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BM: Unit 2 > Pharm for Mood Disorders > Flashcards

Pharm for Mood Disorders Flashcards

1
Q

What are the indications for antidepressants?

A
  1. Depression
  2. Anxiety
  3. Insomnia
  4. PMS
  5. Smokin cessation
  6. Eating disorders
  7. OCD
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2
Q

What drug is used for smoking cessation?

A

Zyban/Wellbutrin

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3
Q

What drug is used for OCD?

A

Luvox

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4
Q

What are 1st generation antidepressants?

A
  1. Tricyclic Antidepressants (TCA)

2. Monoamine oxidase inhibitors (MAOI’s)

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5
Q

What are 2nd generation antidepressants?

A
  1. SSRIs

2. Usually first choice

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6
Q

What must occur when switching from a 1st generation to a second generation antidepressant?

A

Must have a washout period

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7
Q

What is the first line class of drugs for treating depression? Why?

A
  1. SSRIs

2. Low side effects, low lethal potential

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8
Q

How long does it take SSRIs to take effect?

A

May take up to four weeks for full effect

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9
Q

How are SSRIs absorbed and metabolized?

A

Absorption: GI
Metabolism: Liver

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10
Q

What is the MOA of SSRIs? What is their peak and half life?

A
  1. Blocks reuptake of Serotonin at pre-synaptic neuron
  2. Peaks 4-6 hr
  3. Long half life = once daily dosing
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11
Q

What drugs are in the SSRI class?

A
  1. Celexa (citalopram)
  2. Lexapro (escitalopram)
  3. Luvox (Fluvoxamine)
  4. Paxil (paroxetine)
  5. Prozac (fluoxetine)
  6. Zoloft (sertraline)
  7. Viibryd (vilazodone)
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12
Q

What are the general se of antidepressants?

A
  1. Orthostatic hypotension
  2. Blood dyscrasia
    A. Agranulocytosis
  3. Cardiac changes
    A. Base line EKG
  4. Sedation
  5. wt gain
  6. Sexual dysfunction
    A. Decreased libido
    B. Anorgasmia
    C. Erectile Dysfunction
    D. Priapism
    E. Retrograde ejaculation
  7. Serotonin Syndrome
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13
Q

What is serotonin syndrome?

A
  1. Rapid increase in serotonin
  2. Too much too fast
  3. Begins hours to days after initial dose
  4. Potentially lethal
  5. Autonomic instability
    A. Tachycardia
    B. Increased BP
    C. Increased temp
    D. Sweating
    E. Shivering
    F. Change in mental Status
    G. Anxiety restlessness
    H. Tremors
    I. Muscular spasms
    J. dec coordination
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14
Q

How is serotonin syndrome treated?

A
  1. Supportive treatment
  2. Antipyretics
  3. Cooling measures
  4. Temporary withdrawal of drug
  5. Antianxiety medication
    A. Valium – Spasms
    B. Ativan - Restlessness
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15
Q

How are antidepressants started and stopped? Why?

A
  1. Taper to start or stop
2. Never discontinue abruptly bc:
A. Nausea
B. Lightheaded
C. Dizzy
D. Fatigue
E. Flu-like symptoms
F. Paresthesia
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16
Q

When are atypical antidepressants used for mood disorders?

A
  1. Used when client has inadequate response to SSRI
  2. Used when side effects are present with SSRI
  3. Block reuptake of different neuroreceptors than SSRI
17
Q

What are examples of atypical antidepressants?

A
  1. Effexor (venlafaxine)
  2. Remeron (mirtazapine)
  3. Wellbutrin (bupropion)
  4. Desyrel (trazodone)
  5. Cymbalta (duloxetine)
  6. Pristique (desvenlafaxiine)
18
Q

What are examples of TCAs?

A
  1. Anafranil (clomipramine)
  2. Elavil (amitriptyline)
  3. Sinequan (doxepin)
  4. Tofranil (imipraamine)
19
Q

What are examples of other cyclic antidepressants?

A
  1. Pamelor
  2. Aventyl (nortriptyline)
  3. Norpramin (dsipramine)
  4. Vivactil (protriptyline)
20
Q

What are the SE and contraindications for TCA?

A
  1. Start low and Go slow
  2. Do not use with glaucoma
  3. Anticholinergic SE’s can be severe
  4. Cardiac arrhythmias
  5. Baseline EKG
  6. Blurred vision
    7.
21
Q

Why shouldn’t ETOH and TCAs be mixed?

A

Both TCA and ETOH are CNS inhibitors
Depressed brain stem = Depressed vital functions

VERY LETHAL Combination

22
Q

What are the anticholinergic SE of TCAs?

A
  1. Can’t see
  2. Can’t pee
  3. Can’t spit
  4. Can’t ________ (Constipated)
23
Q

What is the 3rd line for antidepressant meds?

A

Monoamine oxidase inhibitors (MAOI’s)

24
Q

How are MOAis absorbed and metabolized?

A
  1. Absorbed GI
  2. Metabolized in liver
  3. MAOI’s last 10 days in body
25
Q

What are examples of MOAIs?

A
  1. Nardil (phenelzine)
  2. Parnate (tranylcypromine)
  3. Emsam patch (selequiline)
26
Q

What advantage does Emsam have over nardil and Parnate?

A
  1. Both have dietary restrictions

2. Emsam Bypasses liver and gut, Goes directly into cells, and has No dietary restrictions 6mg or less

27
Q

What are the SE of MAOIs?

A
  1. Peripheral edema
  2. Muscle Weakness
  3. Forgetfulness
  4. Hypertensive Crisis
28
Q

What is the pathophys of an MAOI HTN crisis?

A
  1. Monoamine oxidase (MAO) metabolizes (breaks down) neurotransmitters
    A. Seratonin
    B. Norepinephrine
    C. Tyramine
  2. These neurotransmitters are vasoconstrictors
  3. MAOI = Inhibit the breakdown of the neurotransmitters
  4. Vasoconstrictors build up
  5. Increased vasoconstrictors = hypertensive crisis
29
Q

What are the sxs of an MAOI htn crisis?

A
  1. Headache
  2. Stiff neck
  3. Tachycardia
  4. Flushed & Clammy
  5. Chest pain/tightness
  6. Nosebleeds
  7. Dilated Pupils
  8. Coma
  9. Death
30
Q

How is MAOI HTN crisis treated?

A

Procardia 10 mg p.o.
Rapid absorption
dec BP in 10-15”
Monitor q 15” until stable

31
Q

What dietary restrictions are necessary when on an MAOI?

A
  1. Dec Fermented or aged food
  2. Deli meats
  3. Yeast products
  4. Fava beans
  5. Sauerkraut
  6. Organ meats
  7. Red wines
32
Q

What drugs do MAOIs interact with?

A
  1. All other Antidepressants
  2. Buspar
  3. Demerol
  4. OTC allergy/cold meds
  5. OTC diet meds
  6. Stimulants
33
Q

How long does it take MAOIs to take effect?

A

2-4 weeks to be effective

BM: Unit 2 (7 decks)

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