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Pharmacology Test 3 > Neural System 4: Depression and Anxiety > Flashcards

Neural System 4: Depression and Anxiety Flashcards

1
Q

what is depression?

A

mood disorder described as having the presence of 2 or more symptoms effecting:

  1. energy level
  2. sleep
  3. appetite
  4. self-esteem
  5. concentration
  6. decision-making
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2
Q

what are the 2 major categories of depression?

A
  1. major depressive disoder
  2. dysthymic disorder
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3
Q

what is major depression disorder?

A

symptoms for 2+ weeks

classified as mild, moderate, or severe

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4
Q

what is dysthymic disorder?

A

mild chronic depression

symptoms for 2+ months

can still have major depressive episodes

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5
Q

what are the symptoms typically for dysthymic disoder?

A

more cognitive features (low self-esteem)

affective (low mood)

social dysfuncction (social withdrawal)

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6
Q

what are the overall symptoms of depression?

A
  1. low mood
  2. lost of interest
  3. loss of motivation
  4. loss of libio
  5. feelings of helplessness, hopelessness
  6. sleep distrubances
  7. suicidal thoughts
  8. eating disturbance
  9. pessimism
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7
Q

Depression can increase your risk for what other diseases?

A
  1. reduced cardiovascular health (MI)
  2. osteoporosis, PUD, DM
  3. increased cortisol levels
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8
Q

Pathophysiology of Depression

A

exact pathogenesis not completely understood

Possible factors:

  1. Monoamine hypothesis
  2. receptor downregulation and changes in sensitivity
  3. Neuroplasticity hypothesis
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9
Q

what is the monoamine hypothesis?

A

deficiency or imbalance of monoamines leading to receptor downregulation and changes in sensitivity

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10
Q

what is neuroplasticity hypothesis?

A

neurohistological changes lead to changes in the hardwiring of the brain

Antidepressants reverse these changes

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11
Q

General MOA of antidepressants

A

inhibit reuptake of monoamines (5-HT or NE)

desensitizationof autoreceptors

enhance NE release

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12
Q

What is a risk in treatment of depression?

A

Serotonin Syndrom

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13
Q

Individuals undergoing Antidepressant therapy should be monitored for what?

A
  1. DDIs (cyp enzymes)
  2. BP/HR
  3. worsening depression (**red flag statement)
  4. serotonin syndrome
  5. boxed warnings
    • increased suicidal thoughts
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14
Q

What is Serotonin Syndrome?

A

accumulation of high levels of serotonin

classified as mild, moderate, severe, and life threatening

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15
Q

what are the symptoms of mild Serotonin Syndrome?

A
  1. HTN
  2. tachycardia
  3. tremor
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16
Q

what are the symptoms of moderate Serotonin Syndrome?

A

same as mild in addition to:

  1. hyperthermia (1040)
  2. hyperactive bowels
  3. mild agitation
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17
Q

what are the symptoms of severe Serotonin Syndrome?

A

all of the mild/moderate symptoms

hyperthermia (106 degrees)

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18
Q

what medication puts you at the highest risk of Serotonin Syndrome?

A

MAO Inhbitors

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19
Q

treatment for Serotonin Syndrome?

A
  1. Benzodiazepines
  2. Serotonin antagonist
  3. discontinuing serotonergic agents
  4. cardiac monitoring
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20
Q

what is the goal of Antidepressant Therapy (treating depression)?

A
  1. reduce acute symptoms
  2. return to baseline level of function
  3. prevent further episodes
  4. prevent suicide attempts
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21
Q

how long does it take after starting meds to see improvements in physical symptoms of depression ?

A

usually 2 weeks

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22
Q

how long does it take after starting meds to see improvements in emotional symptoms of depression?

A

usually 6-8 weeks

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23
Q

Drug Classes for Depression

A
  1. Selective Serotonin Reuptake Inhibitors (SSRI)
  2. Seretonin/NE Reuptake Inhibitors (SNRI)
  3. Atypical agents
  4. Tricyclic Antidepressants
  5. MAO Inhibitors
  6. Other
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24
Q

SSRI suffix

A

-pram

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25
Q

SSRI Drugs

A
  1. citalopram (Celexa)
  2. escitalopram (Lexapro)
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26
Q

SSRI MOA

A

selectively inhibit 5-HT reuptake

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27
Q

SSRI AE

A
  1. HA
  2. N/V/D
  3. insomnia
  4. sexual side effects

*Rare = hyponatremia, bleeding

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28
Q

SSRI Indications

A
  1. Depression
  2. eating disorders
  3. PTSD
  4. anxiety
  5. OCD
  6. bipolar disorder
  7. vasomotor menopausal symptoms
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29
Q

SNRI suffix

A

-ine

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30
Q

SNRI drugs

A
  1. venlafaxine (Effexor)
  2. duloxetine (Cymbalta)
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31
Q

SNRI MOA

A

inhibits 5-HT and NE reuptake

32
Q

SNRI AE

A
  1. HA
  2. nausea
  3. dry mouth
  4. sweating
  5. sexual dysfunction
  6. insomnia
33
Q

SNRI indications

A
  1. depression
  2. anxiety
  3. OCD
  4. panic disorder
  5. PTSD
  6. vasomotor menopausal symptoms
  7. fibromyalgia
  8. neuropathic pain
34
Q

Atypical Agents used to treat Depression

A

Buproprion (Wellbutrin)

35
Q

what is buproprion (Wellbutrin) used to treat in depression?

A

used as adjunct therapy to reduce sexual dysfunction

36
Q

buproprion (Wellbutrin) MOA

A

inhibits reuptake of DA and NE

37
Q

buproprion (Wellbutrin) AE

A
  1. HA
  2. nausea
  3. insomnia
  4. tremor
  5. dry mouth
  6. decreased appetite

**risks of seizures

38
Q

buproprion (Wellbutrin) Indications

A
  1. depression
  2. ADHD
  3. smoking cessation
  4. weight loss
39
Q

T/F: Tricyclic Antidepressants are cholinergic?

A

FALSE -> they are anticholinergic

40
Q

Tricyclic Antidepressants MOA

A

inhibits reuptake of 5-HT and NE. Creates receptor blockades for other NTs

41
Q

Tricyclic Antidepressants AE

A
  1. weight gain
  2. sexual dysfunction
  3. sedation
  4. anticholinergic effects (ABCDs)

**risks = overdose (cardiac)

42
Q

Tricyclic Antidepressants Indications

A
  1. Depression
  2. Neuropathic pain
  3. migraine prevention
  4. insomnia
43
Q

MAO Inhibitors MOA

A

inhibits MAO enzyme = more monoamines

44
Q

MAO Inhibitors AEs

A
  1. OH
  2. weight gain
  3. sexual dysfunction
45
Q

MAO Inhibitors Risks

A

Serotonin Sydrome

Hypertenisve crisis

46
Q

someone on an MAO Inhibitor should avoid what things to reduce their risk of hypertensive crisis?

A
  1. tyramine containing foods (wine, beer, cheese)
  2. sympathomimetic agents
47
Q

MAO Inhibitors Indications

A
  1. depression
  2. Parkinson’s Disease
48
Q

Other agents used to treat depression?

A
  1. alpha 2 antagonists
  2. 2nd generation antipsychotics
  3. Katamine (for highly trx resistant depression)
    • admin in providers office
  4. Trazodone
  5. Nefazodone
49
Q

What medication is 1st line in treating depression?

A

SSRI

due to efficacy and tolerability

50
Q

what drug is 1st line for fibromyalgia and neuropathic pain?

51
Q

Therapeutic Concerns for Antidepressant therapy

A
  1. intermittent tx may diminish drug efficacy
  2. monitor BP/HR
  3. tremor and sedation will impact participation in PT
52
Q

what is anxiety?

A

an appropriate response that becomes pathologic when out of proportionto the siutation

53
Q

Somatic symptoms of anxiety?

A
  1. muscle ache
  2. GI issues
  3. fatigue
  4. restlessness
54
Q

Psychological symptoms of anxiety

A
  1. sleep disturbances
  2. excessive worrying
  3. poor concentration
55
Q

Pathophysiology of anxiety

A

impacts the following regions of the brain

  1. periaqueductal gray matter (PAG)
  2. locus coeruleus
  3. hypothalamus
  4. limbic system
    • amygdala
    • hippocampus
56
Q

what does stimulation of the PAG cause?

A

vascular effects of anxiety

57
Q

what does stimulation of the locus coeruleus cause?

A

anxious behavior and panic

58
Q

how is the hypothalamus involved in anxiety?

A

central to anxiety response (hypothalmus-pituitary-adrenal axis)

secretes hormones involved in stress reaction

59
Q

describe the limbic system’s role in anxiety

A
  1. amygdala is connected to area involved in anxiety
  2. chronic stress (cortisol) reduces hippocampal volume
60
Q

Neurochemistry of Anxiety

A
  1. Monoamines = alpha 2 decrease sympathetic outflow to decrease anxiety
  2. serotonergic system = releases serotonin
  3. GABAergic system = inhibits release of GABA
61
Q

drugs used to treat anxiety act where?

A
  1. Serotonergic system
  2. GABAergic system
62
Q

Treatment of Anxiety

A
  1. SSRIs
  2. SNRI
  3. Tricyclic Antidepressants
  4. MAO Inhibitors
  5. Propranolol
  6. Benzodiazepines
  7. buspirone (Buspar)
63
Q

what is the 1st line treatment for anxiety?

A

SSRIs and SNRIs

64
Q

what is used in maintenace treatment for anxiety?

A

Tricyclic antidepressants and MAO inhibitors

65
Q

what is used for long-term treatment of anxiety?

A

propranolol = for panic attacks

66
Q

how are benzodiazepine used to treat anxiety?

A

only for acute treatment

67
Q

how is buspirone used to treat anxiety?

A

maintenance in generalized anxiety

68
Q

Benzodiazepines drug

A

alprazolam (Xanax)

69
Q

alprazolam (Xanax) MOA

A

binds BZD receptors ot enhance GABA inhibitory effects

70
Q

alprazolam (Xanax) AEs

A
  1. sedation
  2. ataxia
  3. memory problems

**high abuse potential

71
Q

alprazolam (Xanax) Indications

A
  1. spasticity
  2. muscle spasms
  3. acute anxiety
  4. serotonin syndrome
72
Q

buspirone (Buspar) MOA

A

unknown

binds to 5-HT and DA receptors

73
Q

buspirone (Buspar) AEs

A
  1. dizziness
  2. paradoxical anxiety (potentially)
74
Q

buspirone (Buspar) indications

A
  1. anxiety
  2. panic disorders (less useful)
75
Q

what are the advantages to using buspirone (Buspar)?

A
  1. no abuse risk
  2. no dependence
  3. no withdrawal
76
Q

what are the disadvantages of using buspirone (Buspar)?

A
  1. DDIs (cyp enzymes)
  2. onset = 3 weeks
77
Q

Therapeutic concerns with drugs that treat anxiety

A
  1. caution in elderly -> BZDs increase fall risk
  2. BZDs can interfere with sleep cycle (REM)
  3. overall sedation will
    • limit PT participation
    • increase fall risk

Pharmacology Test 3 (10 decks)

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