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HLSC 220 > Antidepressants and Anxiety drugs (Ch 35+38) > Flashcards

Antidepressants and Anxiety drugs (Ch 35+38) Flashcards

1
Q

Adverse effects to SSRIs

A

CNS: Headache, nervousness, insomnia, fatigue

GI: Nausea

Other:
* Sexual dysfunction
* weight gain

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2
Q

What happend when you increase the dosage for Benzodiazepines?

A

-anxiolytic
-sedation
-hypnotic (promote sleep)
-stupor (near-unconsciousness or insensibility)

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3
Q

What are the indications of use for SSRIs? (When are they prescribed)

A

They are prescribed for:
-Major depressive disorder
-Bipolar affective disorder (not alone)

Also:
-Eating disorders
-OCD
-Panic attacks
-Myoclonus

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4
Q

What are the major advantages and disadvantages to Buspirone?

A

1.) No abuse potential
2.) Does not intensify the effects of CNS depressants

(5-HT1 agonist
non-sedating and non-habit-forming)

Major disadvantage is that effects develop slowly and can take a week to appear, and several more weeks must pass before responses peak

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5
Q

Ex of a benzodiazepines?

A

Lorazepam (Ativan)

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6
Q

How long does it take to see effects from SSRIs?

A

May take from 2-6 weeks to have effects

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7
Q

What drugs are a second choice drug for anxiety?

A

Benzodiazepines (BZDs)

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8
Q

What is the way a patients emotional state is conveyed that relates more to other perception of the patients emotional state, responsiveness?

A

Affect

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9
Q

What reuptakes do TCAs block?

A

Blockade of NE reuptake

Blockade of 5-HT reuptake

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10
Q

TCA overdoses can be?

A

Can be lethal

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11
Q

When administering TCAs what existing disorders must we bear in mind?

A

Caution in patients with existing disorders:
Cardiac Dysrhythmias
Anticholinergic effect
Slows conduction in Bundle of His

*Seizures (excessive excitability of brain neurons)

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12
Q

Mechanism of action for benzodiazepines?

A

-GABA reduces excitability of neurones

-Benzodiazepines enhances effect of GABA

-Decreased neuronal excitability

*Depress CNS activity

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13
Q

What are the most common adverse effects to TCAs?

A

-Sedation

-Anticholinergic effects (blurred vision, dry mouth, constipation, urinary retention, tachycardia)

-Orthostatic hypotension (most serious of the common adverse effects)

*Most dangerous is Cardiac toxicity

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14
Q

SSRI and SNRI are not more effective then?

They have fewer?

and few?

A

No more effective than older TCAs and MAOIs

Fewer adverse effects than
TCAs eg anticholinergic action
MAOIs eg ‘cheese reaction’

Few drug-drug or drug-food interactions

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15
Q

What is anxiety?

A

unpleasant emotional state

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16
Q

What class of antidepressants does sertraline belong to?

A

SSRIs

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17
Q

What reuptake do SSRIs not block?

A

Do not block reuptake of dopamine or norepinephrine

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18
Q

What agent is used for GAD and take weeks before effects are felt?

A

Buspirone

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19
Q

What do selective serotonin reuptake inhibitors block the reuptake of?

A

Selectively inhibit 5-HT reuptake

-They selectively block neural reuptake of serotonin

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20
Q

What agents are the second or third choice for use as an antidepressant?

A

Monoamine Oxidase Inhibitors (MAOIs)

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21
Q

Ex of a TCA

A

Amitriptyline

Others end in “Pramine “

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22
Q

Food to avoid while on MAOIs?

A

Avoid foods that contain tyramine!
Aged, mature cheeses (cheddar, Blue, Swiss)

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23
Q

What classes of drugs are the first choice for antidepressants? What the second? Why?

A

-First choice is SSRI’s and SNRI’s

-Second choice are TCA’s and MOI’s because they have more adverse effects and are generally less well tolerated then that first one treatments and are generally reserved for those have more responses to the first-line drugs

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24
Q

MAOIs: Adverse Effects

A

*Orthostatic hypotension most common
dizziness/light-headedness
tachycardia

CNS stimulation
Insomnia, anxiety

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25
Q

What are the 3 main emotional and mental health disorders?

A

1.) Anxiety

2.) Mood (affective) disorders

3.) Psychoses

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26
Q

What are the Client care implications for patients on antidepressants?

A

Inform clients that it may take 2 to 4 weeks to see therapeutic effects

Monitor clients closely during this time, assess for suicidal tendencies, and provide support

Sedation often occurs with tricyclic therapy
notify physician if this lasts more than 2 weeks

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27
Q

How can patients experiencing orthostatic hypotension reduce the effects?

A

By moving slowly when assuming an upright posture
-Patient should also be instructed to sit or lie down if symptoms (dizziness, light-headedness) occur

28
Q

What is the antidote for acute TCA toxicity?

A

-No antidote for acute toxicity

decrease drug absorption with activated charcoal

29
Q

Examples of mood (affective) disorders?

A

-Depression

-Mania

-Or episode of both

30
Q

How long does it take for serotonin syndrome to start? Signs and symptoms?

A

-Within 2 -72 hours

-Confusion, agitation, restlessness

-tachycardia, hypertension, hyperthermia, sweating

-clonus, hypereflexia, tremour

31
Q

When given PO what do benzodiazepines have little of? They are much safer in?

A

Little respiratory depression given po

-Safer in overdose

32
Q

What are the psychologic and physical components of Anxiety?

A

Uncomfortable state that has both:

Psychologic components
Fear, apprehension, dread, uneasiness

Physical components
Tachycardia, palpitations, trembling, sweating, shortness of breath

33
Q

What is Psychosis?

A

major emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in everyday life

34
Q

What therapeutics effects must we monitor for when giving anxiolytics?

A

mproved mental alertness, cognition, and mood
Fewer anxiety and panic attacks
Improved sleep patterns and appetite
Less tension and irritability, fewer feelings of fear, impending doom, and stress
More interest in self and others

35
Q

What drugs are considered first line treatment for GAD?

A

SSRIs and SNRIs

36
Q

How do Benzodiazepines (BZDs work?

A

-Depress activity in brainstem and limbic system

-Immediate relief

-Used sparingly long term

37
Q

Example 3 atypical antidepressants?

A

1.)mirtazapine
-Increase release of 5-HT
-antagonism at certain 5-HT receptors

2.)bupropion
-block of DA and NE reuptake

3.) vortioxetine
-block of 5-HT reuptake, agonist at some 5-HT receptors and antagonism at other 5-HT receptors

38
Q

Why can’t antidepressants not be used “as needed”

A

With all antidepressants, symptoms resolve slowly. Initial responses will develop in 1 - 3 weeks. Maximal responses may not be seen until 12 weeks.

39
Q

What class of drugs are initially used in depression? (antidepressants)

A

SSRIs and SNRIs for all anxiety disorders

40
Q

If switching from an SSRI to MAOI what must occur?

A

must be a 2- to 5-week “wash-out” drug-free period between MAOI and SSRI therapy

41
Q

Indications of use/when do we use TCAs? (Tricyclic Antidepressant)

A

Depression

Childhood enuresis (uncontrolled urination; *imipramine)
Obsessive-compulsive disorders (clomipramine)
Adjunctive analgesics
Trigeminal neuralgia

42
Q

Benzodiazepines: Adverse Effects

A

-Decreased CNS activity (Drowsiness, loss of coordination, dizziness, confusion, Affects manual skills)

-Potentially habit-forming and addictive

43
Q

Signs of depression?

A

-Persistent sad, anxious, or “empty” mood

-Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

-Feelings of worthlessness, inappropriate guilt, helplessness, hopelessness, pessimism

-Thoughts of death or suicide or attempts at suicide

-Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders or chronic pain

44
Q

What anxiolytic drugs are used as Antipsychotics in GAD and PTSD?

A

Olanzepine, risperidone

45
Q

What are some characteristic side effects of SSRI’s?

A

nausea, agitation/insomnia, and sexual dysfunction

46
Q

What anxiolytic drugs are used for sezure in GAD?

A

Valproate, gabapentin

47
Q

What have TCAs been replaced as?

A

Have largely been replaced as first-line drugs for depressant by SSRIs/SNRIs

48
Q

Disadvantages to MAOIs?

A

Disadvantage: potential to cause hypertensive crisis when taken with tyramine (cheese effect)

49
Q

Ex of a benzodiazepines?

A

Lorazepam (Ativan)

50
Q

If switching from MAOI to a TCA/SSRI what must occur? what must you maintain?

A

must be a 2-week “wash-out” drug-free period between drugs

also maintain diet restriction 2 weeks after MAOI cessation

51
Q

Indications of use/when do we use TCAs? (Tricyclic Antidepressant)

A

Depression

Childhood enuresis (uncontrolled urination; *imipramine)
Obsessive-compulsive disorders (clomipramine)
Adjunctive analgesics
Trigeminal neuralgia

52
Q

Example of a SNRI? What does its retake inhibitor inhibit?

A

-Venlafaxine (Effexor)

(serotonin and norephinephrine reuptake inhibitor)

53
Q

What predictable effects can TCA’S lead to?

A

Leads to predictable adverse effects

54
Q

What class of antidepressants does Amitriptyline belong to?

A

TCA

55
Q

What is GAD? charcteristics?

A

GAD (general anxiety disorder)
-Chronic condition characterized by uncontrollable worrying
-Symptoms may be intense, but are temporary
*Halmark is unrealistic or excessive anxiety about several events or activities that lasts 6 months or longer

56
Q

Hypertensive crisis characteristics? What can it lead to?

A

-Sever headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating

-Can possibly lead to a stoke, cerebral hemorrhage and death

57
Q

what is a sustained emotional attitude?

A

Mood

58
Q

What are the indications of use for Benzodiazepines??when do we use them?

A

Anxiety

-BZDs also for Sedation
(including conscious sedation)

Muscle relaxation
Seizure control
Adjuvant therapy for depression
Alcohol withdrawal

59
Q

Examples of mental disorders with loss of contact with reality?

A
  • Schizophrenia

-Depressive and drug-induced psychoses

60
Q

What does vortioxetine block?

A

block of 5-HT reuptake, agonist at some 5-HT receptors and antagonism at other 5-HT receptors

61
Q

Example of a mood (affective) disorder?

A

*Biopolar disorder - periodic swings

-Mania (abnormally pronounced emotions)

-Depression (abnormally reduced emotions)

62
Q

What agent is used for depression when it is not responsive to other drugs?

A

MAOIs

63
Q

What is phenelzine? How long to take effect?

A

MAOs

2-4 weeks

64
Q

Adverse effects to TCAs?

A

AE: cardiac dysrhythmias and seizures, can be fatal

65
Q

How long does it take for SSRI to take effect?

A

2-6 weeks

HLSC 220 (18 decks)

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