Exam 4: Anti-Depressants

Question 1

Mood disorders affect ___-___% of Americans… Which sex is more affected?

Answer 1

women

Question 2

________ depression – one or more prolonged episodes of depression measured in weeks

Answer 2

Unipolar

Question 3

What are the 2 sub-types of unipolar depression?

Answer 3

Primary and Secondary

Question 4

______ depression-The absence of clearly identifiable factors leading to the secondary affective state….“chemical imbalance”…Responds to antidepressant medications…Endogenous or Exogenous?

Answer 4

Primary…Endogenous

Question 5

_______ depression-Chronologically occurs with preexisting nonaffective disorders; develops because of non affective disorders….Disease, trauma, chronic pain…Completely alleviated by treatment of non affective disorder…Endogenous or Exogenous?

Answer 5

Secondary…exogenous

Question 6

_________ disorder… Characterized by recurrent wide SWINGS in mood from depression to mania… Usually treated with _____.

Answer 6

Manic-depressive..lithium

Question 7

___% of adolescence and ___% of children show symptoms of depression.

Answer 7

8%…. 2%

Question 8

What is a main concern for adolescents without treatment for depression?

Answer 8

self-medication w. drugs and alcohol

Question 9

Women are ______ as more likely to experience depression as men.

Answer 9

2x

Question 10

Causes of Depression-imbalance in __________..E.G.—low levels of _______.

Answer 10

neurotransmitters….SERO-TON-IN

Question 11

Serotonin- elevates ____, helps you to fall ____ and have good quality sleep, acts on ______ center in brain to help you feel full after eating.

Answer 11

mood….asleep…saitey

Question 12

Affective disorders are associated with ________ and ________ neurotransmission in the brain

Answer 12

noradrenergic and serotonergic

Question 13

Biogenic Amine Hypothesis for Affective Disorders—Depression related to decreased levels of synaptically released __________ and/or ______ in the brain…_____ is a result of an EXCESS of these transmitters

Answer 13

norepinephrine and/or serotonin…mania

Question 14

Biogenic Amine Hypothesis for Affective Disorders—A flaw…although antidepressants increase NT right away, it takes several _____ of Tx for any effect….but this might be to antidepressants improving _______ function.

Answer 14

weeks!…receptor

Question 15

Why are women predisposed to fluctuating levels of serotonin? ______ lowers serotonin levels…._______ increases serotonin…estrogen fluctuations during puberty, pregnancy and menopause may trigger _______.

Answer 15

stress….estrogen…depression

Question 16

comorbidity between anxiety disorders and major depression exceeds ___%

Answer 16

50%

Question 17

How many classes of antidepressants are there? What are the ONLY 2 methods of action?

Answer 17

9…Inhibition of NT reuptake and enzymatic degradation

Question 18

Selected mechanisms of action- _______ = increase synaptic serotonin and norepinephrine

Answer 18

tri-cyc-lics

Question 19

Selected mechanisms of action- ________= increase synaptic norepinephrine

Answer 19

Tetracyclics

Question 20

Selected mechanisms of action-_______ = block the degradation of norepinephrine, dopamine and serotonin

Answer 20

MAOIs

Question 21

Selected mechanisms of action- _______ = increase synaptic serotonin

Answer 21

SSRIs

Question 22

What is our example of a weak inhibitor of reuptake of

dopamine, norepinephrine, serotonin?

Answer 22

bu-pro-pion (Wellbutrin, Zyban)

Question 23

Bu-pro-prion binds to alpha1 and alpha2 _________ receptors

Answer 23

adrenergic

Question 24

Bu-pro-prion has increased risk for _______, alcohol lowers its threshold…also, risk for emergent _________
with concurrent nicotine patch use

Answer 24

seizures….hypertension

Question 25

MAOIs: inhibit _______ which is an enzyme responsible for the metabolism of norepinephrine, serotonin and dopamine (outside of their storage vesicles) in the presynaptic nerve terminals

Answer 25

MAO

Question 26

MAOIs are used for _______ depression as well as depression associated with these 3 common diseases....

Answer 26

atypical...Parkinsons, Alzheimers, & PTSD

Question 27

CONTRAINDICATION FOR MAOIs in dentistry-take _____ prior to administering local anesthesia; caution with ________

Answer 27

BP....epi

Question 28

MAOI adverse events with food! When patients ingest food containing ________ amines, they are not catabolized, but enter the bloodstream, and are then taken up by sympathetic nerve terminals...Causes release of endogenous ___________.....Results in hyperadrenergic crisis....Severe hypertension, fever, arrhythmias....Avoid _______ containing foods = follow strict diet (hard cheese, red wine) = poor compliance

Answer 28

vasoactive...catecholamines...tyramine

Question 29

What are three popular SSRIs? What are the two biggest market sellers?

Answer 29

Flu-Ox-Et-Ine (Prozac, Sarafam).....Par-ox-et-Ine (Paxil)*Big market seller*.....Ser-Tra-Line (Zoloft)*big market seller*

Question 30

_______ is the only drug approved for use in children with OCD.

Answer 30

Zoloft

Question 31

SSRIs-Highest risk time for suicidal attempt is within ____ weeks of initiation of drug therapy

Answer 31

6 weeks

Question 32

What are the TWO Serotonin/Norepi Reuptake inhibitors to know? (Tx for MAJOR depression)

Answer 32

1. Dul-ox-et-ine (Cymbalta) 2.Ven-la-fax-ine (Effexor XR)

Question 33

Effexor XR-Generic Name: _________....Therapeutic Category: ________...Use: _____ depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder; investigational for OCD, hot flashes, neuropathic pain, ADHD....Oral Complications: _______, stomatitis, loss of taste, taste alteration, tongue discoloration

Answer 33

ven-la-fax-ine...SSRI....MAJOR...xerostomia!!!!

Question 34

Tetra-cyclics: name-________, onhibits reuptake of _______, depression, anxiety with depression,sedative effective on anxiety, dsythymic disorder (depressive neuroses)...investigational: bulimia, enuresis, pain, panic attacks, tension headache, cocaine withdrawal

Answer 34

map-ro-til-ine....norepi

Question 35

TRI-cyclics: Block reuptake of ________ AND ________....Severe anxiety, panic attacks, phobias, OCD, bulimia, chronic fatigue, sleep apnea...Adjunctive therapy for chronic pain, peripheral neuropathies (*________*)= exhibit analgesic properties...investigational for substance abuse-related disorders, ADHD...WARNING----Take _____ on patients prior to local anesthesia; caution with _________.

Answer 35

norepinephrine and serotonin...(*TRI-geminal neuralgia!!*)..BP...epi

Question 36

What am I describing? Weed-like plant, Most widely studied herb with demonstrated efficacy, MANY drug interactions...CAN NOT take with prescription antidepressants

Answer 36

St. John's Wort

Question 37

St. John's Wort interactions-Components implicated in bleeding: hypericin...Effect: ________ some cytochrome P450 liver enzymes and Reduces anticoagulant effect of warfarin (INCREASES/DECREASES???? clotting) and lowers the INR......Decreases effects of many medications...Multiple drug interactions

Answer 37

INDUCES....INCREASES

Question 38

St. John's Wort interactions cont.-Many drug interaction....Renders oral _________ ineffective in some...General anesthetics = patient difficult to _____ some users....Increases photosensitivity of tetracyclines...Reduces effect of glucocorticoids....Decreased efficacy of anticoagulants...Discontinue ALL herbs ____ days prior to surgery!!!

Answer 38

contraceptives...awaken (yikes!)...14 days

Question 39

Pharmokinetics of antidepressants-generally taken _____.....well absorbed from _______....reach maximal concentration in blood within __-4 hours after oral administration...half-life = more than ___ hours...._____ daily dosing, at bedtime...potency and efficacy are similar

Answer 39

orally....stomach...2..24..once

Question 40

Adverse events of anti-depressants: ________ = watch for FALLING in older adults....sedation...dizziness...light-headedness-AKA-FAINTERS AND FALLERS

Answer 40

orthostatic hypotension...