Neuro part 4 Flashcards
Depression diagnosis
Presence of 2 or more symptoms affecting energy level, sleep, appetite, self-esteem, concentration, and decision-making
Depression two categories
Major depressive disorder- 2 or more weeks
Dysthymic disorder- more than 2 months
causes for depression
Deficiency or imbalance of monamines
Receptor downregulation and changes in sensitivity
Neurohistological changes
mechanisms of antidepresants
Block reuptake of serotonin or norepinephrine
Block receptors that shut off the release of monamines
increase release of norepinephrine release
Serotonin syndrome
accumulation of high levels of serotonin
hyperthermia, dramatic swings in HR/BP, truncal rigidity that progress to respiratory failure
General Monitoring and risk with antidepressants
Monitor DDI- interactions due to CYP450 metabolism, anticholinergic effects
tapered to avoid withdrawal symptoms
serotonin syndrome
increased risk of suicidality in patients <24 years
escitalopram (Lexapro), sertraline (Zoloft)- Class, MOA, AE
SSRI
MOA: inhibit reuptake of 5-HT in CNS
Less anticholinergic and cardiovascular effects than other classes
Common AE: HA, N/V/D, insomnia, sexual side effects
Venlafaxine (Effexor), duloxetine (Cymbalta) class, MOA, AE
SNRI
MOA: inhibit reuptake of 5-HT and NE in CNS
Common AE: HA, nausea, sweating, sexual dysfunction, insomnia
Bupropion (Wellbutrin) MOA, AE
MOA: inhibits NE and DA reuptake
Common AE: HA, nausea, significant insomnia, tremor, dry mouth, ↓ appetite
Risk of seizures, especially at high doses or with electrolyte abnormalities
when is SNRI 1st line
concomitant neuropathic pain or fibromyalgia
TCA MOA
Inhibit the reuptake of serotonin and NE
TCA AE
Common AE: weight gain, sexual dysfunction, sedation (histamine receptors), anticholinergic effects (muscarinic receptors), hypotension/dizziness (alpha receptors)
when should most SSRI be taken?
morning
taking Bupropion (Wellbutrin) is at risk
Risk of seizures, especially at high doses or with electrolyte abnormalities
Common AE with antidepressant
HA, GI upset, sexual dysfunction, insomnia, BP issues
Therapeutic Concerns with Antidepressants
Monitor BP and HR (arrhythmia)
TCAs and SSRIs may cause tremor
AE such as sedation and decreased alertness may hinder participation in PT
treatment for anxiety
SRI and SNRIs = common first line treatment
Can be used for long-term maintenance
Propranolol
Buspirone = maintenance in generalized anxiety
Alprazolam (Xanax) Class, MOA, AE
Benzodiazepines
Basic MOA: binds BZD receptors on GABA channels to enhance GABA inhibitory effects
Common AE: sedation, ataxia, memory problems
Alprazolam (Xanax) uses and how to take it
use for acute anxiety or short-term while waiting on matintence med
avoid taking it for maintance because of dependence
If taking long-term must taper to avoid rebound and withdrawal
Buspirone (Buspar)
to bind to 5-HT1a, 5-HT2 and dopamine receptors
Buspirone (Buspar) advantage
No risk of abuse
No physiologic dependence or withdrawal
Buspirone (Buspar) advantage disadvantage
dizziness
Metabolized by CYP3A4 = potential DDI
Therapeutic Concerns with Anxiolytics
Older adults + benzodiazepine = increased fall risk
Benzodiazepines also disturb the sleep cycle
Sedative effect
Schizophrenia causes
diminished dopamine activity
Reduced prefrontal bloodflow during cognitive tasks
Drug treatment for schizophrina
antipsycotics
FGA and SGA (1st line b/c less EPS and TD)
FGA MOA, AE
D2 receptor block in other areas contribute to EPS
EPS is acute (parkinsonism, akathisia and dystonic reaction) or delayed (TD, sometimes irreversible
Quetiapine (Seroquel) Class, MOA, AE
SGA
MOA: block D2 receptors but less than FGA; more affinity for 5-HT2
Higher risk of metabolic dysfunction (glucose and lipid abnormalities, weight gain) – monitor for new onset dyslipidemia, diabetes
Rehab Concerns: FGA Agents
Patient at risk for cardiac abnormalities
impaired thermoregulation
EPS
Rehab Concerns: SGA Agents
Produce significant weight gain, hyperglycemia, and lipid abnormalities
Increased risk for cardiac abnormalities
Increased risk for heat intolerance
Pathogenesis of bipolar disorder
dysregulation in dopamine and serotonin systems
Lithium uses
acute manic episode
Maintenance treatment
Acute depressive episode treatment for bipolar
SSRI and bupropion
Lithium AE
Refer if s/sx of toxicity: persistent diarrhea, vomiting, coarse tremor, mild ataxia, drowsiness, muscular weakness
