Week 6 Flashcards
signs of clinical depression
SIGECAPS
where is the detailed assessment of depression discussed?
DSM-IV
diagnostic and statistical manual of mental disorders
what is a scale used to measure depression
Hamilton depression scale
HAM-D (abbreviated)
A HAM-D of ____ is regarded within the normal range and a HAM-D of ____ is thought of as serious depression
7
25
clinical depression may be due to low levels of what?
- monoamine neurotransmitters norepinephrine
- serotonin
- dopamine
what are two common tricyclic antidepressants
and these drugs are available as generic
- Amitriptyline
- Imipramine
TCA’s prevent repute of ____ and _______ at afferent neurons, thus untensifying
- serotonin
- norepinephrine
what are some adverse effects of TCA’s
orthostatic hypotension dry mouth urinary retention sedation heart block
unlabelled uses if tricyclics include
migraine headaches
neurological pain
____ ____ were some of the earliest antidepressants on the market in the 60;s. they inhibit ___ ____ in the brain and hence increase noreepi levels at brain synaese. Thus patients should stay away from food that are higher in NE such as figs, banana, and avocados.
MAO inhibitors
monoamine oxidase
____ ____ _____ _____ are the most commonly prescribed prescibed family of antidepressant drugs. This drug works by increasing the amount of serotonin in the brain controlling mood. They have less adverse effects when compared to TCA’s These drugs will not cause heart ___ and or ____. The use of these drugs for patients under ___ is controversial because of a small increase in suicide rates.
selective serotonin re-uptake inhibitors
arrhythmias and or seizures
14
______ suggest that SSRIS are only modestly better than placebo and difference may be due to breaking blind
Metaanalysis
_____ (——)(1989) was the first SSRI and at one time the most commonly prescribed antidepressant. It has been approved for treating depression, OCD, pre-menstrual syndrome, bulimia, panic disorder it primarily inhibits re-uptake of serotonin
Fluoxetine (Prozac)
what are major adverse effects f prozac
50%-
21%-
20%-
sexual dysfunction
nausea
headache
Prozac has a half about a ____. Prozac inhibits several isozymes of the _____-___
week
cyt P-450
What are four other SSRI’s
Paxil
Sertraline (zoloft)
Citalopram (celexa (1998)
Escitalopram (Lexapro)2001
what was the first most commonly prescribed SSRI in 2005 and what was the second most common
Sertraline
Escitalopram
The 4 SSRI’s are similar to prozac but they have shorter __ ___. They also have less inhibitor of ___-___ thus fewer drug interactions.
half-lives
CYT P-450
SSRI’s can cause insomnia and anxiety sometimes and this can be alleviated by taking a TCA such as _____ which tends to be sedating.
SSRI’s can produce E___ ____ ___ causing nausea, vomiting, agitation and sweating.
amitriptyline
Excess Serotonin Syndrome
High dosages if SSRI’s should not be terminated abruptly as it can cause ___ ____ ____ (flu-like withdraw symptoms: nausea, tremors and dizziness)
Serotonin discontinuation syndrome
what is the SARI and what drug is it
Serotonin Antagonist and reuptake inhibitors
Trazodone
_____ is thought to inhibit serration repute and to block certain serotonin receptors. It is also used as a sedative for insomnia as well as second line antidepressant.
trazodone
____ are classified separately from tricyclics because do not have as many adverse effects of TCA’s
SNRI antidepressants
Serotonin and norepinephrine Reuptake inhibitors.
_______ claims lower incidence of agitation than SSRI’s because it is a SNRI. This drug has a short half life which has contributed to substantial withdrawal problems. Effexor XR is available as the long acting form
Venlafaxine
______ is actually a metabolite of fenlafaxine. It is not cleat that it is any better than venlafaxine as an anted and is not approved in _____
Desvenlafaxine
europe
______ is a potent inhibitor of both serotonin and noreepi repute because it is a SNRI. it has also been approved by the FDA for treatment of depression and diabetic neuropathic pain. it has obtained FDA approval for treating _____ and generalized anxiety disorder.
cymbalta
fibromyalgia
what does NDRI stand for and what is a drug in its class
Norepinephrine andd dopamine reuptake inhibitors
Bupropion
______ has less effect on sexual disfunction which is a weak inhibitor of NE and dopamine repute. This drug is a NDRI and there is risk of cardia arrhythmias at high doses. This drug takes about 3-4 weeks to show effect. ____ is the same drug which is used for aiding smoking cessation.
Bupropion
Zyban
Bipolar people that cycle from manic to depressed stages rapidly are called _____ cyclers and ____ cyclers go through the stages more slowly. Patients who have very elevated moods during the manic phase are called ____ bipolar. those who have high anxiety levels are referred to as _____
rapid
slow
euphoric
dysphoric
____ _____ was the drug of choice for treatment of bipolar disorder. This drug has a low ti and numerous adverse effects. it must be taken 2 to 3 times a day because it is pee’d out. Effect don’t usually appear until 1-2 weeks.
Lithium Carbonate
these three drugs are anti seizure drugs and are approved for bi-polar disorder
Valproic acid
Carbamazepine
Trileptal
what are four atypical anti-psychotic medications approved for bi-polar disorder
Zyprexa
Seroquel
abilify
Risperidone
what are 4 SSRI’s as appetite suppressants
Fenfluramine (drowsiness counter acted by PHENTERMINE and combo is known as fen-phen)
Redux
Meridia
Xenedrine
If your systolic blood pressure is over _____ and diastolic is over ____ then you have hypertension. ( this was the past)
The number are now ___/____
140
90
120/80
Blood pressure can be reduced by three ways???
- reduce blood volume (Diuretics)
- Vasodilation
- decrease pumping rate or strength (beta blockers)
it is estimated that 50 million americans have some degree of hypertension but about 37 million are being treated and only ___ million have blood pressure under control
25
Many people have a dip on the order of __ mm HG in their blood pressure during the night, flooded by a blood pressure surge in the morning. there is an increased incidence of ___ in the morning
15
MI
what are some non-pharmacological methods of reducing blood pressure
- weight reduction
- DASH (Diet Approach to stop hypertension) diet low in saturated fats, high fruits/veggies
- reduce caffeine
- reduce alcohol
- aerobic exercise
- na restriction
what are some medications that increase BP
- Birth control pills
- antihistamines
- corticosteroids
- Tricyclic antidepressants
what are first line drugs for reducing blood pressure
- diuretics
- ACE inhibitors and ARBS
- Ca channel blockers
- beta-1-blockers
Diuretics are used primarily in the treatment of ___ and to reduce ____ in congestive Heart failure. They work by inhibiting ___ resorption which inhibits water resorption which in turn lowers blood volume. These drugs are recommend by the ___ (JNC). Ample data indicates that diuretics not only lower hypertension, they also reduce heart attacks, heart failure and stroke. They are also effective when combined with low does of Ca channel blockers, ACE inhibitors and beta blockers.
hypertension
edema
Joint National Committee
________ works to inhibit Na+ resorption in EARLY distal convoluted tubule. It is more commonly used for treatment of hypertension. this drug was #13 of the most commonly prescribed drugs in 2008
Hydrochlorothiazide (HCTZ)
Hydrochlorothiazide (HCTZ) causes, electrolyte imbalance, dehydration, hyperlipidemia, and not used while breast feeding, and hypokalemia which can be treated by a.) b.) c.)
a. ) K supplements
b. ) K sparing drugs
c. ) Diets rich in fruits and veggies
______ (#17 in number of prescriptions in 2008) is the most potent common diuretic. it works on the ASCENDING LOOP OF HENLE and is sometimes referred to as _____ _____ or __ _____ ___. This drug has a higher efficacy than HCTZ but higher risk of same adverse effects
Furosemide (lasix)
loop diuretic
high ceiling diuretic
what is a rare adverse effect of lasix
ototoxicity
potassium sparing diuretics inhibit na+/K+ exchange in ____ convoluted tubule. expect for spironolactone and they are rarely given by themselves because they are not very potent diuretics
distal
what are three potassium sparing diuretics
amiloride
triamterene
spironolactone
________ inhibits the synthesis of Na+/K+ exhacnge protein in the last distal convoluted tubule and hence conserves potassium. This drug take _____ day to reach full efficacy because it doesn’t inhibit the already present channel protein. It was shown to reduce ___ ____ ____ (RALES study) by 30%. it is a weak ____ inhibitor thus may cause gynecomastia in males and its off label uses are to reduce facial hair growth in trans-genders
spironolactone
several
congestive heart failure
testosterone
______ is freely filtered at the glomerulus and has minimal reabsorption. it sets up osmotic pressure differential result in no reabsorption by the kidneys. it is given IV in medical emergencies such as ____ failure, and cerebral _____ resulting from head injuries
Mannitol
renal
edema
what are 2 beta-1 blockers
- metoprolol
- atenolol
Beta-1 blockers work better in ____ and _____ aged patients. In old people and blacks they do not seem to reduce the blood pressure or risk of heart attacks. Adverse effects include fatigue, depression, male sexual dysfunction and slight increased risk of diabetes. Do seem to reduce the risk of a second MI.
young and middle
decrease mortality =
decrease blood pressure=
real clinical outcome
surrogate outcome.
what are two other specific alpha and non-specific beta blockers that are trying to replace atenolol and metoprolol. X2
CARVEDILOL
Bystolic`
likewise the ASCOT trial likewise showed a reduction in mortality in patients on the calcium channel blocker ____ compared with the beta-1 blocker atenolol
amlodipine
ACE inhibitors work by inviting the synthesis of the potent ______ _____ ___
Vasoconstrictor angiotensin II
angiotensin II stimulates ____ secretion in the adrenal cortex which results in Na ion and water retention
aldosterone
Angiotensin II causes vasoconstriction of arterioles, as well as venous vasoconstriction. Inhibition of ____ causes vasodilation and resulting lower blood pressure. These are used in the treatment of hypertension and congestive heart failure. They have also been found to reduce progression of kidney failure in diabetics. These are often less effective in the ___ and ____
ACE
elderly and african americans
ACE inhibitors can cause ____ therefore K supplements should be DC’d. ACE inhibitors also cause fetal injury and are teratogenic in the ___ trimester and _____ in the trimester. They also cause persistent dry ___ in 5-12% of people.
hyperkalemia
2nd
3rd
cough
what was the six most commonly prescribed drug in 2008 for an ACE inhibitor
Lisinopril
____ is used IV for hypertensive crisis and for clinical test as well as PO for reduction of hypertension
Enalapril
_____ was the first ACE inhibitor on the market. It has a short half-life 2hrs and should be taken on an empty stomach because absorption is inhibited by food. it is rarely prescribed except for clinical _____ medicine test assessing _____ _____ where its short half life allows its rapid elimination.
Capoten
nuclear
renal stenoses
what are 3 other ACE inhibitors
Accupril
Ramipril
Benazepril
Angiotensin II Receptor Anagonsits or Blockers (ARA’s or ARB) act as inhibitors of the angiotensin II receptor sire in the vascular system and adrenal cortex. These do not cause persistent ___ that occurs with ACE inhibitors. They are ineffective in ___ and are teratogenic in the2nd and 3rd trimester. They are commonly prescribed especially to ___ patients and __ patients. All of the generic names end with -_____
cough blacks diabetic asian -sartan
what are 5 ARB’s
Valsartan Losartan olmesartan Irebesartan candesartan
