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Pharm 323 - Royce > 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

“SSRI = Sex Sucks”

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10
Q

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

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

days to weeks after cessation of drug –> can last 1-3 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
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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

24
Q

what is prototype of tricyclic antidepressants?

A

imipramine

“ines”

25
Q

when are tricyclic antidepressants usually scheduled? why?

A

at bedtime - can cause sedation

26
Q

what SE of tricyclic antidepressants is common during initial treatment?

A

sedation

27
Q

what are SE of tricyclic antidepressants? (2 - one broad, one specific)

A
  1. anticholinergic: can’t pee, can’t see, can’t spit, can’t shit
  2. orthostatic hypotension
    (you can’t do all of those things while you’re riding your bike)
28
Q

what antidepressant is associated with a high risk of overdose - large doses are lethal and can cause cardiac toxicity (avoid with suicidal patient)?

A

tricyclic antidepressants

29
Q

what drug-drug interactions occur with tricyclic antidepressants (broad, not specific)?

A
  1. MAOIs (duh they suck with everything)
  2. sympathomimetics
  3. anticholinergics
30
Q

what effect would you see with someone on tricyclic antidepressants + other CNS drugs?

A

increased sedation

31
Q

what is MAO?

A

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
Q

what is MOA of MAOIs? (say that 5 times fast)

A

inhibit breakdown of NE + dopamine + serotonin

33
Q

how long does the action of MAOIs last?

A

the “lifetime” of the neurotransmitter - 2 weeks

34
Q

when can you see full effect of MAOI use?

A

4-8 weeks

35
Q

what are the 4 prototypes for MAOIs?

KNOW THEM ALL

A

SPIT:

  1. Selegiline
  2. Phenelzine
  3. Isocarboxiazide
  4. Tranylcypromine
36
Q

what AE comes from the drug-food interactions between MAOIs + tyramine foods?

A

hypertensive crisis

37
Q

how long is the washout period between MAOIs and new drugs [that could interact with MAOIs]?

A

14 days

“MA, OI! NO NEW FRIENDS for 14 DAYS!!!”

38
Q

name some tyramine foods that interact with MAOIs?

A

all the good things…

avos, caffeine, wine, aged cheeses, meats, bananas, chocolate, yogurt, fava beans

39
Q

do we need to know what specific reaction we would see with MAOIs + specific drugs?

A

………

??? make an edit if you think so!

40
Q

what is the prototype for atypical antidepressants?

A

bupropion (Wellbutrin)

41
Q

bupropion is similar in structure to what?

A

amphetamine

42
Q

what are the pros of bupropion? (2)

A
  1. no weight gain

2. no sexual dysfunction (can actually increase)

43
Q

what are the SE of buproprion?

A
  1. seizures
  2. agitation
  3. HA
  4. psychotic symptoms
44
Q

patients with which disorder should avoid use of bupropion?

A

seizure disorders (SE of bupropion is seizures)

45
Q

what is DOC for bipolar (per Knowlton)?

A

lithium

46
Q

what is lithium known as? (therapeutic class)?

A

mood stabilizer

47
Q

what is the therapeutic range for lithium? what is optimal?

A
  1. 4-0.1 mEq/L

0. 4-0.8 is BEST <3

48
Q

TOXIC levels are seen at what number for lithium?

A

1.5 mEq

49
Q

lithium acts like ______; what scenarios r/t this would we see an increased risk of lithium toxicity?

A

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
50
Q

what are the s+s of lithium toxicity? (6)

A
  1. tremors
  2. N/V
  3. polyuria
  4. muscle weakness
  5. ataxia
  6. EKG changes

…can lead to convulsions, coma, death

51
Q

how do we treat lithium toxicity?

A

we just manage symptoms; unless > 2.5, we can give dialysis

52
Q

AE of lithium (a fuck ton - 7)

A
  1. GI: N/V/D
  2. HYPOthyroidism + goiter
  3. tremors
  4. renal damage
  5. polyuria
  6. edema
  7. birth defects
53
Q

how can we mitigate the AE of GI disturbances with lithium?

A

give with food + split up doses

54
Q

how could we mitigate hand tremors with lithium use? (2 options)

A

lower dose or give with BB

55
Q

what nursing intervention would you implement for patient with polyuria on lithium therapy?

A

encourage good oral intake of fluids + monitor their levels

56
Q

what drug-drug interactions exist with lithium? (2)

A
  1. NSAIDS - can impact kidneys + therefore toxicity

2. diuretics - can increase risk of toxicity

Pharm 323 - Royce (28 decks)

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