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Pharmacology > Depression, Bipolar Disorder, and Marijuana > Flashcards

Depression, Bipolar Disorder, and Marijuana Flashcards

1
Q

Define cannabis

A

Cannabis, also known as marijuana, is a plant first grown in Central Asia that is now grown everywhere. It is derived from Cannabis Sativa. The Cannabis plant makes a resin that contains compounds called cannabinoids (>100 compounds).

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2
Q

What schedule is Cannabis

A

Cannabis is a controlled substance that is a schedule I agent (high potential for abuse and no accepted medical use)

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3
Q

Define Cannabinoids

A

Cannabinoids, also known as phytoannaboids, are chemical in cannabis that causes drug-like effects in the body, including the CNS and immune system

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4
Q

what are the psychoactive cannabinoids? What do they do?

A
  1. Psychoactive cannabinoid (Delta-9-THC)
  2. Can cause a high, help treat the side effects of cancer and cancer treatment
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5
Q

What are non-psychoactive cannabinoids? What do they do to the state of mind? What are the therapeutic effects?

A
  1. Non psychoactive (CBD) (Cannabidiol) = NO HIGH
  2. CBD does not induce a high or alter a persons state of mind in the way that THC does
  3. CBD is extracted from HEMP (high levels of CBD and low levels of THC)
  4. CBD has potential therapeutic effects such as reduced anxiety, chronic pain, epilepsy, and sleep disorders
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6
Q

What is the indication for FDA approved Dronabinol (Marinol and Syndros)?

A

Stimulate appetite in patients with AIDS or cancer and counteract weight loss, mitigate nausea and vomiting associated with chemotherapy

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7
Q

What is the indication for FDA approved Nabilone (Cesamet)?

A

Used for nausea and vomiting caused by chemotherapy

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8
Q

What is the indication for FDA approved Cannabidiol (Epidiolex) (CBD)?

A

For seizure disorders associated with two rare and severe forms of epilepsy [Lennox-Gestaut Syndrome, Dravet Syndrome]

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9
Q

what is the therapeutic use of THC?

A
  1. Pain relief
  2. Appetite stimulation
  3. Nausea and vomiting relief from chemotherapy
  4. Glaucoma
  5. Sleep aid
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10
Q

what is the therapeutic use of CBD?

A
  1. Epilepsy
  2. Anxiety and depression relief
  3. Anti inflammatory and pain relief
  4. Neuroprotective properties
  5. Potential heart health benefits
  6. Addiction treatment
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11
Q

what are the side effects of THC

A
  1. Altered perception and mood
  2. Impaired cognitive function
  3. Dry mouth
  4. Increased HR
  5. Potential for anxiety and paranoia
  6. Risk of addiction and withdrawal
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12
Q

what are the side effects of CBD?

A

Generally well tolerated but there can be..
1. Fatigue
2. Diarrhea
3. Changes in appetite
4. Possible interaction with blood thinner

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13
Q

what are the PT considerations for marijuana with regard to pain management and perception

A

Medical marijuana can alter pain perception which can potentially ease chronic pain. This can help with exercise. However, pain is an important feedback mechanism and altered perception can lead to overexertion or injury.

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14
Q

`What are PT considerations for marijuana with regard to cognitive and motor function?

A

Therapists should monitor patients for signs of
impaired balance, coordination, or judgement, especially during exercises that require precision and balance. Adjustments in therapy routines may be necessary to ensure safety.

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15
Q

What are PT considerations for marijuana with regard to motivation and engagement?

A

While some patients may experience increased relaxation and reduced anxiety, others might face
decreased motivation or lethargy. This can affect their engagement and consistency in therapy sessions. Tailoring sessions to individual patient needs and responses to their medication is key

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16
Q

What are PT considerations for marijuana with regard to legal and ethical considerations?

A

Therapists must be aware of the legal status of medical marijuana in their region and any relevant
professional guidelines. Patient privacy and ethical considerations around discussing and managing treatment involving marijuana use should be prioritized

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17
Q

What is major depressive disorder?

A

Major Depressive Disorder (MDD) is a complex and often debilitating mental health condition characterized by a range of symptoms affecting a person’s mood, body, thoughts, and behavior

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18
Q

What are the hallmark characteristics of Major Depressive Disorder (MDD)?

A

depressed mood or loss of interest or pleasure (anhedonia) that lasts for at least two weeks that is different from previous function level

19
Q

List out various types of depressive disorders

A

Major depressive disorder, Persistent depressive disorder, Seasonal affective disorder (SAD), Disruptive mood dysregulation disorder (DMDD), Premenstrual dysphoric disorder (PMDD), Psychotic depression

20
Q

What are the theories of depression pathophysiology?

A
  • Monoamine hypothesis: Decreased brain levels of the neurotransmitters norepinephrine (NE), serotonin (5-HT), and dopamine (DA) may cause depression.
  • Postsynaptic changes in receptor sensitivity: Studies have demonstrated that desensitization or downregulation of NE or 5-HT1A receptors may relate to onset of antidepressant effects.
  • Dysregulation hypothesis: Failure of homeostatic neurotransmitter regulation, rather than absolute increases or decreases in their activities.
21
Q

What is the current theory of depression pathophysiology? What neurotransmitters are involved?

A

Current theory: caused by defect in CNS biogenic amines: Serotonin (5-hydroxytryptamine), Norepinephrine, Dopamine

22
Q

What antidepressants are used as the first line of defense for depression?

A
  1. Tricyclics (non-selective, share a 3-ring of chemical structure); Amitriptyline (Elavil), Nortriptyline (Pamelor)
  2. Monoamine oxidase inhibitors (enzyme that helps remove released NT through enzymatic destruction); Moclobemide (Auririx), Phenelzine (Nardil)
23
Q

What are the 2nd generation anti-depressants?

A
  1. Selective Serotonin reuptake inhibitor (SSRI) – more selective for serotonin
  2. Serotonin-Norepinephrine reuptake inhibitors(SNRI)
  3. Norepinephrine and Dopamine reuptake inhibitors (NDRI)
24
Q

What is the general mechanism of action of antidepressants?

A
  1. Prolong the effect of amine NT by inhibiting NT reuptake (tricyclics and 2nd generation drugs)
  2. autoreceptor blockade
  3. decrease NT breakdown (MOA inhibitors)
25
Q

What are the general adverse effects of 2nd generation antidepressants? How do they compare to TCAs?

A
  1. Some GI problems, sexual side effects
  2. Less sedation than TCAs
  3. Low incidence of CV problems and anticholinergic effects
26
Q

What are MAO inhibitors and what are general adverse effects?

A
  1. Not drug of choice with depression however may be helpful for patients who do not respond to TCAs, SSRIs, SNRIs
  2. CNS excitation (in contrast to TCAs) causing restlessness, agitation, sleep loss, irritability
  3. Increase in BP (especially with other drugs/foods that cause catecholamine release) which can lead to HTN crisis
  4. Food drug-interactions (tyramine containing foods-HTN Crisis)
27
Q

What are the general effects of TCAs?

A
  1. Sedation: Can be desirable in patients who are agitated, can cause sluggishness which may impair adherence to drug therapy and failure to take meds
  2. Anticholinergic effects: central anticholinergic properties (confusion & delirium), peripheral anticholinergic properties (dry mouth, constipation, urinary retention, tachycardia, confusion)
  3. Orthostatic hypotension (& arrhythmias)
28
Q

What are the primary antidepressant medications for chronic pain? What is the MOA? What is the pathway that likely leads to chronic pain syndrome?

A
  1. TCAs, SSRIs, SNRIs
  2. affect chronic pain by their actions on CNS monoamine NTs
  3. modulate the effects of serotonin, NE, dopamine and their effects on chronic pain
  4. Serotonin seems especially important in regulating certain pathways that may be important in inhibiting pain
  5. Animal model studies suggest that activity in descending pathways (efferent) serotonergic pathways that inhibit pain may lead to chronic pain syndromes
29
Q

What are the names of selective serotonin reuptake inhibitors (SSRI), MOA, and side effects?

A
  1. Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Celexa)
  2. Inhibition of serotonin (5-HT) transporters
  3. Side effects: Sexual side effects, somnolence, insomnia, headache, hyponatremia
30
Q

What are the names of serotonin and norepinephrine reuptake inhibitors (SNRI), MOA, and side effects?

A
  1. Duloxetine (Cymbalta), Venlafaxine (Effexor), Desvenlafaxine (Pristiq)
  2. Inhibition of serotonin and norepinephrine (NE) transporters
  3. Side effects: Sexual side effects, somnolence, insomnia, headache, hyponatremia, increased HR, narrow angle glaucoma, dry mouth
31
Q

What are the names of norepinephrine and dopamine reuptake inhibitors (NDRI), MOA, and side effects?

A
  1. Bupropion (Wellbutrin)
  2. Inhibition of norepinephrine and dopamine transporters
  3. Side effects: Insomnia, tremors and seizures, weight loss
32
Q

What are the names of tricyclic antidepressants, MOA, and side effects?

A
  1. Amitriptyline (Elavil), Nortriptyline (Pamelor)
  2. Primarily inhibit NE and serotonin uptake ( TCAs named based on their chemical structures)
  3. Side effects: QT prolongation with overdose, Orthostatic hypotension and tachycardia, anticholinergic effects, vivid dreams, weight gain
33
Q

What are the names of MAO inhibitors, MOA, and side effects?

A
  1. Moclobemide (Auririx), Phenelzine(Nardil)
  2. Reversible inhibition of monoamine oxidase (RIMAs)
  3. Side effects: Sedation and Orthostatic hypotension, sexual dysfunction. Hypertensive crisis occurs when combined with TCAs, SSRIs, SNRIs, several other drugs (tramadol, meperidine etc) and tyramine rich foods
34
Q

What is serotonin syndrome?

A

A side effect from overstimulation of serotonin receptors that is possible with all antidepressants

35
Q

What are the mild, moderate, and life threatening side effects of serotonin syndrome?

A
  1. Mild: mydriasis, shivering, sweating, tachycardia
  2. Moderate: altered mental status, autonomic hyperactivity (rigidity, tachycardia, hyperthermia), neuromuscular abnormalities (tremor, clonus, hyperreflexia)
  3. Life-threatening: delirium, hypertension, hyperthermia, muscle rigidity, tachycardia
36
Q

What are management strategies for the side effects of serotonin syndrome?

A
  1. If mild side effects: Observe 6 hours on benzodiazepines
  2. If moderate side effects: Admit to hospital and begin cardiac monitoring (cyproheptadine)
  3. If life threatening side effects: Intensive care unit (esmolol, nitroprusside, cooling measures, sedation, ventilation)
37
Q

What is Brexanolone?

A

The first FDA approved drug for postpartum depression. It is thought to exert antidepressant effect by allosteric modulation of GABAA receptors, which may increase 5HT and NE transmission.

38
Q

What are the common adverse effects of Brexanolone?

A

Common adverse effects are headache, dizziness, and somnolence

39
Q

Why is Risk Evaluation and Mitigation Strategies (REMS) and Elements to Ensure Safe Use (ETASU) needed for use of Brexanolone?

A

due to the incidence of excessive sedation or loss of consciousness

40
Q

List drugs used for the treatment of bipolar disorder

A
  1. The primary treatment modality for manic episodes is mood-stabilizing agents or antipsychotic drugs, often in combination: Lithium (Lithobid) * Divalproex (Depakote)
  2. The primary treatment for depressive episodes in bipolar disorder is mood-stabilizing agents or certain antipsychotics: Lithium (Lithobid), Lamotrigine (Lamictal), Aripiprazole (Abilify), Quetiapine (Seroquel), Risperidone (Risperdal)
  3. Lithium is the drug of choice for bipolar disorder with euphoric mania, whereas valproate has better efficacy for mixed states and irritable/dysphoric mania compared with lithium.
41
Q

Describe the mechanism of action and list adverse effects of lithium

A
  1. Lithium (Eskalith, Lithobid) helps reduce the severity and frequency of mania and may also help relieve or prevent bipolar depression.
  2. MOA: Lithium works by multiple mechanisms: Neuroprotection, Neurotransmitter modulation, Inhibits Inositol phosphate 3
  3. Acute effects: nausea, diarrhea, lethargy, impaired cognitive function, hand tremor
  4. Long term effects: hypothyroidism, cardiac effects, weight gain, leukocytosis, acne, psoriasis
42
Q

What are PT considerations for antidepressants?

A
  1. Time lag before beneficial effects begin (2-4 weeks)
  2. There is a chance of increased depression during initial treatment
  3. Affected exercise tolerance (incorporate rest periods)
    Increased risk of suicidal behaviors
43
Q

What are PT considerations for patients using tricyclics?

A
  1. Sedation, lethargy, muscle weakness
  2. Orthostatic hypotension can cause syncope and injury if the patient falls during gait training
44
Q

What are PT considerations for patients using MAO inhibitors?

A

Increase in blood pressure so care needs to be taken to avoid a hypertensive crisis

Pharmacology (14 decks)

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