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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
Adverse effects of SSRIs
insomnia, reslessness, GI, agitation, anxiety, panic
26
Drug types that SSRIs interact with
MAOIs, dextromethorphan, meperidine
27
Serotonin Syndrome
careful with SSRIS -as confusion, hypomania, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, and incoordination.
28
Treatment for Serotonin Syndrome
Discontinue offending agent, supportive measures
29
Is there a difference in efficacy among SSRIs?
No. But patients who don't respond well to one may respond better to another
30
SSRI withdrawl syndrome
-make sure to tapper them
31
Escitalopram
-is the active ingredient in citalopram, only need hald as much escitalopram
32
SNRI Rxs
Venlafaxine, Desvenlafaxine, Duloxetine
33
MOA of SNRI
balanced NE and 5HT reuptake inhibitor | -at low doses 5HT effect is more prominant
34
Duloxetine (Cymbalta)
SNRI - also indicated for for diabetic peripheral neuropathy - CYP2D6 interactions - liver toxicity- monitor BP
35
What happens as you increase SNRI dose?
NE becomes more pronounced, increased BP is likely
36
For severly depressed pts. is venlafaxine more effective than SSRIs?
Yes
37
Trazodone MOA
serotonin reuptake inhibitor that also blocks 5-HT2A receptors
38
Adverse effects of trazadone
orthostatic hypotension | sedating
39
MOA Nefazodone
- 5-HT and NE reuptake inhibitor that also blocks 5-HT2A - more effective for anxiety related to depression - short 1/2 life
40
Nefazodone Adverse effects
Black Box Warning- liver toxicity | -potent inhibitor of CYP3A4
41
Bupropion MOA
inhibitor of dopamine and NE reuptake, with minimal effects on 5-HT
42
Adverse Effect of Bupropion
- increase seizure risk | - titrate dose up
43
Mirtazapine MOA
antagonizes the presynaptic autoreceptor (α2) and the receptor that prevents the release of NE - increase NE and 5-HT in synapse
44
Antidepressants and suicide
- Antidepressants are associated with increased risk of suicidal thinking and behaviors, mainly in children, adolescents and young adults - watch pts for two months
45
Are anti depressants ever combined?
Yes. They are commonly combined at lower doses
46
Lithium
-helps treatment resistant depression
47
Second generation antipsychotics used as adjuncts in antidepression therapy
Abilify | Zyprexa
48
3 Phases of Antidepressant therapy
1) Short term- 6-12 to resolve symptoms 2) COntinuation- keep symptoms in remission 6-12 mo 3) MAintinance- long term therapy
49
What is considered treatment resistance?
when 2 or more agents from different classes have been tried and failed
50
Bipolar 1
manic + depressive
51
Bipolar 2
hypomanic + depressive
52
Lithium MOA - Bipolar
-we think it alters cation transport which influences reuptake of serotonin and/or NE
53
How long does it take lithium to work in a bipolar pt?
-2 weeks-
54
what is the ideal blood concentration of lithium? | What is the initial dose?
.8-1.2 600-900 mg/day
55
Adverse effect of lithium
CNS toxicity, hypothyroidism, TERATOGEN
56
how often should a lithium pt have labs done?
6-12 months
57
Anti convulsants Rx list for bipolar
- considered mood-stabilizing drugs that reduce manic and depressive episodes - Divalproex (Depakote) - Carbamazepine (Tegratol) - Lamotrigine (Lamictal) - Topiramate (Topamax)
58
Divalproex (valproic acid)
- usualy used as anti seizure med - just as effective as lithium - used for mania and depression episodes - good for rapid cyclers - neuro toxicity
59
Carbamazepine
- used in acute situations | - discontinue if sodium level is below 130
60
Lamotrigine
- used as maintinance therapy for Bipolar | - may cause rash
61
List of antipsychotics for Bipolar
Aripiprazole (Abilify), asenapine (Saphris), Lurasione (Latuda) olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)
62
What do antipsychotics do for bipolar patients?
-help with agitation and overactivity
63
What two Benzodiazepines are used for Bipolar? What are they used for?
Lorazepam and diazepam | -used for agitation
64
Symptoms of Schizophrenia are...
``` Perception (hallucinations) Ideation, reality (delusions) Cognition (loose associations) Emotions (flat affect) Behavior (disorganization) Attention, concentration, motivation Judgment ```
65
5 Types of Schizophrenia
1) paranoid 2) Disorganized 3) Catatonic 4) Undifferentiated 5) Residual
66
Paranoid Schizophrenia
preoccupation with delusions/hallucinations
67
Disorganized schiz
affects speech/behavior, flat or inappropriate affect
68
Catatonic schiz
motor symptoms with nonreactivity to the environment
69
Undifferentiated
no clear prominent symptoms
70
Residual
No prominent symptoms but ongoing disturbances
71
when is the onset of Bipolar?
Early 20s
72
what are the 4 phases of Schizophrenia?
- Prodromal - Acute - Stabilization - Stable
73
What are the risk factors of schizophrenia?
-Low SEC, family hx, poor birth hx, urban living, stress
74
Typical Antipsychotics 1st gen.
-Chlorpromazine was the first one ever Fluphenazine, trifluoperazine, perphenazine, chlorpromazine, thioridazine, prochlorperazine
75
Atypical Antipsychotics 2nd gen
Clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saprhis), lurasidone (Latuda), Iloperidone (Fanapt)
76
MAO Typical Antipsychotics
antagonist at dopamine D2 receptors, also posses anticholinergic, antihistaminic, and alpha adrenergic blocking properties
77
Adverse Effects of 1st generation typical antipsychotics
- sedation - anticholinergic effects - orthostatic hypotension - parkinsonism - dystonia - akathisia - tardive dyskinesia
78
Endocrine adverse effects of 1st generation antipsychotics
- Weight gain - Diabetes - Sexual dysfunction - Pigmentary deposits on retina - Arrhythmias
79
Available preparations of FGAs
oral, IV, IM
80
haloperidol
IM FGA
81
therapy duration FGA
try drug free period after being symptom free for 2 years, those with history of episodes should be symptom free for 5 years
82
Atypical Antipsychotics SGAs
- more weight gain, more expensive, increased DM, insulin resistance
83
SGA Clozapine (clozaril) SGA
- Less potent dopamine blocker & a 5-HT antagonist | - affects brain region selectively
84
adverse effect of closapine
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
Risperidone (Risperdal) SGA
- used for: Bipolar, schizophrenia, irritability with autistic disorder - MOA: dopamine D2 antagonist and 5-HT2 antagonist
86
Olanzapine (zyprexa) SGA
used for: Bipolar, schizophrenia, treatment resistant depression MOA: similar to clozapine, except no agranulocytosis
87
Quetiapine (Seroquel) SGA
Bipolar, major depressive disorder, schizophrenia used in parkinsons
88
Ziprasidone (Geodon)
Bipolar, irritability with autistic disorder, schizophrenia QT arythmias
89
Aripiprazole
bipolar, irritability with autistic disorder, major depressive disorder, schizophrenia, Tourette's
90
Lurasidone
Bipolar, schizophrenia
91
Paliperidone
schizophrenia
92
Asenapine
bipolar schizophrenia

Pharm-Neuro (6 decks)

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