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NURS 7310 > Psychobiology of depressive disorders > Flashcards

Psychobiology of depressive disorders Flashcards

1
Q

What five regions are consistently dysfunctional in most patients with depression?

A

dorsolateral prefrontal cortex, medial prefrontal cortex, orbital frontal cortex, anterior cingulate cortex, and hippocampus

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2
Q

Patients with depression have an excessive activity of BLANK and increased BLANK.

A

Patients with depression have an excessive activity of the Hypothalamic-pituitary-adrenal axis (HPA axis) and increased plasma cortisol levels.

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3
Q

Those with anhedonia or inability to feel pleasure suffer from impairment of

A

the reward system

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4
Q

Postmortem microscopic examinations have shown what happens to the brain in those with depressive disorders?

A

decreased cortical thickness as well as diminished neural size

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5
Q

What is BDNF

A

brain-derived neurotrophic factor a brain growth factor

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6
Q

Increased BDNF leads to

A

increased neurogenesis

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7
Q

What five things have been shown to have increases in BDNF and neurogenesis that treat depression?

A

antidepressants, lithium, stimulation treatments, estrogen, and exercise

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8
Q

A single IV administration of this drug can have a robust response in less than 2 hours in upward of 75% of the subjects-lasting several days to 2 weeks in relieving depression.

A

Ketamine

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9
Q

Diathesis

A

what you are born with, genetically determinants

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10
Q

Stress

A

What happens later, environmental determinants

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11
Q

When is a depressive improvement called a remission?

A

removal of essentially all symptoms. it is called remission for the first several months and then recovery if it is sustained for longer than 6 months.

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12
Q

When are depressive symptoms referred to as a relapse?

A

When depression returns before there is a full remission of symptoms or within the first several months following remission of symptoms

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13
Q

When are depressive symptoms referred to as a recurrence?

A

When depression returns after a patient has recovered

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14
Q

How many of depressed patients will remit during treatment with any antidepressant initially?

A

One third

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15
Q

What are the most common residual symptoms in patients who do not achieve remission?

A

insomnia, fatigue, painful physical complaints, problems concentrating, and lack of interest

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16
Q

What age group is the risk benefit ratio for antidepressants the most favorable?

A

adults 25-64

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17
Q

What age group is the risk benefit ratio for antidepressants the worst?

A

Ages 6-12

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18
Q

What age group has the an increased risk of suicide when on antidepressants?

A

19-24 and possibly children and adolescents

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19
Q

What age group may not respond as well to antidepressants and may experience more side effects?

A

65 and older

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20
Q

What hypothesis explains the delayed clinical affect of antidepressants as well as possibly anxiolytics (and additionally the development of tolerance to the acute side effects of antidepressant drugs)?

A

Changes in neurotransmitter receptor sensitivity may mediate the clinical effects of antidepressant drugs

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21
Q

What hypothesis explains the delayed clinical affect of antidepressants as well as possibly anxiolytics (and additionally the development of tolerance to the acute side effects of antidepressant drugs)?

A

Changes in neurotransmitter receptor sensitivity may mediate the clinical effects of antidepressant drugs

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22
Q

Name the six SSRIs?

A

Fluoxetine (Prozac), Sertraline (zoloft), Paroxetine (paxil), Fluvoxamine (Luvox), Citalopram (Celexa)/Escitalopram (Lexapro)

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23
Q

All six SSRIs have what same major pharmacologic feature in common?

A

Selective and potent inhibition of serotonin reuptake, also known as inhibition of serotonin transporter or SERT

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24
Q

The action of SSRIs occurs at

A

both the presynaptic axon terminal and at the somatodendritic end of the serotonin neuron

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25
Q

Which new medication is a “SPARI” (Serotonin partial agonist/reuptake inhibitor)?

A

Vilazodone

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26
Q

Why would the predominance of 5HT1A be potentially significant in Vilazodone?

A

It may mitigate the sexual dysfunction

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27
Q

Prozac (Fluoxetine)

Mechanism of Action:

A

Prozac (Fluoxetine)

Mechanism of Action: SSRI (selectively blocks neuronal reuptake of serotonin which increases the concentration of 5HT

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28
Q

Prozac (Fluoxetine)

Approved Therapeutic use:

A

Approved Therapeutic use: Depression, bipolar, OCD, panic disorder, bulimia nervosa, and premenstrual dysphoric disorder

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29
Q

Prozac (Fluoxetine)

Off label therapeutic use:

A

Off label therapeutic use: social phobia, generalized anxiety disorder, PTSD

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30
Q

Prozac (Fluoxetine)

pharmacokinetics:

A

pharmacokinetics: hepatic metabolism by CYP2D6, half life of 2 days

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31
Q

Prozac (Fluoxetine)

Adverse Effects:

A

Adverse Effects: Sexual dysfunction, weight gain, serotonin syndrome, during pregnancy causes NAS and PPHN, overall low risk for teratogenicity

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32
Q

Prozac (Fluoxetine)

Important Drug reactions:

A

Important Drug reactions: MAOIs, tricyclic antidepressants, lithium, antiplatelet drugs, and anticoagulants.

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33
Q

Prozac (Fluoxetine)

Availability:

A

Availability: 20/5mL liquid, 10, 20, 60 mg tablets, 90 mg delayed release, 10, 20, 40 mg capsules

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34
Q

Prozac (Fluoxetine)

Initial dose:

A

Initial dose: 20 mg

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35
Q

Prozac (Fluoxetine)

Maintenance dose:

A

Maintenance dose: 20-80

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36
Q

Prozac (Fluoxetine)

Approach to discontinuing:

A

Approach to discontinuing: taper over 1-3 weeks

37
Q

Prozac (Fluoxetine)

Approach to switching meds:

A

Approach to switching meds: takes 4 weeks to get out of system

38
Q

Venlafaxine (Effexor)

Mechanism of action

A

Inhibits the reuptake of both serotonin and norepinephrine

39
Q

Venlafaxine (Effexor)

Approved therapeutic use:

A

major depression, generalized anxiety disorder, social anxiety disorder, and panic disorder

40
Q

Venlafaxine (Effexor)

Off label use:

A

ADHD, fibromyalgia, diabetic neuropathy, complex pain syndromes, hot flashes, migraine prevention, PTSD< OCD, premenstrual dysphoric disorder

41
Q

Venlafaxine (Effexor)

pharmacokinetics

A

Processed through the liver with a half life of 5 hours for the drug and 11 hours for the metabolite

42
Q

Venlafaxine (Effexor)

Adverse effects:

A

Nausea, headache, anorexia, nervousness, sweating, somnolence, and insomnia, dose related sustained diastolic hypertension, and sexual dysfunction. Neonatal withdrawal syndrome

43
Q

Venlafaxine (Effexor)

Important drug reactions

A

hyponatremia with diuretics, MAOI contraindicated

44
Q

Venlafaxine (Effexor)

Availability

A

25, 37,.5, 50, 75, 100 mg tablets

  1. 5, 75, 150, 225 mg extended release tablets
  2. 5, 75, 150 mg extended release capsules
45
Q

Venlafaxine (Effexor)

Initial dosing

A

37.5 mg-75 mg

46
Q

Venlafaxine (Effexor)

Maintenance dosing

A

75 mg-375 mg

47
Q

Venlafaxine (Effexor)

Discontinuing:

A

Taper over 2-4 weeks

48
Q

Venlafaxine (Effexor)

Switching

A

MAOI should be discontinued at least 14 days prior to starting Venlafaxine. Venlafaxine should be discontinued 7 days prior before starting the MAOI

49
Q

What are the four SNRIs?

A

Venlafaxine (effexor), Desvenlafxine (Pristiq), Duloxetine (cymbalta), Milnacipran (Savella)

50
Q

What are the signs and symptoms of serotonin syndrome?

A

It begins 2-72 hours after treatment onset and include altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration), incoordination, myoclonus, hyperreflexia, excessive sweating, tremor and fever.

51
Q

Bupropion (Wellbutrin, Zyban)

Mechanism of action

A

inhibits the reuptake of both dopamine and norepinephrine

52
Q

Bupropion (Wellbutrin, Zyban)

Approved therapeutic use:

A

Major depression, seasonal affect disorder, and smoking cessation

53
Q

Bupropion (Wellbutrin, Zyban)

Off label use:

A

neuropathic pain, depressive episodes in bipolar, management of ADHD

54
Q

Bupropion (Wellbutrin, Zyban)

Pharmacokinetics:

A

hepatic metabolism primarily by CYP2B6 and half life 8-24 hours

55
Q

Bupropion (Wellbutrin, Zyban)

Adverse Reactions:

A

agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, and tachycardia. SEIZURES, do not use in patients with psychotic disorders

56
Q

Bupropion (Wellbutrin, Zyban)

Important drug reactions:

A

Do not combine with sertraline, fluoxetine, paroxetine or MAOIs

57
Q

Bupropion (Wellbutrin, Zyban)

Initial dosing

A

200 mg

58
Q

Bupropion (Wellbutrin, Zyban)

Maintenance dosing

A

300-450 mg

59
Q

Bupropion (Wellbutrin, Zyban)

Discontinuing:

A

Taper over 1-2 weeks

60
Q

Bupropion (Wellbutrin, Zyban)

Switching

A

Stop MAOIs at least 2 weeks prior to starting bupropion

61
Q

Bupropion (Wellbutrin, Zyban)

Switching

A

Stop MAOIs at least 2 weeks prior to starting bupropion

62
Q

Trazadone

Mechanism of action

A

At moderate to high doses it is a 5HT2A/5HT2C antagonism with SERT and at low doses it is a 5HT2A antagonist, H1 histaminic and alpha 1 adrenergic receptors

63
Q

Trazadone

Approved therapeutic actions

A

at moderate to high doses it is an antidepressant. At low doses it is for insomnia

64
Q

Trazadone

Availability

A

50, 100, 150, 300 mg tablets

150 and 300 mg XR

65
Q

Trazadone

initial dosing

A

200 OR 150 XR

66
Q

Trazadone maintenance dosing

A

150-600 OR 150-375 XR

67
Q

Trazadone

Adverse Effects

A

daytime grogginess and postural hypotension

68
Q

Phenelzine (Nardil)

Mechanism of Action

A

Irreversible enzyme inhibitors of Monoamine Oxidase (Increasing 5HT, NE, and DA)

69
Q

Phenelzine (Nardil)

Approved therapeutic use:

A

Depression

70
Q

Phenelzine (Nardil)

Off label uses

A

treatment-resistant depression, panic disorder, obsessive-compulsive disorder, and social anxiety disorder

71
Q

Phenelzine (Nardil)

Adverse Reactions

A

Central nervous system stimulation (anxiety, insomnia, agitation, hypomania, mania), Orthostatic hypotension, hypertensive crisis from dietary tyramine

72
Q

Phenelzine (Nardil)

Important drug reactions

A

Indirect-acting sympathomimetic agents, epinephrine, NE, and dopamine, tricyclic antidepressants, SSRIs, antihypertensives

73
Q

What types of food have tyramine?

A

avocados, anything fermented or over ripe, figs, bananas, aged, smoked meats, liver, spoiled meats, dried, cured fish, all cheeses, yeast, beers, wine, shrimp paste, soy sauce

74
Q

Phenelzine (Nardil)

Availability

A

15 mg tablets

75
Q

Phenelzine (Nardil)

Initial dosing

A

45 mg

76
Q

Phenelzine (Nardil)

Maintenance dosing

A

60-90 mg

77
Q

Phenelzine (Nardil)

Discontinuing

A

taper

78
Q

Phenelzine (Nardil)

Switching

A

at least 14 days before switching to a different medication

79
Q

Imipramine (Tofranil)

Mechanism of Action

A

Block both serotonin and norepinephrine reuptake and have antagonist actions at 5HT2A and 5HT2C

80
Q

Imipramine (Tofranil)

Adverse reaction

A

Agitation, insomnia, diaphroesisanticholinergic, sedation, hypotension, seizure toxicity, CARDIAC toxicity, weight gain and sexual dysfunction

81
Q

Imipramine (Tofranil)

Availability

A

10, 25, 50 mg tablets

75, 100, 125, 150 mg tablets

82
Q

Imipramine (Tofranil)

Initial dose:

A

25-50 mg

83
Q

Imipramine (Tofranil)

Maintenance dose

A

100-200 mgs

84
Q

Imipramine (Tofranil)

Approved therapeutic uses:

A

Depression

85
Q

Imipramine (Tofranil)

Off label uses

A

neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD

86
Q

Imipramine (Tofranil)

Important drug reactions

A

MAOI, direct acting sympathomimetic drugs (epinephrine, dopamine), indirect acting sympathomimetic drugs (ephedrine and amphetamine), anticholinergic agents, CNS system depressants (alcohol, antihistamines, opioids, and barbiturates)

87
Q

Imipramine (Tofranil)

discontinuing

A

taper

88
Q

Imipramine (Tofranil) switching

A

half life is 19 hours (out of system in 3-5 days)

NURS 7310 (15 decks)

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