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mood disorders Flashcards

1
Q

biological factors/NT of depression

A 
DECREASED NOREPINEPHRINE
o Fewer β-adrenergic activity DECREASED SEROTONIN
o Fewer 5HT activity
DECREASED DOPAMINE
o Fewer D1 activity
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2
Q

Biological Factors: Neurotransmitters- Mania

A

INCREASED DOPAMINE psychosis, hyperactivity
INCREASED NOREPINEPHRINE euphoria, grandiosity
DECREASED SEROTONIN
depression-mania mood swing (due to activation of other NT that are normally inhibited )

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3
Q

atypical paralysis

A

“leadened paralysis”
eating and sleeping MORE
can use buproprion

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4
Q

both buproprion and mirtazapine do not have ??

A

anti-libido side effects

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5
Q

mirtazapine

A

a2 antagonist

a2 limits NE release

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6
Q

SSRIs

A

Fluoxetine Paroxetine
Sertraline Citalopram

5-HT-specibic reuptake inhibitor

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7
Q

SSRIs SE

A

GI & Sex dysfunction Better tolerated than TCA or MAOIs

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8
Q

SNRIs

A

Venlafaxine

Duloxetine

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9
Q

TCAs have ??? effect

bad for who ??

A

anticholinergic effects
hallucinations, can worsen alzheimers, cognitive impairment, constipation, Tachycardia Urinary retention Dry mouth
Amitriptyline is the most

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10
Q

TCAs

A

3oAmitriptyline 3oImipramine 3oClomipramine

3oDoxepin 2oNortriptyline 2oDesipramine`

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11
Q

avoid foods rich in ?? when taking MAO-i

A

tyramine

not breaking down, can cause hypertensive crisis

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12
Q

risk of ?? with MAO-i and other antideps.

A

serotonin syndrome: 5HT syndrome with any drug that ↑ 5HT: hyperthermia, confusion, myoclonus, cardiovascular, diarrhea, seizures

can treat with antihistamine:
Cyproheptadine (5HT2 receptor antagonist)

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13
Q

bipolar tx: lithium

A

mood stabilizer
may supplement with anti-psych, benzo, etc
-interferes w. ibuprofen clearance

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14
Q

lithium SEs

A

Tremor, diabetes insipidus, Hypothyroidism, congenital abnormality Gastric distress, renal dysfunction
may want to use anticonvulsants instead

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15
Q

carbamazepine

A

bipolar (mood stabilizer)
diabetic neuropathy
trigeminal neuralgia
anti-epileptic

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16
Q

atypical antipsychotics

A

??

17
Q

drugs that cause agranulocytosis

A

carbamazepine

clozapine

18
Q

bipolar tx

A

need mood stabilizer along with antidepressant even when in depressed phase
-just antidep. may trigger manic episode
-some compound:
Symbyax is a bixed combination of
bluoxetine + olanzapine [antidepressant + atypical antipsychotic]

19
Q

bipolar maintenance (greatest challenge)

A

-Lithium, carbamazepine, valproic acid
▫ (lithium in particular reduce suicide risk and relapse)
▫ Thyroid supplementation necessary for long-term
-lamotrigine: prophylactic antidepressant & mood stabilizing

20
Q

treatment response

A

f. u 4-6 wks, 50% require modification
- fair-good: keep same dose
- partial: augment (SSRI (lithium + thyroid + buproprion + mirtazapine)
- no response: switch to a different class
- if not responsive to 2+ tx: “treatment-resistant”

21
Q 
what agent poor choice for old man due to a1 antagonism-->higher risk of falls?
lithium
bupropion
excitalopram
imipramine
A

imipramine

22
Q

a 3 month supply of ??? could be lethal

A

TCA (i.e. amitriptyline)

-1 month is normal dose

23
Q

it takes longer than ??? for SSRIs to start working

A

4–8 weeks

24
Q

on highest dose SSRI (sertraline) and having weight gain, insomnia

A

add buproprion

for atypical depressant symptoms

25
Q

pt on fluoxetine, lost 8 lbs, seeing some improvement

A

keep on tx, reevaluate in 1 month

26
Q

bipolar pt taking 0.7 mEq/L lithium (0.6-1.2 mEq/L) and having continuing mania symptoms

A

increase lithium dose
-still on low end of range

-benzos can be added if agitation/anxiety if haven’t optimized lithium yet

27
Q

hospitalized pt on max dose lithium, sleeping 2-3 hrs, making rude sexual coments, pacing, pressured speech

A

augment lithium w. antipsychotic

next best option: switch to carbamazepine

28
Q

pt. with periods of intense sadness and anhedonia w. alternate periods of extreme mood elevation and energy bursts
should be on ??

A

fluoxetine and olanzapine

29
Q

pt depressed for 6 mos and having trouble sleeping, good tx?

A

paroxetine
-is sedating
fluoxetine has opposite effect

30
Q

pt. has mood swings and reckless behavior
has elevated BUN/Cr
has N/V etc

A

on lithium

31
Q

taking citalopram and MAO-i at same time

A

serotonin syndrome

32
Q

pt w. MDD but doesn’t want sexual dysfunction, should take

A

buproprion

33
Q

pt slow moving and flat affect put on fluoxetine, showing greatly increased activity levels, flight of ideas, pressured sleep

A

medication precipitated a manic episode

34
Q

pt w. biplar disorder, started on lithium, should order what tests before??

A

thyroid function, creatinine, pregnancy test

pulmonary function not affected

psych (5 decks)

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