Antidepressant and mood stabilizer drug therapy

Question 1

what is antidepressant used to treat

Answer 1

depression

aka major depressive disorder

Question 2

major depressive disorder

Answer 2

mood disorder that is characterized as feeling of persistent sadness and dispair, loss of energy, and difficulty dealing with everyday life

last more than 2 weeks

change from previous functions

accompany by withdrawal from social contact, loss of appetite, lack of interest in previous engaging acitivites

some insomnia and hypersomnia

Question 3

antidepressant drugs

Answer 3

TCA
SSRI
SNRI
atypical antidepressants
MAOIs

Question 4

TCA

Answer 4

first generation

used for MDD, neuropathic pain, insomnia, eating d/o

amitriptyline
imipramine
trimipramine
protrityline
amoxapine
doxepin

block reuptake of serotonin and norepinephrine, resulting in elevation of synaptic concentration and enhanced neurotranmission

Question 5

SSRI

Answer 5

second generation

used for
MDD, anxiety (OCD), panic attack, phobias, PTSD, eating disorder, and selected drug abuses
premenstrual dyphoric disorder (PMDD- sertraline)
social anxiety disorder (sertraline)

fluoxetine
sertraline
paroxetine
fluvoxamine
citalopram
escitalopram

block reuptake of serotonin
resulting in elevation of synaptic concentration and enhance neurotransmission

other uses for SSRI
premenstrual tension
migraine prevention
minimize aggression in patient with borderline PD
binge eating disorder
body dysmorphic disorder
bulimia nervoosa (sertraline)

Question 6

SNRI

Answer 6

second generation

used for
MDD
GAD
social anxiety disorder

duloxetine
venlafaxine
desvenlafaxine

blocks reuptake of serotonin and norepinephrine, resulting in synaptic concentration and enhance neurotransmission

Question 7

atypical antidepressant

Answer 7

second generation

used for MDD, reactive depression and anxiety
sleep disorder (mirtazapine-remeron)
smoking cessation (bupropion- zyban)

*bupropion
mirtazapine

mechanism of actions
varies with medications

affects one or two of the three neurotransmitter (serotonin, norepinephrine, dopamine)

Question 8

MAOIs

Answer 8

first generation

used for atypical depression and parkinson disease

isocarboxazid
phenelzine
selegiline
tranycypromine

blocks monoamine oxidase activity, prevents the breakdown of monoamine neurotransmitters, and enhances their availability

risk for hypertensive crisis which can be trigger by eating food or drinking beverage rich in tyramine (cheese, red wines, and cured or smoked meats or fish)

Question 9

pharmacokinetic of antidepressants

Answer 9

Sertraline (SSRI), Duloxetine (SNRI), and buspropion (atypical antidepressant)

all metabolize in liver and exreted in urine and feces

Question 10

mood stabilizer medicaiton

Answer 10

used to treat bipolar disorder and manic episodes

alteration in mood and behaviors, vacillating between mania and depression

lithium
carbamazepine
valproic acid
divalproex
lamotrigine

short half-life and high toxicity, administered in daily divided doses

not metabolize but excreted in urine
serum sodium affect excretion of lithium since kidney process lithium and sodium in the same manner

Question 11

when should TCA be taken

Answer 11

at night due to sedation

Question 12

when should a patient not take SSRI and atypical antidepressant

Answer 12

if the patient had taken MAOI in the previous 14 days

Question 13

those taking SNRI should avoid what?

Answer 13

St. John’s word
increase risk of serotonin syndrome and NMS

Question 14

what food should those on MAOI avoid?

Answer 14

foods rich in tyramine

Question 15

sertraline

Answer 15

don’t use with MAOI, pimozide or disulfiram (oral)
don’t use within 14v days of stopping MAOI

don’t use if hypersensitivity to sertraline or inactive substance in sertraline

caution when used with suicidal patients (peds and young population)
other SSRI (risk for serotonin syndrome)

aspirin, NSAIDS, antiplatelet/anticoagulant (bleeding risk)

patient with bipolar d/o-acitivate mania/hypomania

studies not done on patients with seizure

patients with angle closure galucoma-risk for angle closure attack

pregnancy in 3rd trimester pulmonary hypertension and neonatal withdrawal
ped patients

avoid taking with St John’s wort and MAOI (serotonin syndrome and NMS)
pimozide cause QT prolongation and ventricular arrhythmias

Question 16

side effect of Sertraline

Answer 16

sexual dysfunction
wt gain
dizziness
fatigue
diarrhea
skin rash
nausea
excessive sweating

serotonin syndrome
occur 2-72 hours after starting

altered mental status (confused agitated, disorienting, anxiety, hallucination, poor concentration)
alter coordination
myoclonus, tremors, hyperreflexia
excessive sweating
fever

fetal if treatment not done: tachycardia, hypertension, hyperthermia, seizure, and coma leading to death

new born
irritable, abnormal crying, tremor, respiratory distress, seizure
supportive treatment resolves within couple of day

may cause platelet aggregation - risk for bleeding

withdrawal symptoms
dizziness
headache
nausea
sensory disturbances
tremor
anxiety
dysphoria

Question 17

duloxetine

Answer 17

for mood, anxiety, persistent pain (depression and anxiety)

contraindicated in those who take linezolid or methylene blue IV
don’t use within 14 days of MAOI therapy

increase risk for NMS, hyperthermia, instability of vital signs, mental status change if taken iwthin 14 days of MAOI

bleeding

increase ALT and bili if taken by those using alcohol

Question 18

side effect of duloxetine

Answer 18

insomnia
visual disturbances
nausea

adverse effect
serotonin syndrome
NMS
thrombophlebitis
hepatic failure
Steven-Johnson syndrome
anaphylaxis

Question 19

contraindication for duloxetine

Answer 19

patient’s who have head trauma, stroke, seizure, or intracranial mass

within 14 days of MOAI

Question 20

drug interaction of duloxetine

Answer 20

toxicity with ritonavir and cimetidine

decrease effect of
tamoxifen
carbamazepine
phenobarbital
phenytoin

Question 21

side effec tof bupropion

Answer 21

headache
dizziness
dsyrhythmias
nausea and vomiting
wt loss

adverse effect
seizure
QRS prolongation
Steven-Johnson syndrome

Question 22

Eval antidepressants

Answer 22

vital signs

orthostatic hypotension can occur

hypertension if taken with MAOI

weight patient

suicidal thoughts

seizures

serotonin syndrome with sertraline and duloxetine

QRS prolongation

Question 23

what to report

Answer 23

SSRI
wt gain, sexual dysfunction, and rash

duloxetine
insomnia, visual disturbances, and nausea

bupropion
headache, dizziness, dysrhythmias, nausea and vomiting and wt loss

tca
anticholinergic effects, sexual dysfunction, wt gain, cardiovascular disturbances (ortho hypo, dysrhythmia

MAOI
ortho hypo, isomia, dry mouth, weakness, and wt gain

do not take sympathomimetic-like drug and food containing tyramine (red wine, cheese, smooked meats) -hypertensive crisis (HTN, HA, neck stiffness, nausea and vomiting, and palpitation)

Question 24

what happends when lithium is taken with NSAIDs

Answer 24

decrease renal clearance and accumulation of the med

Question 25

labs to do with lithium

Answer 25

CBC with diff serum electrolyte renal and hepatic (BUN sCr and liver enzyme) urine output thyroid function test (T3,T4, TSH)

Question 26

contraindication of lithium

Answer 26

severe cardiovascular or renal disease (toxicity) severe debilitation (toxicity) dehydration (increase toxicity) sodium depletion (toxicity) Concurrent use with diuretics pregnancy and breastfeeding hypothyroidism can occur with med

Question 27

Lithium with other meds

Answer 27

diuretic -toxicity, increase sodium, increase lithium in the system NSAID increase reabsorption of lithium in kidneys not aspirin and sulindac ACh antihistamine such as phenothiazine, antipsychotic, and TCA urinary hesitancy while lithium cause polyuria

Question 28

how does lithium come

Answer 28

capsules and tablets slow release tablets syrupt taken with meals or milk to reduce gatric upset given in divided doses 3-4 x d for long term control therapeutic plasma acute 8 and 1.4 mEq/L maintenance 0.4-1 mEq/L do not exceed 1.5 mEq/L to avoid toxicity above 2.5 mEq/L death can occur

Question 29

SE of lithium

Answer 29

nausea diarrhea abd bloating anorexia fatigue muscle weakness headache confusion memory impairment fine hand tremor that worsens with stress, fatigue, caffeine, and use of certain med such as antidepressant or antipyschotic poluria and thirst interferes with secretion of antidiuretic hormone (urine output may exceed 3L/day) goiter inhibit thyroid hormone secretion may develop hypothyroidism

Question 30

adverse reaction of lithium

Answer 30

CNS depression heart failure (direct myocardial toxicity) hypercalcemia (w or w/o hyperparathyroidism) hypothyroidism (women) 6-8 months of Tx pseudotumor cerebri renal concerns (long-term use causes diminished renal concentrating ability)

Question 31

labs for lithium

Answer 31

drawn in the morning (12 hours after evening dose obtain every 2-3 days during initial therapy and every 3-6 months during maintenance labs every years CBC with diff, electrolytes, renals, thyroid

Question 32

what should be avoided when taking lithium

Answer 32

caffeine exacerbate manic episodes adequate sodium intake

Question 33

lithium side effect

Answer 33

early drowsiness slurred speech muscle weakness tremors loss of appetite nausea and vomiting diarrhea late symptoms seizures confusion blurred vision increase urination seveer tremors unsteady gait