Exam 2; Anti-Depressants and Lithium Flashcards
This is 60% of all depressions; normal response to a loss or problem; usually limited in time
reactive depression
This is 40% of all depressions; no clear correlation with life events
endogenous depression
What are the two types of endogenous depression
uni-polar
bi-polar
What are some symptoms of depression
depressed mood decrease interest in life in general sleep disturbances appetite changes loss of energy feeling of worthlessness/denial of past accomplishments guilt
What are two symptoms of severe depression
psychological pain
suicidal tendencies; recurrent thoughts of death
loss of cognitive function
What are two factors that can cause depression
heredity and environmental factors
What is the biochemical basis of depression
depletion of neurotransmitters in the CNS (NE and SHT)
This treatment of depression is used primarily when the patient is not responsive to drug treatments
electroconvulsive treatment; shock therapy
What are five conditions that anti-depressants can be used to treat
depression bulimia OCD panic attacks ADD
What are the two mechanisms behind anti-depressants
prevent NE or SHT re-uptake
prevent neurotransmitter breakdown
What are two first generation NE re-uptake inhibitors; tricyclic anti-depressants
imipramine
amitriptyline
What are the second generation SSRIs (selective serotonin re-uptake inhibitors); inhibiting SHT re-uptake in the CNS
fluoxetine sertraline paroxetine fluvoxamine citalopram escitalopram vilazodone vortioxetine
What are the third generation SNRIs; inhibiting the re-uptake of SHT and NE
Venlafaxine
duloxetine
milnacipram
desvenlafaxine
What are three other anti-depressants
buproprion
nefazodone
mirtazapine
Which class of anti-depressants is more likely to have side effects
the first generation; acts on multiple receptors
What are four symptoms of first generation anti-depressants
sedation
weight gain
anticholinergic effects; arrthymias, hypotension, α1 blockade
What are four side effects of second generation anti-depressants
GI upset
insomnia
headache
decreased libido
What are some side effects of third generation anti-depressants
just like second generation plus cardiovascular stimulation
What is the therapeutic index of anti-depressants
fairly low; 5-6 (5-6 times the recommended dose to be toxic
first generation more toxic than second generation
What happens to someone who takes a massive overdose of anti-depressants
seizures
respiratory depression
cardiac arrthymias
renal failure
The difference between first, second, and third generation, is mainly what
pharmacokinetic
What is the half like of anti-depressants like
very long; stays in the body a long time after you take them
What are anti-depressants metabolized by
P450
The effects of anti-depressants are synergistic with what
ethanol; will see unwanted effects
These three anti-depressants inhibit the metabolism of NE and SHT
tranylcyrpromine
phenelzine
isocarboxazid
What is the metabolism of MAO inhibitors
irreversibly inhibit the metabolism of SHT and NE; slow onset
What are the CNS effects of MAO inhibitors
insomnia
agitation
hallucinations
seizures
What are three non-CNS effects of MAO inhibitors
liver toxicity
weight gain
hypotension
This interacts poorly with MAO inhibitors
indirect acting amines like amphetamines
What is the mechanism behind the poor interaction of indirect acting amines and MAO inhibitors
amphetamines cause an increase in NE, the MAO inhibitor will inhibit the metabolism on NE, resulting in a huge excess of NE and the inability to break it down = hypertensive crisis
Certain foods that contain this will lead to hypertensive crisis similar to that of taking MAO and ampthetamines
food containing the indirect acting amine; tyramine
aged cheeses, wines, smoked food
What is it that the FDA warns about involving anti-depressants
all anti-depressants will increase the risk of suicide in children and adolescents; depression with a manic phase will be much worse
This is probably hereditary condition type of depression
bipolar (manic) depression
What are some symptoms of manic depression
euphoria increased motor and sexual activity flight of ideas decreased sleep poor judgment social intrusiveness tantrums
What is the percentage of those with manic depression that attempt suicide
25-50%
mostly in conjunction with drug/alcohol abuse
What are three treatments for those with manic depression
electroconvulsive therapy
anti-psychotic drugs
lithium
What are two anti-psychotic drugs used to treat manic depression
phenothiazine
haloperidol
This is the most effective at treating manic depression; used prophylactically
lithium; 70% success in patients
What is the mechanism of action of lithium
alters glutamate metabolism
decreases NE release
alters SHT
What is the therapeutic index of lithium
very low; <2
What are six side effects of taking lithium short term
tremors increased thirst increased urine production edema weight gain nystagmus
What are two side effects of taking lithium long term
rengal damage
hypothyroid
What are three symptoms of taking lithium at a toxic level
nausea
delirium
coma
These are five mood stabilizers to treat bipolar; all are anti-seizure
valproic acid carbamazepine lamotripene acetazolamide aripriprazole
