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Thought And Mood Flashcards

1
Q

Antidepressants

A

SSRIs, SNRIs, tricyclic antidepressants, MAOIs

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2
Q

General considerations for antidepressants

A

Usually start with SSRIs/SNRIs bc safest; all have risk of SI, mental imbalance—assess suicide risk (may start meds in patient or daily checks if SI is present); monitor for 4-8 weeks for efficacy; can inc dose, switch drug or class, add second drug

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3
Q

SSRIs MOA

A

Inhibit Sr reuptake which keeps more Sr in the synapse and dec dep and anx sx

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4
Q

SSRI SE

A

Wt gain, GI (N/V/D, constipation, dry mouth), Dec sex drive; Sr sx—2-72 hours after tx—AMS, inc occurrence with MAOIs and other serotonergic drugs, withdrawal sx—dizzy, HA, sensory disturbance, tremor, anxiety, dysphoria; Suicidal risk, small risk of pulmonary HTN in neonates and abstinence syndrome during pregnancy

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5
Q

SSRI NC

A

May play with dose to Dec SE, can’t abruptly stop, be careful if pregnant, monitor suicidal risk

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6
Q

Fluoxetine (Prozac), sertraline (Zoloft), escitalapram (Lexapro) and NC

A

SSRI; 2nd gen drug; therapeutic benefit in 3-4 weeks, can’t take with MAOIs

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7
Q

Venlafazine (Effexor) MOA

A

SNRI; blocks reuptake of Sr and NOR uptake leaving more in the synapse

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8
Q

Venlafzine SE

A

Nausea, HA, anroexia, insomnia, somnolence, sexual dysfunction, w/d sx, sweat, blurred vision, inc LFTs with dulxetine—liver; CI with MAOIs

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9
Q

Amitriptyline (Elavil)

A

Tricyclic antidepressant

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10
Q

tricyclic antidepressants

A

More severe intx; used for long time, good efficacy, SE profile tolerable; more inexpensive; ASSOCIATED WITH FATAL OVERDOSES, can inc SI; also tx neuropathic pain and nocturnal enuresis

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11
Q

Tricyclic antidepressants MOA

A

Block reuptake of NOR and SR (monoamine transmitters), making more available in the synapse

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12
Q

Anticholinergic SE of TCAs

A

Hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter—get hot, dry mucus membranes, blurry vision, turn red, confusion

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13
Q

TCA SE

A

Sedation, orthostatic hypotension, sex dysfunction, cardiac toxicity; hypertensive crisis when given with MAOIs

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14
Q

Phenelzine (Nardil)

A

MAOIs; used for refractory depression (nothing else working); better for atypical depression (diff sx)

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15
Q

MAOI probs

A

Cause hypertensive crisis when taken with other drugs and tyramine

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16
Q

MAOI MOA

A

Inhibit monoamine oxidase which is found in liver, intestinal walls, and neuron terminals and usually converts NOR, 5HT, and Dp to inactive form; so MAO inc availability of NTs at the synapse

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17
Q

MAOI SE and NC

A

Food drug intx—tyramine rich foods like aged cheese, smoked meat, red wine, anything aged or smoked, can make you on edge, orthostatic hypotension, rapid inc in BP, stroke, coma when taken with tyramine or other intx drugs (ephedrine, antihypertensive SSRI, TCA, merperidine)

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18
Q

Bupropion (Wellbutrin)

A

Atypical antidepressant similar to amphetamine, stimulant effect, Dec appetite; 1-3 weeks for effect; unclear MOA

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19
Q

Bupropion SE

A

Seizure, agitation, HA, dry mouth, weight loss, GI upset, dizzy, tremor

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20
Q

Ketamine

A

Atypical antidepressant and painkiller; low dose—works for refractory depression and extreme depression—helps with SI

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21
Q

High dose ketamine SE

A

Perceptual disturbances—tripping/hallucinate, dissociation

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22
Q

Trazadone (Oleptro)

A

Second line agent of atypical antidepressant; blocks 5HT reuptake, minimal effectiveness in depression, often used to help with anxiety and insomnia

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23
Q

Benzodiazepines

A

Alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)

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24
Q

BDZs MOA and indications

A

Enhance inhibitory effects of GABA in the CNS—calming effect; for acute sx of GAD and panic disorders

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25
BDZs SE
SLEEPY; CNS dep (Dec LOC), w/d sx, memory loss, resp dep—more common with IV use
26
BDZs NC
Can’t use while preg (teratogenic), schedule 4 med—addiction concern and only rx short-term, be careful when taking with other meds that can impact CNS/dec LOC (Benadryl, alc, opioids, barbiturates); CYP says—avoid eating with grapefruit or fatty foods—can inhibit abs
27
BDZs antidote
Flumazenil (Romazicon)
28
NTs
Chemicals that enable the path of electrical transmission in the brain across synapses—neurotransmission
29
Dopamine functions and associated conditions
Attention, motivation, pleasure, reward; Low levels associated with Parkinson’s (slow rxns, anergia) , anhedonia, depression and craving
30
Serotonin functions and associated conditions
Low serotonin—OCD-like sx (obsession and compulsions), impulsivity—suicide, aggression, susc to enviro triggers, depression and craving
31
GABA
Inhibitory NT (relaxes); dysfunction (low GABA)—anxiety especially panic disorder, MDD
32
Norepinephrine
Excitatory NT—fight or flight response; excess—high anxiety, stress, hyperactivity; low—lack energy, focus motivation
33
What conditions are you most likely to have with depression?
CAD (64% more likely to develop), disability, inc risk of suicide, family history—enviro, bio, psych function
34
Leading cause of disability worldwide
Depression
35
Depression diagnosis
Sx intense enough to cause distress and persistently impair psychosocial function with multiple sx (besides mood) and interfere with living
36
Depression etiology
Situational depression, meds, chemical imbalance
37
Sx of depression
Anhedonia, fatigue, restless, Dec conc, low self-esteem, sleep and appetite disturbance
38
Depression tx
Meds (can take weeks to feel effects), CBT and talk therapy, support and education, deep brain stimulation therapy; works best when combines and individual to pt
39
Panic disorder
Anticipatory anxiety (expectation of anxiety onset) and avoidance—personal strategy to increase feelings of control and Dec risk of panic attack
40
Panic disorder etiology
Biopysch and physiological—genetics, family history; linked to early childhood stress
41
Neuro chemical explanation for panic disorder
Overwhelming stress induces circulating stress hormones which stimulate glutamate (most abundant NT in body)—excess glutamate with panic
42
Panic
Unexpected episodes of anxiety out of proportion with events going on around them; cyclical process of fear
43
Panic attacks
Recurrent uncomfortable episodes of panic with sudden onset of sx like VS change, heart palpitations, SOA, dizzy, nausea, fear of losing control, tingling, chills/flush
44
How many people with panic disorder also have depression?
50%
45
Panic tx
CBT—dec fear thinking, antidepressants (SSRIs, SNRIs, BDZs (for acute sx/attack in the moment), MAOIs)
46
Generalized anxiety disorder
Persistent feeling of anxiety or dread that interferes with how you live your life
47
GAD timeline
Chronic; anxiety over 6 months
48
GAD sx
Excessive, uncontrolled, unrealistic worries, muscle tension, autonomic hyperactivity, concentration problems
49
Risk factors for GAD
Abuse and trauma, drug use
50
GAD tx
CBT, antidepressants—SSRIs; BDZs, Buspirone—unknown MOA, no sedation/abuse; doesn’t worsen other drug effects, antioxyltic effect slows anxiety
51
PTSD 3 core sx and MOA
Hyperarousal, avoidance of reminders, re-experiencing events; chronic activation of stress response in relation to exposure to potentially life-threatening events
52
Other PTSD sx
Flashbacks, nightmares, emotional blunting, irritability, exaggerated startle
53
PTSD causes
#1 is rape; M—combat, neglect, abuse in childhood; F—sex molestation, physical attack, threatened with a weapon
54
PTSD tx
Psychotherapy, CBT, exposure therapy, EMDR, SSRIs, SNRIs
55
Social anxiety disorder
Intense fear of criticism by others, persistent fear of humiliation, negative evaluation of embarrassment by peers (embarrassment is worst that can happen) causing withdrawal from a situation or intense discomfort
56
Social anxiety causes
Inherited, amygdala—fear response, learned environment
57
Social anxiety tx
CBT, SSRIs, BDZs, propranolol (Dec HR)
58
OCD
Repetitive unwanted thoughts/obsessions usually followed by repeated activities/rituals; time-consuming and maybe distressing to ind, friends, family
59
Subtypes of OCD
Hoarding, contamination with cleaning, checking for safety, symmetry, w/o visible compulsions
60
OCD tx
Hard to tx; SSRIs, TCAs, deep brain stimulation, EMDR

PATHO (32 decks)

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