Just drugs for Depression- Depression ppt

Question 1

Selective Serotonin Reuptake Inhibitors (SSRIs) examples

Answer 1

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

Question 2

Selective Serotonin Reuptake Inhibitors (SSRIs) side effects

Answer 2

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

Question 3

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

Answer 3

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

Question 4

Serotonin/Norepinephrine Reuptake Inhibitors side effects

Answer 4

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

Question 5

Tricyclic Antidepressants

Answer 5

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

Question 6

Tricyclic Antidepressants: management pearls

Answer 6

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*

Question 7

Tricyclic Antidepressants side effects sentence

Answer 7

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

Question 8

Monoamine Oxidase Inhibitors

Answer 8

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

Question 9

How often are MAOIs used?

Answer 9

rarely used due to side effect profile

Question 10

Hypertensive crisis

Answer 10

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

Question 11

To prevent hypertensive event while taking MAOIs:

Answer 11

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

Question 12

Treatment for Hypertensive crisis caused by MAOIs

Answer 12

Treatment: Intravenous vasodilator
Labetalol, sodium nitroprusside, phentolamine

Question 13

Atypical Antidepressants

Answer 13

Bupropion

Question 14

When do effects of Bupropion begin?

Answer 14

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

Question 15

Bupropion can be given with what to increase effect?

Answer 15

Can be given with Paroxetine to augment effect.

Question 16

Advantages of taking atypical antidepressants like Bupropion

Answer 16

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

Question 17

Disadvantages of taking atypical antidepressants like Bupropion

Answer 17

No as effective as SSRI
Can increase anxiety

Question 18

Bupropion side effects

Answer 18

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

Question 19

What kind of pts should you avoid giving bupropion to?

Answer 19

Lowers seizure threshold*

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

Question 20

Serotonin Syndrome- when does it begin?

Answer 20

Often begins within 72 hours after treatment

Question 21

Effects of Serotonin Syndrome?

Answer 21

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

Fever, excessive sweating, incoordination, hyperreflexia, and tremor

Question 22

What causes Serotonin Syndrome?

Answer 22

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

Question 23

How does Serotonin syndrome stop?

Answer 23

Spontaneously resolves after discontinuing the drug*

Question 24

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

Answer 24

Can lead to death if medication is not discontinued*

Question 25

Drug interactions that cause Serotonin Syndrome

Answer 25

MAOIs + SSRIs

SSRIs + SSRIs

Saint John’s Wort

Question 26

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

Answer 26

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

Question 27

St. John’s wort

Answer 27

Causes serotonin syndrome

Not FDA approved

Question 28

What is the difference between Sustained Release and Extended Release?

Answer 28

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.

Question 29

Rule for XL and SR drugs?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

Electroconvulsive therapy (ECT)

Answer 31

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

Question 32

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

Answer 32

Initial response develops after 1 to 3 weeks

Question 33

Maximal responses for antidepressants will be seen when?

Answer 33

Maximal responses may not be seen for 12 weeks