Depression and BPD

Question 1

causes predisposing to depression

Answer 1

blood relatives with depression
trauma/stress/death in family/financial trouble
major life changes
medical problems
certain medications
alc/drug use

Question 2

depression hypotheses: monoamine

Answer 2

decreased brain levels of NE, serotonin, dopamine

Question 3

depression hypotheses: postsynaptic changes in receptor sensitivity

Answer 3

desensitization/downregulation of NE/5HT receptors

Question 4

depression hypotheses: dysregulation

Answer 4

failure of homeostatic NT regulation
no absolute increase or decrease in NT activity

Question 5

tricylics

Answer 5

amitriptyline
nortriptyline
older, now second line

Question 6

monoamine oxidase inhibitor: list

Answer 6

moclobemide
older, now second line

Question 7

SSRIs list

Answer 7

fluoxetine
sertraline
citalopram
escitalopram

Question 8

SNRIs list

Answer 8

duloxetine
venlafaxine
desvenlafaxine

Question 9

NDRI: NE and dopamine reuptake inhibitor

Answer 9

bupropion/wellbutrin

Question 10

antidepressant MOA

Answer 10

prlong effects of amine NTs by inhibiting NT reuptake (new)
autoreceptor blockade
decreasing NT breakdown

Question 11

side effects of TCAs

Answer 11

sedation
anticholinergic: confusion/delerium, dry mouth, constipation, urinary retention, tachycardia, confusion
OH
arrhythmias

Question 12

MAO inhibitor side effects

Answer 12

CNS excitment: restlessness, agitation, sleep loss, irritability
increased BP
food drug interactions with tyramine containing foods

Question 13

side effects of 2nd generation antidepressants
including SSRIs, etc

Answer 13

GI
sexual side effects
less sedation
OH
arrhythmia
anticholinergic

Question 14

serotonin syndrome

Answer 14

overstimulation of serotonin receptors

Question 15

serotonin syndrome s/s

Answer 15

mild: mydriasis, shivering, sweating, tachycardia
mod: altered mental status, autonomic, neuromuscular tremor/clonus
severe: delirium, HTN, hyperthermia, muscle rigidity, tachycardia

Question 16

antidepressants mechanism for chronic pain

Answer 16

effect on CNS monoamine NTs, esp serotonin

Question 17

brexanolone MOA

Answer 17

antidepressant by allosteric modulation of GABA A receptors to increase 5HT and NE transmission

Question 18

brexanolone indications

Answer 18

post partum depression, IV infusion

Question 19

side effects of brexanolone

Answer 19

headache, dizzines, somnolence

Question 20

drugs for manic episodes in BPD

Answer 20

lithium *best for euphoric mania
divalproex

Question 21

drugs for depressive episodes in BPD

Answer 21

lithium
lamotrigine
aripiprazole
quetiapine
risperidone

Question 22

lithium MOA

Answer 22

neuroprotection
NT modulation
cellular inhibition of inositol phosphate 3

Question 23

side effects of lithium

Answer 23

acute: nausea, diarrhea, lethargy, impaired cog fx, hand tremor
long term: hypothyroidism, cardiac, weight gain, leukocytosis, acne/psoriasis

Question 24

PT considerations for antidepressants

Answer 24

lag time on beneficial effects
sedation, lethargy, muscle weakness
OH
increased BP w MAO inhibitors
exercise tolerance decreased
increased risk of suicide