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Pharm-Neuro > General Psychiatry Depression > Flashcards

General Psychiatry Depression Flashcards

1
Q

Two Types of Depressive Disorders

A

1) Major Depressive Disorder

2) Dysthymic Disorder

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2
Q

Bipolar Disorders

A

1) Bipolar 1
2) Bipolar 2
3) Cyclothymic Disorder

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3
Q

Clinical Features of MDD

A
  • decrease in interest in usual activities
  • Decreased ability to think/concentrate
  • Recurrent thoughts of suicide
  • appetite changes
  • sleep disturbances
  • changes in energy levels
  • feelings of guilt, helplessness, or worthlessness
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4
Q

Psychotherapy

A
  • interpersonal psychotherapy and cognitive-behavioral therapy
  • good for preventing relapse
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5
Q

Pharmacotherapy

A

may lead to a more rapid response, but increased risk of relapse

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6
Q

Selection of Rx

A

Rx interaction, family hx

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7
Q

Onset

A

4-6 weeks

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8
Q

Adequate trial

A

give enough time for optimal dosing

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9
Q

Response and Remission

A

defined as 50% reduction

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10
Q

Efficacy

A

-drugs are shown to do better in clinical trials
-Clinical trials have not shown that mixed action drugs work better than single action drugs
But, clinicians are seeing results in patients by using mixed action drugs

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11
Q

Drug interactions

A

CYP2D6 and CYP3A4

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12
Q

CYP 450 Enzyme 2D6 interaction antidepresant Med (2)

A

Fluoxetine, paraoxitine

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13
Q

5 Main Classes of anti-depressant Medications

A

1) TCAs
2) Monoamine Oxidase Inhibitors
3) Selective Serotonin Reuptake Inhibitors
4) Selective Serotonin Norepinephrine reuptake Inhibitors
5) Miscellaneous

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14
Q

TCAs: history, MOA

A

-first ones
-severe toxicity
MOA: block the reuptake of serotonin (5-HT) and norepinephrine (NE).
-have receptor effects including: alpha adrenergic blocking effects, antihistamine effects, anticholinergic effects, and effects on cardiac conduction

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15
Q

TCAs that cause high degree of Orthostatic Hypotension and Cariotoxicity

A

1) Imipramine

2) Amitriptyline

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16
Q

4 TCAs

A

1) Imipramine
2) Amitriptyline
3) Desipramine
4) Nortriptyline

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17
Q

What are the two major risks of TCAs

A

orthostatic hypotension- fall risk pts.

  • cardiac pts.
  • seizure pts.
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18
Q

How should TCA pts. have their dose if you want them taken off them

A

gradually tappered off

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19
Q

Monoamine Oxidase Inhibitors Rxs

A
  • phenelzine (Nardel)
  • Isocarboxazid (marplan)
  • tranlcypromine (Parnate)
  • selegline [parkinsons] (Eldepryl)
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20
Q

What foods and drugs must MAOI pts. avoid and why?

A

They must avoid foods hihg in tyramine- aged cheese, cause potential hypertensive crisis

-avoid antihistamines

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21
Q

How do you switch a patient taking MAOI to another antidepressant?

A

-wait 2 weeks after antidepressant is discontinued before starting MAOI- it is irreversibly binding so you need to wait to make new receptors
Exception: fluoxetine should be removed for 5-6 week

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22
Q

patch form of MAO Selegiline is called

A

Emsam

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23
Q

SSRI Rx names

A

Fluoxetine, sertraline, paroxetine, citalopram, and escitalopram

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24
Q

SSRI MOA

A

selectively inhibit the reuptake of 5-HT into the presynaptic neuron

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25
Q

Adverse effects of SSRIs

A

insomnia, reslessness, GI, agitation, anxiety, panic

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26
Q

Drug types that SSRIs interact with

A

MAOIs, dextromethorphan, meperidine

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27
Q

Serotonin Syndrome

A

careful with SSRIS
-as confusion, hypomania, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, and incoordination.

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28
Q

Treatment for Serotonin Syndrome

A

Discontinue offending agent, supportive measures

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29
Q

Is there a difference in efficacy among SSRIs?

A

No. But patients who don’t respond well to one may respond better to another

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30
Q

SSRI withdrawl syndrome

A

-make sure to tapper them

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31
Q

Escitalopram

A

-is the active ingredient in citalopram, only need hald as much escitalopram

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32
Q

SNRI Rxs

A

Venlafaxine, Desvenlafaxine, Duloxetine

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33
Q

MOA of SNRI

A

balanced NE and 5HT reuptake inhibitor

-at low doses 5HT effect is more prominant

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34
Q

Duloxetine (Cymbalta)

A

SNRI

  • also indicated for for diabetic peripheral neuropathy
  • CYP2D6 interactions
  • liver toxicity- monitor BP
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35
Q

What happens as you increase SNRI dose?

A

NE becomes more pronounced, increased BP is likely

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36
Q

For severly depressed pts. is venlafaxine more effective than SSRIs?

A

Yes

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37
Q

Trazodone MOA

A

serotonin reuptake inhibitor that also blocks 5-HT2A receptors

38
Q

Adverse effects of trazadone

A

orthostatic hypotension

sedating

39
Q

MOA Nefazodone

A
  • 5-HT and NE reuptake inhibitor that also blocks 5-HT2A
  • more effective for anxiety related to depression
  • short 1/2 life
40
Q

Nefazodone Adverse effects

A

Black Box Warning- liver toxicity

-potent inhibitor of CYP3A4

41
Q

Bupropion MOA

A

inhibitor of dopamine and NE reuptake, with minimal effects on 5-HT

42
Q

Adverse Effect of Bupropion

A
  • increase seizure risk

- titrate dose up

43
Q

Mirtazapine MOA

A

antagonizes the presynaptic autoreceptor (α2) and the receptor that prevents the release of NE
- increase NE and 5-HT in synapse

44
Q

Antidepressants and suicide

A
  • Antidepressants are associated with increased risk of suicidal thinking and behaviors, mainly in children, adolescents and young adults
  • watch pts for two months
45
Q

Are anti depressants ever combined?

A

Yes. They are commonly combined at lower doses

46
Q

Lithium

A

-helps treatment resistant depression

47
Q

Second generation antipsychotics used as adjuncts in antidepression therapy

A

Abilify

Zyprexa

48
Q

3 Phases of Antidepressant therapy

A

1) Short term- 6-12 to resolve symptoms
2) COntinuation- keep symptoms in remission 6-12 mo
3) MAintinance- long term therapy

49
Q

What is considered treatment resistance?

A

when 2 or more agents from different classes have been tried and failed

50
Q

Bipolar 1

A

manic + depressive

51
Q

Bipolar 2

A

hypomanic + depressive

52
Q

Lithium MOA - Bipolar

A

-we think it alters cation transport which influences reuptake of serotonin and/or NE

53
Q

How long does it take lithium to work in a bipolar pt?

A

-2 weeks-

54
Q

what is the ideal blood concentration of lithium?

What is the initial dose?

A

.8-1.2

600-900 mg/day

55
Q

Adverse effect of lithium

A

CNS toxicity, hypothyroidism, TERATOGEN

56
Q

how often should a lithium pt have labs done?

A

6-12 months

57
Q

Anti convulsants Rx list for bipolar

A
  • considered mood-stabilizing drugs that reduce manic and depressive episodes
  • Divalproex (Depakote)
  • Carbamazepine (Tegratol)
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
58
Q

Divalproex (valproic acid)

A
  • usualy used as anti seizure med
  • just as effective as lithium
  • used for mania and depression episodes
  • good for rapid cyclers
  • neuro toxicity
59
Q

Carbamazepine

A
  • used in acute situations

- discontinue if sodium level is below 130

60
Q

Lamotrigine

A
  • used as maintinance therapy for Bipolar

- may cause rash

61
Q

List of antipsychotics for Bipolar

A

Aripiprazole (Abilify), asenapine (Saphris), Lurasione (Latuda)
olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)

62
Q

What do antipsychotics do for bipolar patients?

A

-help with agitation and overactivity

63
Q

What two Benzodiazepines are used for Bipolar? What are they used for?

A

Lorazepam and diazepam

-used for agitation

64
Q

Symptoms of Schizophrenia are…

A 
Perception (hallucinations)
Ideation, reality (delusions)
Cognition (loose associations)
Emotions (flat affect)
Behavior (disorganization)
Attention, concentration, motivation
Judgment
65
Q

5 Types of Schizophrenia

A

1) paranoid
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual

66
Q

Paranoid Schizophrenia

A

preoccupation with delusions/hallucinations

67
Q

Disorganized schiz

A

affects speech/behavior, flat or inappropriate affect

68
Q

Catatonic schiz

A

motor symptoms with nonreactivity to the environment

69
Q

Undifferentiated

A

no clear prominent symptoms

70
Q

Residual

A

No prominent symptoms but ongoing disturbances

71
Q

when is the onset of Bipolar?

A

Early 20s

72
Q

what are the 4 phases of Schizophrenia?

A
  • Prodromal
  • Acute
  • Stabilization
  • Stable
73
Q

What are the risk factors of schizophrenia?

A

-Low SEC, family hx, poor birth hx, urban living, stress

74
Q

Typical Antipsychotics 1st gen.

A

-Chlorpromazine was the first one ever

Fluphenazine, trifluoperazine, perphenazine, chlorpromazine, thioridazine, prochlorperazine

75
Q

Atypical Antipsychotics 2nd gen

A

Clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saprhis), lurasidone (Latuda), Iloperidone (Fanapt)

76
Q

MAO Typical Antipsychotics

A

antagonist at dopamine D2 receptors, also posses anticholinergic, antihistaminic, and alpha adrenergic blocking properties

77
Q

Adverse Effects of 1st generation typical antipsychotics

A
  • sedation
  • anticholinergic effects
  • orthostatic hypotension
  • parkinsonism
  • dystonia
  • akathisia
  • tardive dyskinesia
78
Q

Endocrine adverse effects of 1st generation antipsychotics

A
  • Weight gain
  • Diabetes
  • Sexual dysfunction
  • Pigmentary deposits on retina
  • Arrhythmias
79
Q

Available preparations of FGAs

A

oral, IV, IM

80
Q

haloperidol

A

IM FGA

81
Q

therapy duration FGA

A

try drug free period after being symptom free for 2 years, those with history of episodes should be symptom free for 5 years

82
Q

Atypical Antipsychotics SGAs

A
  • more weight gain, more expensive, increased DM, insulin resistance
83
Q

SGA Clozapine (clozaril) SGA

A
  • Less potent dopamine blocker & a 5-HT antagonist

- affects brain region selectively

84
Q

adverse effect of closapine

A

agranulocytosis

  • increases risk for serious of fatal infections)
  • Must have weekly CBC for 6 months then every 2 weeks while on drug.
  • WBC must be above 3500 & ANC above 2000
  • Patients have to be registered in Clozaril National Registry
85
Q

Risperidone (Risperdal) SGA

A
  • used for: Bipolar, schizophrenia, irritability with autistic disorder
  • MOA: dopamine D2 antagonist and 5-HT2 antagonist
86
Q

Olanzapine (zyprexa) SGA

A

used for: Bipolar, schizophrenia, treatment resistant depression

MOA: similar to clozapine, except no agranulocytosis

87
Q

Quetiapine (Seroquel) SGA

A

Bipolar, major depressive disorder, schizophrenia

used in parkinsons

88
Q

Ziprasidone (Geodon)

A

Bipolar, irritability with autistic disorder, schizophrenia

QT arythmias

89
Q

Aripiprazole

A

bipolar, irritability with autistic disorder, major depressive disorder, schizophrenia, Tourette’s

90
Q

Lurasidone

A

Bipolar, schizophrenia

91
Q

Paliperidone

A

schizophrenia

92
Q

Asenapine

A

bipolar schizophrenia

Pharm-Neuro (6 decks)

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