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Pharm 323 Spring 22 > Depression + Bipolar > Flashcards

Depression + Bipolar Flashcards

1
Q

what are some overall nursing considerations for antidepressants? (5)

A
  1. slow onset: 1-3 weeks; max 12
  2. wean off
  3. no PRN use
  4. suicide risk: mostly seen with <25 yrs old
  5. start low + go slow
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2
Q

what are the 3 monoamine neurotransmitters?

A

norepinephrine, serotonin + dopamine

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3
Q

what will you see with changes in both biochemistry + symptoms with antidepressants? (referring to time frame)

A

biochemistry: quick changes
symptoms: slow changes

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4
Q

what are the 5 classes of antidepressants?

A
  1. SSRIs
  2. SNRIs
  3. tricyclic antidepressants
  4. MAOIs
  5. atypical antidepressants
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5
Q

what antidepressant drug class tends to be our 1st line? (b/c of SE profile)

+ what would be our last choice drug class?

A

SSRIs

last = MAOIs

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6
Q

what is our SSRI prototype?

A

fluoxetine (Prozac)

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7
Q

what is the MOA of fluoxetine?

A

slow reuptake of serotonin into presynaptic nerve terminals = MORE serotonin in synaptic cleft

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8
Q

what antidepressant has the BEST safety profile? (w/same efficacy as the others) <3

A

SSRIs

fluoxetine

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9
Q

what is most prominent + significant SE of SSRIs?

A

sexual dysfunction

“Sex Sucks with an SSRI”

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10
Q

aside from sexual dysfunction, what are some other SE of SSRIs? (5)

A
  1. weight gain (when nausea resolves)
  2. anxiety
  3. insomnia
  4. nervousness
  5. nausea

“you want to WAINN off of SSRIs”

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11
Q

should SSRIs be used in pregnancy?

A

not late in pregnancy - can cause pulmonary HTN + withdrawal in infant

*can they be used earlier in pregnancy?? if you know will you send me an edit to this card

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12
Q

with SSRI use, patients are at an increased risk of what?

A

bleeding (esp. GI)

-older adults, hx of GI bleed, anticoag or NSAID use increases this risk

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13
Q

what is serotonin syndrome?

A

getting too much serotonin - from taking multiple meds that affect synthesis or reuptake of serotonin - LIFE THREATENING

LONG LIST OF MEDS!!

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14
Q

when can serotonin syndrome occur?

A

2-72 hours after treatment starts

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15
Q

what are the s+s of serotonin syndrome? (5)

A
  1. mental status change
  2. tremors
  3. fever + sweating
  4. HTN
  5. ataxia
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16
Q

what is tx for serotonin syndrome?

A

STOP the SSRI + give supportive therapies (aimed at treating the symptoms - orientation, keep patient safe/fall precautions, antipyretic, keep linens dry, antihypertensives)

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17
Q

what are s+s serotonin withdrawal syndrome? (7) + why does it happen?

A

b/c of abrupt discontinuation….

  1. dizziness
  2. HA
  3. nausea
  4. sensory disturbances
  5. tremor
  6. anxiety
  7. dysphoria (“general unhappiness with life”)
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18
Q

when can serotonin withdrawal syndrome occur? + how long can it last? (time frame)

A

most symptoms start 1-3 days after cessation of drug

can last: WEEKS

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19
Q

how can we prevent serotonin withdrawal syndrome?

A

slowly taper drug + educate patient on this!

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20
Q

what is the prototype of SNRIs?

A

venlafaxine (Effexor)

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21
Q

what is the MOA of venlafaxine?

A

block reuptake of serotonin + norepinephrine

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22
Q

what are the SE of venlafaxine?

A
  1. nausea
  2. HA
  3. HTN
  4. nervousness
  5. insomnia
  6. somnolence
  7. sweating

“SNRI: Sweating, Somnolence, Sexual dysfunction, Nervousness, Nausea, Raging blood pressure, Insomnia + HA”

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23
Q

what is the MOA of imipramine?

A

inhibit reuptake of serotonin + norepinephrine

(also blocks ACh receptors and/or histamine + also has an effect on alpha 1 receptors - why we see orthostatic hypotension)

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24
Q

what is prototype of tricyclic antidepressants?

A

imipramine

“ines”

25
when are tricyclic antidepressants usually scheduled? why?
at bedtime - can cause sedation
26
what SE of tricyclic antidepressants is common during initial treatment?
sedation
27
what are SE of tricyclic antidepressants? (3 - 1 broad, 2 specific)
1. sedation 2. orthostatic hypotension 3. anticholinergic: can't pee, can't see, can't spit, can't shit (you can't pee, shit etc + be dizzy and tired while you ride your TRICYCLe)
28
what antidepressant is associated with a high risk of overdose - large doses are lethal and can cause cardiac toxicity (avoid with suicidal patient)?
tricyclic antidepressants "you don't want IMI to run into OVERDOSE rock while he's riding his TRICYCLe, or it could be deadly!!"
29
what drug-drug interactions occur with tricyclic antidepressants (broad, not specific)? (3)
1. MAOIs 2. sympathomimetics 3. anticholinergics *duh MAOIs b/c they suck with everything, the other 2 are essentially acting on the same NT b/c tricyclics block ACh*
30
what effect would you see with someone on tricyclic antidepressants + other CNS drugs?
increased sedation/CNS effects
31
what is MAO?
enzyme that converts our MAO NTs into active products; is also in foods (which explains the drug-food interactions b/c liver needs MAOs to break down MAO foods)
32
what is MOA of MAOIs? (say that 5 times fast)
inhibit breakdown of NE + dopamine + serotonin
33
how long does the action of MAOIs last?
the "lifetime" of the neurotransmitter - 2 weeks
34
when can you see full effect of MAOI use?
4-8 weeks MAOI=4 letters=4 weeks
35
what are the 4 prototypes for MAOIs? *KNOW THEM ALL*
SPIT: 1. Selegiline 2. Phenelzine 3. Isocarboxiazide 4. Tranylcypromine
36
what AE comes from the drug-food interactions between MAOIs + tyramine foods?
hypertensive crisis
37
how long is the washout period between MAOIs and new drugs [that could interact with MAOIs]?
14 days "MA, OI! NO NEW FRIENDS for 14 DAYS!!!"
38
name some tyramine foods that interact with MAOIs?
all the good things... avos, caffeine, wine, aged cheeses, meats, bananas, chocolate, yogurt, fava beans
39
what is the prototype for atypical antidepressants?
bupropion (Wellbutrin)
40
bupropion is similar in structure to what?
amphetamine
41
what are the pros of bupropion? (2)
1. no weight gain 2. no sexual dysfunction (can actually increase) "get skinny + have sex with buproprion!!"
42
what are the SE of buproprion?
1. HA 2. agitation 3. psychotic symptoms 4. SEIZURES "i just HAPSened to take a buproprion" (think, it's similar in structure to amphetamine)
43
patients with which disorder should avoid use of bupropion?
seizure disorders (SE of bupropion is seizures)
44
what is DOC for bipolar?
lithium
45
what is lithium known as? (therapeutic class)?
mood stabilizer
46
what is the therapeutic range for lithium? what is optimal?
0. 4-1.0mEq/L | 0. 4-0.8 is BEST <3
47
TOXIC levels are seen at what number for lithium?
1.5 mEq
48
lithium acts like ______; what scenarios r/t this would we see an increased risk of lithium toxicity? (5)
salt - when Na is low in the body, it will hold onto lithium to compensate 1. diarrhea 2. dehydration 3. poor oral intake 4. diuretics 5. acute renal failure
49
what are the s+s of lithium toxicity? (6)
1. tremors 2. N/V 3. polyuria 4. muscle weakness 5. ataxia 6. EKG changes ...can lead to convulsions, coma, death
50
how do we treat lithium toxicity?
we just manage symptoms; unless > 2.5, we can give dialysis
51
AE of lithium (a fuck ton - 7)
1. GI: N/V/D 2. HYPOthyroidism + goiter 3. tremors 4. renal damage 5. polyuria 6. edema 7. birth defects
52
how can we mitigate the AE of GI disturbances with lithium?
give with food + split up doses
53
how could we mitigate hand tremors with lithium use? (2 options)
1. lower dose | 2. give with BB
54
what nursing intervention would you implement for patient with polyuria on lithium therapy?
encourage good oral intake of fluids + monitor their levels
55
what drug-drug interactions exist with lithium? (2)
1. NSAIDS - can impact kidneys + therefore toxicity | 2. diuretics - can increase risk of toxicity
56
MAOI + antidepressant/sympathomimetic = ? (drug-drug interaction effect)
HTN crisis
57
MAOI + antihypertensive = ? (drug-drug interaction effect)
EXCESSIVE HYPOtension
58
MAOI + antidiabetic = ? (drug-drug interaction effect)
hypoglycemia
59
MAOI + meperidine = ? (drug-drug interaction effect)
hyperpyrexia

Pharm 323 Spring 22 (18 decks)

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