Just drugs for Depression- Depression ppt Flashcards

1
Q

Selective Serotonin Reuptake Inhibitors (SSRIs) examples

A

Fluoxetine (Prozac, Sarafem)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Paroxetine (Paxil, Pexeva)
Citalopram (Celexa)
Escitalopram (Lexapro, Cipralex)

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2
Q

Selective Serotonin Reuptake Inhibitors (SSRIs) side effects

A

feeling agitated, shaky or anxious
feeling or being sick
diarrhea or constipation
headache or dizziness

blurred vision
dry mouth
sexual dysfunction/ decreased libido
insomnia
sweating

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3
Q

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

A

Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)
Venlafaxine (Effexor XR)

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4
Q

Serotonin/Norepinephrine Reuptake Inhibitors side effects

A

Common Side Effects
Nausea
Headache
Nervousness
Sweating
Insomnia*
Hypertension*
Sexual dysfunction*

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5
Q

Tricyclic Antidepressants

A

Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Clomipramine (Anafranil)
Imipramine (Tofranil)
Doxepin (Silenor)

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6
Q

Tricyclic Antidepressants: management pearls

A

Administer at bedtime to reduce daytime sedation
Orthostatic hypotension: teach pts to sit or lie down when feeling lightheaded
Most dangerous adverse effect: Cardiac toxicity*

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7
Q

Tricyclic Antidepressants side effects sentence

A

Hot as a hare,
blind as a bat,
dry as a bone,
red as a beet,
mad as a hatter.

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8
Q

Monoamine Oxidase Inhibitors

A

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Emsam)

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9
Q

How often are MAOIs used?

A

rarely used due to side effect profile

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10
Q

Hypertensive crisis

A

-Severe headache, confusion
-Tachycardia, hypertension, profuse sweating
-Nausea and vomiting
-Stroke and death

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11
Q

To prevent hypertensive event while taking MAOIs:

A

avoid aged meat, bananas, smoked fish, cheese, wine, beer

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12
Q

Treatment for Hypertensive crisis caused by MAOIs

A

Treatment: Intravenous vasodilator
Labetalol, sodium nitroprusside, phentolamine

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13
Q

Atypical Antidepressants

A

Bupropion

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14
Q

When do effects of Bupropion begin?

A

Antidepressant effects begin in 1 to 3 weeks. A delayed antidepressant effect.

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15
Q

Bupropion can be given with what to increase effect?

A

Can be given with Paroxetine to augment effect.

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16
Q

Advantages of taking atypical antidepressants like Bupropion

A

No Weight gain
No Sexual dysfunction
No Sedation
Assist with smoking cessation

17
Q

Disadvantages of taking atypical antidepressants like Bupropion

A

No as effective as SSRI
Can increase anxiety

18
Q

Bupropion side effects

A

Lowers seizure threshold*

Do not give to an anorexic/bulimic patient or patient with a seizure disorder

Insomnia, agitation, tremor
Weight loss
Nausea, GI upset, take w/food, constipation
Blurred vision, dizziness, headache, dry mouth
Tachycardia

19
Q

What kind of pts should you avoid giving bupropion to?

A

Lowers seizure threshold*

Do not give to an anorexic/bulimic patient or patient with a seizure disorder

20
Q

Serotonin Syndrome- when does it begin?

A

Often begins within 72 hours after treatment

21
Q

Effects of Serotonin Syndrome?

A

Altered mental status (agitation, anxiety, confusion, disorientation, hallucinations, and impaired concentration)

Fever, excessive sweating, incoordination, hyperreflexia, and tremor

22
Q

What causes Serotonin Syndrome?

A

Concurrent use of MAOIs and other SSRI agents that raise serotonin*

23
Q

How does Serotonin syndrome stop?

A

Spontaneously resolves after discontinuing the drug*

24
Q

What happens if medication is not stopped when patient has serotonin syndrome?

A

Can lead to death if medication is not discontinued*

25
Q

Drug interactions that cause Serotonin Syndrome

A

MAOIs + SSRIs

SSRIs + SSRIs

Saint John’s Wort

26
Q

Since MAOIs + SSRIs may cause serotonin syndrome, how should you take these or switch between them?

A

Minimum 14 day wash-out period required when switching to or from an SSRI

27
Q

St. John’s wort

A

Causes serotonin syndrome

Not FDA approved

28
Q

What is the difference between Sustained Release and Extended Release?

A

The differences between Wellbutrin XL and Wellbutrin SR are found in the dosing. XL stands for extended release; it only needs to be taken once per day. SR stands for sustained release; it may be taken twice per day.

29
Q

Rule for XL and SR drugs?

A

Swallow the tablets whole. Don’t crush, split, or chew them.

30
Q

Other medical treatments and psychotherapy for Depression (other then drugs)

A
  1. Electroconvulsive therapy (ECT)
  2. Psychotherapy (combined with medications)
  3. Cognitive behavioral therapy (CBT): focus on cognitive distortions
31
Q

Electroconvulsive therapy (ECT)

A

A brief electrical current is passed through the brain to produce generalized seizures lasting 25 to 150 seconds

32
Q

In general, initial responses to antidepressants won’t develop until when?

A

Initial response develops after 1 to 3 weeks

33
Q

Maximal responses for antidepressants will be seen when?

A

Maximal responses may not be seen for 12 weeks