
Describe the mechanism of action, therapeutic use, and adverse effects including nursing patient education for the following drugs:
Floxetine (PROZAC)
mechanism of action: selective blockade of serotonin, and this blockade increases serotonin which gives relief of symptoms.
therapeutic use: antidepressant
ae’s: sexual dysfunction, weight gain, serotonin syndrome, withdrawal, neonatal risks (neonatal abstinence syndrome and persistent pulmonary hypertension of the newborn)
SUICIDE RISK
patient education: advise family members and caregivers to monitor for symptoms of clinical decline (anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, hypomania, emergence of suicidal thoughts. IMMEDIATELY report symptoms that are severe or develop abruptly.
inform patient that antidepressant effects usually develop slowly over one to three weeks. educate patients about the importance of taking their medication as prescribed, even though they may feel ‘cured’
warn patients to continue tx once mood has improved–relapse.
inform patients about sexual dysfunction (anorgasmia, impotence, decreased libido) and encourage them to report problems. Inform patients about possible dizziness and fatigue while using SSRIs, and advise them to use caution when performing hazardous tasks, like driving.
inform patients about the risk of rash and instruct them to notify the prescriber.
inform patients about the risk of bruxism and the symptoms and signs of that (headache, jaw pain, dental problems–cracked fillings).
Describe the mechanism of action, therapeutic use, and adverse effects including nursing patient education for the following drugs:
Bupropion (WELLBUTRIN)
MOA: bupropion acts via dual inhibition of norepinephrine and dopamine reuptake, which constitutes a novel mechanism of antidepressant action.
therapeutic use: antidepressant
ae’s: generally well tolerated. Common side effects are: agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, tachycardia.
small risk of psychotic symptoms (hallucinations and delusions)
increase suicide risk
NO adverse sexual effects.
seizures are of great concern. avoid by: avoiding doses over 450mg/day (seizure risk) , avoiding rapid dose titration, avoiding drugs that can inhibit CYP2B6, which can elevate bupropion levels, avoiding it’s use in patients that have seizure risk factors: head trauma, pre-existing seizure disorder, CNS tremor, and use of other drugs that lower seizure threshold.
pt. education:
advise family members and caregivers to monitor for symptoms of clinical decline (anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, hypomania, emergence of suicidal thoughts. IMMEDIATELY report symptoms that are severe or develop abruptly.
inform patient that antidepressant effects usually develop slowly over one to three weeks. educate patients about the importance of taking their medication as prescribed, even though they may feel ‘cured’
warn patients not to continue tx once mood has improved–relapse.
significance of SSRIs
ease of dosing, low toxicity, efficacious.
