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Kol- Pharm 323 Spring > Antidepressant/ Bipolar > Flashcards

Antidepressant/ Bipolar Flashcards

(51 cards)

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1
Q

5 classes of antidepressant!

A
  1. Selective serotonin reuptake inhibitors (SSRIs)
  2. Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
  3. Tricyclic antidepressants (TCA)
  4. Monoamine oxidase inhibitors (MAOIs)
  5. Atypical antidepressants
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2
Q

Antidepressant (general) nursing considerations

A
  • Slow onset (1-3 weeks for sxs change/12 weeks maximal effect)
  • Wean off
  • *No PRN use
  • Start slow and titrate up
  • continue drug even when sxs free and 4-9 months after sxs approve
  • Better response: drugs+ psychotherapy
  • Relapses
  • Suicide risk can increase initially: more common in <25 yrs
  • —>energy levels increase and have energy to carry out suicide plan without transition in brain to get rid of suicidal thoughts
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3
Q

3 monoamine NT that are linked to depression - why do I care?

A
  1. Norepinephrine
  2. Dopamine
  3. Serotonin

*all antidepressants increase 1 or more of these monoamine NT

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4
Q

3 theories on how antidepressant treatment works (i doubt she will ask about this)

A
  1. If increase amt of NT –> post synaptic receptors decrease/desensitize = downregulation
    - -> downregulation is what actually has an effect on the brain and doesn’t have effect until 4-6 weeks
  2. brains adaptation to NT
  3. New synaptic formations have to form in order for mood/behavior to change
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5
Q

SSRI prototype

A

fluoxetine (Prozac)

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6
Q

which antidepressant has the best safety profile and it a first line choice?

A

fluoxetine (Prozac) (SSRI)

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7
Q

how does fluoxetine (Prozac) fxn?

A

Slow the reuptake of serotonin (5-HT) into presynaptic nerve terminals (accumulation of serotonin in synapse)

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8
Q

Side effects of fluoxetine (Prozac)

A

sexual dysfunction, nausea, headaches, nervousness, insomnia, anxiety, weight gain

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9
Q

onset of fluoxetine

A

May take up to 5 weeks to work

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10
Q

admin for fluoxetine (Prozac)- timing?

A

give in morning b/c of insomnia

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11
Q

can we use SSRI like fluoxetine in preg?

A

not in LATE preg

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12
Q

____ risk with SSRI (think about population)

A

Bleeding risk in elderly/someone w/ GI predisposition

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13
Q

Serotonin Syndrome (SES)- onset?

A

2-72 hours after treatment start

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14
Q

Serotonin Syndrome (SES) treatment?

A

stop the SSRI, break b/w drugs when transitioning to new med

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15
Q

sxs of Serotonin Syndrome (SES)

A

mental status changes, hypertension, tremors, fever and sweats, hyperpyrexia, or ataxia

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16
Q

Serotonin Withdrawal Syndrome sxs?

A

Dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria

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17
Q

Serotonin Withdrawal Syndrome duration?

A

Persists 1-3 weeks

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18
Q

Serotonin Withdrawal Syndrome prevention

A

slowly tapering drug

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19
Q

prototype for Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)

A

venlafaxine (Effexor)

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20
Q

how does venlafaxine (Effexor) fxn?

A

Block the uptake of both serotonin and norepinephrine

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21
Q

how are Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) similar to SSRI?

Study These Flashcards
A

sexual dysfunction, sustained myandriasis, serotonin syndrome, neonates, withdrawal symptoms

22
Q

Side effects of venlafaxine (Effexor)

Study These Flashcards
A

sexual dysfxn, Nausea, HA, anorexia, nervousness, sweating, somnolence and insomnia, HTN

23
Q

prototype for Tricyclic Antidepressants

Study These Flashcards
A

imipramine (Tofranil)

24
Q

how does imipramine (Tofranil) fxn?

Study These Flashcards
A

inhibit the reuptake of both NE and serotonin into presynaptic nerve terminals.
>To varying degrees-block AcH receptors and/or histamine

25
Side effects of imipramine (Tofranil)
Sedation common initially--> after several weeks tolerance of the sedation develops - Anticholinergic effects are common, less so if drug is gradually increased over 2-3 weeks - Orthostatic hypotension : blocks alpha 1 adrenergic receptors on blood vessels
26
imipramine (Tofranil) admin?
give @ bed time (sedation)
27
imipramine (Tofranil) serious risk of
OVERDOSE lethal (❤️), 8X regular dose * do not give to suicidal patients. - acute depression --> give only 1 week Rx @ a time
28
drug drug interactions w/ imipramine (Tofranil)
>MOAI, sympathomimetic drugs, anticholinergic drugs | >Additive effect with other CNS depressants= sedation
29
prototypes for Monoamine Oxidase Inhibitors
Selegiline (EMSAM) MAO-B at low dose and MAO-A at high doses Phenelzine (Nardil) isocarboxiazide (Marplan) Tranylcypromine (Parnate) (SPIT)
30
how do Monoamine Oxidase Inhibitors fxn?
Inhibit the breakdown of NE, dopamine and serotonin in CNS neurons
31
Whats up with MOA and MOB?
- -MOA --> inactivates norepi and serotonin = inhibiting it keeps norepi/serotonin active for life of enzyme (2 weeks!) - -MOB --> inactivates dopamine --> parkinson's (celleduline)
32
what up with tyramine? what does it cause? who is it not playing nicely with?
(type of monoamine that is not broken down on MOA inhibitor ) if not broken down causes vasoconstriction --> hypertensive crisis
33
who is our most dangerous antidepressant?
MAOI
34
onset of MAOI
4-8 weeks
35
MAOI interacts with
- meperidine (Demerol)= hyperpyrexia - antidepressant or sympathomimetic = hypertensive crisis - antihypertensive = excessive hypotension - diabetic drugs = hypoglycemia MAAD Me Peri make me hot Antidepress= increase BP Antihypertensive = hypotens (more of the same) Diabeet= hypoglyc (more of the same)
36
Must be a ____ interval between the use of MAOI and MAAD drugs
14 day
37
MAOI + tyramine =
hypertensive crisis
38
foods with tyramine
Avocados, bananas, raisins, papaya, meat tenderizers, canned figs, fava beans, cheese, sour cream, yogurt, soy sauce, beer, wine-especially red, yeast/yeast extracts, beef or chicken liver, pate, meat extracts, pickled or kippered hearing, pepperoni, salami, sausage, bologna/hot dogs, chocolate
39
Who is our atypical antidepressant with an unknown mechanism of action?
Bupropion (Wellbutrin)
40
Benefits of Bupropion (Wellbutrin) compared to other antidepressants?
No weight gain or sexual dysfunction --> increase sexual desire (stay skinny and get laid!!!)
41
Side effects of Bupropion (Wellbutrin)
seizures, agitation, HA….psychotic symptoms
42
what else is Bupropion (Wellbutrin) used for?
smoking cessation
43
drug for bipolar disease
Lithium
44
Lets talk ranges for Lithium | safe? best? increase adverse effects? dialysis? toxic?
0.4-1 mEq/L = safe 0.4 - 0.8 = best -->0.8-1 = increase adverse effects 1.5 = toxic >2.5 = dialysis
45
how does lithium treat bipolar disorder
no one knows... #science, but here are some theories - reduce glutamate - ion w/ + charge --> effects electrical conduction of nerves
46
whats up with salt and lithium?
When Na is low (hyponatremia); body holds on to lithium in an attempt to compensate summer sweating + lithium = Lithium toxicity
47
s/s of toxicity of lithium
-N/V, tremors, polyuria, muscle weakness, ataxia, EKG changes, convulsions, coma and death
48
prototype for antidote for lithium?
no antidote! only give symptom management | >2.5 = dialysis
49
how do we admin lithium?
take 2/day or w/ food to prevent gi upset
50
adverse effects of Lithium
``` GI Hypothyroidism & Goiter --> check TSH, T3, T4 before/during therapy Tremors Renal damage Increases risk for toxicity Polyuria Birth defects ```
51
drug interactions with lithium?
NSAIDS | Diuretics

Kol- Pharm 323 Spring (41 decks)

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