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NURS 320 > Exam 1: Drugs For Emotional And Mood Disorders > Flashcards

Exam 1: Drugs For Emotional And Mood Disorders Flashcards

1
Q

2 Major Categories of Mood Disorders

A
  1. Depression

2. Bipolar Disorder

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2
Q

Emotional disorder

A

Attention deficit hyperactivity disorder (ADHD)

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3
Q

Depression

A

Disorder characterized by a sad or despondent mood.

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4
Q

Symptoms of Depression

A

Includes lack of energy, sleep disturbances, abnormal eating patterns, and feelings of despair, guilt or hopelessness.

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5
Q

Depression is commonly seen in

A

Elderly adults

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6
Q

What are the forms of Depression?

A
  1. Major Depressive Disorder
  2. Dysthymic Disorder
  3. Postpartum Depression
  4. Seasonal Affective Disorder
  5. Psychotic Depression
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7
Q

Major Depressive Disorder

A

Needs to have a depressed affect plus at least 5 of the following symptoms lasting a minimum of 2 weeks to diagnose depression.

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8
Q

What symptoms are included in patients with major depressive disorder?

A

Difficulty sleeping or sleeping too much
Extremely tired; without energy
Abnormal eating patterns (too much or not enough)
Vague physical symptoms (GI pain, joint/muscle pain, HA)
Inability to concentrate or make decisions
Feelings of despair, guilt, and misery; lack of self-worth
Obsessed with death (suicidal tendencies or attempts)
Avoiding psychosocial and interpersonal interactions
Lack of interest in personal appearance or sex
Delusions or hallucinations

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9
Q

Dysthymic Disorder

A

Characterized by less severe depressive symptoms which may prevent someone from feeling well or functioning normally

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10
Q

Postpartum Depression

A

Up to 80% women affected during first several weeks after birth of their baby.

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11
Q

Seasonal Affective Disorder

A

Associated with enhance release of the brain neurohormone melatonin due to lower light levels
Occurs mostly during winter months.

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12
Q

Psychotic depression is characterized by

A

expression of intense mood shifts and unusual behaviors.

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13
Q

Behaviors observed in patients with psychotic depression include

A

Depressive signs, loss of contact with reality, hallucinations, delusions, and disorganized speech patterns.

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14
Q

Antidepressants

A

Drugs used to treat depression.
Treats by enhancing mood.
Has Black Box Warning.

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15
Q

Black Box Warning

A

Need to closely monitor adults and children taking antidepressants for warning of signs of suicide.

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16
Q

How do antidepressants work?

A

Depression is associated with neurotransmitter dysfunction of brain. Regions connected with focused cognition and emotion.
Antidepressants exert effects through actions on specific neurotransmitters in the brain including norepinephrine, serotonin and dopamine.

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17
Q

Antidepressants: MOA

A
  1. Slowing the reuptake of serotonin and norepinephrine

2. Blocking enzymatic breakdown of norepinephrine

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18
Q

Treating Depression with TCA’s

A

Act by inhibiting the presynaptic reuptake of norepinephrine and serotonin.
Has long half-life -> increases risk of side effects especially for those with delayed excretion.

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19
Q

When would you treat depression with TCAs?

A

Used predominately for major depression.

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20
Q

What is the most common side effect of TCA’s?

A

Orthostatic hypotension

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21
Q

What are other side effects of TCAs?

A
  1. Anti-cholinergic effects may occur: dry mouth, constipation, urinary retention, excessive perspiration, blurred vision and tachycardia.
  2. Most serious adverse effect is cardiac dysrhythmias.
22
Q

Treating Depression with SSRIs

A

Serotonin (neurotransmitter in CNS found within neurons of the hypothalamus, limbic system, medulla and spinal cord)
Lack of serotonin in the CNS can lead to depression.

23
Q

SSRIs: MOA

A

Slows the reuptake of serotonin into presynaptic nerve terminals.. postsynaptic receptors become more sensitive.

24
Q

What are the benefits of using SSRIs for depression?

A

Greater safety and more favorable side effect profile.

25
Q

Side Effects of SSRIs

A

Most common include sexual dysfunction, nausea, HA, weight gain, anxiety and insomnia.
Serotonin Syndrome may occur if taking another medication that affects the metabolism, synthesis or reuptake of serotonin -> leads to accumulation of serotonin.

26
Q

Serotonin Syndrome

A

Caution with MAOIs, tricyclic antidepressant, lithium, and more.
Symptoms include mental status changes (confusion, anxiety, restlessness), HTN, tremors, sweating and ataxia.

27
Q

Atypical Antidepressants are considered

A

Serotonin-norepinephrine reuptake inhibitors (SNRIs) class

28
Q

Atypical Antidepressants: MOA

A

Inhibits reabsorption of serotonin and norepinephrine.

29
Q

Atypical Antidepressants (SNRI’s) include

A

Duloxetine (cymbalta)
Venlafaxine (Effexor)
Bupropion (Wellbutrin)

30
Q

Bupropion (Wellbutrin)

A

Inhibits reuptake of serotonin and also affects the activity of norepinephrine and dopamine.
Use caution in pts with seizure disorder.. lowers the seizure threshold.

31
Q

Actions of norepinephrine at adrenergic synapses are terminated through 2 means:

A
  1. Reuptake into the presynaptic nerve

2. Enzymatic destruction by the enzyme monoamine oxidase (MOA)

32
Q

MAO inhibitors: MOA

A

Decreases the effectiveness of MAO. Limits the breakdown of norepinephrine, dopamine and serotonin in the CNS -> Creates higher levels of these neurotransmitters in the brain to facilitate neurotransmission -> Alleviates symptoms of depressions

33
Q

MAO inhibitors are reserve for patients who

A

Do not respond to other antidepressant classes

34
Q

Common side effects of MAO inhibitors include

A

Orthostatic hypotension
HA
Insomnia
Diarrhea

35
Q

MAO Inhibitors: Interactions

A

Large number of interactions with food and other meds.

  1. Hypertensive crisis combined with other antidepressants or sympathomimetic drugs, in addition to tyramine containing foods.
  2. Combined with other antihypertensives -> leads to severe hypotension.
  3. Potentials hypoglycemic effects of insulin and oral antidiabetic drugs.
36
Q

Bipolar Disorder

A

Characterized by extreme and opposite moods.. episodes of depression alternate with episodes of mania.

37
Q

Bipolar Disorder Symptoms

A

Present with depression symptoms and manic symptoms.

  • inflated self-esteem and grandiosity
  • decreased need for sleep
  • increased talkativeness or pressure to keep talking
  • flight of ideas or subjective feeling that thoughts are racing
  • distractibility
  • increased goal-directed activity or psychomotor agitation
  • excessive involvement in pleasurable activities which have potential for painful consequences
38
Q

Most common drugs used to treat bipolar disorder

A

Are called mood stabilizers.

Anti seizure and atypical antipsychotic drugs also used for mood stabilization.

39
Q

Traditional Treatment for Bipolar disorder is

A

Lithium

40
Q

Lithium remains effective for

A

States of purely manic or purely depressive episodes.

41
Q

Lithium with anti seizure drugs added, valproic acid or carbamazepine is most commonly used in treatment of

A

Mania

42
Q

Newer antiseizure drugs such as lamotrigine are used for

A

Purely depressive episodes. (May be more effective than lithium)

43
Q

What are the atypical antipsychotics effective mood stabilizers for treatment of acute mania include

A

Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Ouetiapine (Seroquel)
Risperidone (Risperdal)

44
Q

Lithium

A

Acts similar to Sodium in body. Conditions with sodium loss (excessive sweating or dehydration) -> causes lithium toxicity.

45
Q

During a depressed phase, what drugs may be added to lithium?

A

Tricyclic antidepressants or bupropion (Wellbutrin)

46
Q

During manic phase, what drugs can be added to lithium?

A

Benzodiazepine will moderate manic symptoms

47
Q

During extreme agitation, delusions or hallucinations, what drugs can be added to lithium?

A

Antipsychotic agents may be indicated

48
Q

Lithium monitoring

A

Has narrow therapeutic index.
Initially monitored via serum levels every 1-3 days.
Monitored every 2-3 months thereafter.

49
Q

Adverse Effects of Lithium

A 
Dizziness
Muscle weakness, fatigue
Short term memory loss
Increase urination
N/V/D
Loss of appetite, dry mouth, abdominal pain
Muscle weakness, tremors
50
Q

Lithium is contraindicated in

A

Debilitated patients and pts with severe cardiovascular disease.
Dehydration
Renal disease
In cases of severe sodium depletion.

NURS 320 (28 decks)

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