Chapter 16 Flashcards Preview

NURS 1065 - Pharmacology > Chapter 16 > Flashcards

Flashcards in Chapter 16 Deck (87):
1

True or False:
Illnesses resulting in mood disorders are associated with an imbalance or dysregulation of neurotransmitters

True

2

True or False:
There is no association between arterial stiffness and depression in the elderly

False
- research shows there IS an association between arterial stiffness and depression in the elderly

3

True or False:
Diagnosing major depression is partly a process of elimination

True

4

What needs to be present in order to complete an accurate diagnosis of major depression?

A pattern of signs and symptoms

5

What are 3 risk factors for depression?

1. Having previously been depressed
2. Having a first-degree relative diagnosed with depression
3. Being a woman, an adolescent, or a young adult

6

What is the defining feature of dysthymic disorder?

Chronicity of symptoms
- 2 years in adults
- minimum 1 year in children and adolescents

7

What has similar symptoms to major depression (such as: depressed mood, sleep disturbance, low energy, and poor concentration)?

Dysthymic disorder

8

When is bipolar disorder diagnosed?

When a person experiences symptoms of depression (at some times) and symptoms of mania at others

9

True or False:
Bipolar disorder is a mood disorder

True

10

What is the first drug of choice for treating depression?

Selective Serotonin Reuptake Inhibitors (SSRIs)

11

Why are SSRIs chosen over tricyclics and MAOIs when treating depression?

They have less side effects

12

What is the prototype drug for SSRIs (selective serotonin reuptake inhibitors)?

Sertraline (Zoloft)

13

What is Sertraline (Zoloft) used to treat?

- Depression
- Anxiety
- PTSD

14

Describe the pharmacodynamics of Sertraline (Zoloft)

Potent and selective inhibitor of neuronal serotonin reuptake
- also has a weak effect on norepinephrine and dopamine neuronal reuptake

15

What is a contraindication for Sertaline (Zoloft)?

Decreased liver function

16

What are the adverse effects of Sertaline (Zoloft)?

- GI distress
- Headache
- Fatigue
- Insomnia
- Sexual dysfunction

17

How does a nurse minimize the adverse effects of Sertraline (Zoloft)?

- Assess for adverse effects
- Assess for worsening of depression

18

What is important teaching involved with Sertraline (Zoloft)?

- educate about realistic expectations for antidepressant therapy
- do NOT abruptly stop medication

19

True or False:
Sertraline (Zoloft) will achieve maximum effect after several days

False
- maximum effect is not achieved for several weeks

20

True or False:
Tricyclic Antidepressants have a very broad therapeutic index

False
- have a very narrow therapeutic index

21

Describe the action of tricyclic antidepressants

Enhance the activity of norepinephrine and serotonin by blocking neuronal reuptake of these neurotransmitters

22

What is the name of the prototype drug for Tricyclic Antidepressants?

Nortriptyline (Pamelor)

23

What is Nortriptyline (Pamelor) used for?

To treat depression and chronic pain

24

Describe the pharmacodynamics of Nortriptyline (Pamelor)

Blocks reuptake of NE into nerve terminals
- allowing increased concentration at postsynaptic effector sites

25

What is the contraindication for Nortriptyline (Pamelor)?

Cardiovascular disorders

26

What are some adverse effects of Nortriptyline (Pamelor)?

- Disturbed concentration and confusion
- Headaches
- Tremors
- Nausea
- Vomiting
- Bone marrow depression
- Urinary retention
- Sexual function disturbances

27

What are the two things done to achieve/maximize the therapeutic effects of Nortriptyline (Pamelor)?

- Monitor blood plasma drug levels
- A single dose at bedtime may be used

28

How can you minimize the adverse effects of Nortriptyline (Pamelor)?

- May need to dose the drug twice a day to avoid adverse effects
- Older adults need to be given a smaller dose initially

29

What is the most significant side effect of Nortriptyline (Pamelor)?

Hypotension
- remember cardiovascular disorders are contraindicated!

30

What is the Monoamine Oxidase Enzyme System (MAO) responsible for?

Metabolizing amines such as:
- dopamine
- epinephrine
- norepinephrine
- serotonin

31

What is the basic action of MAOIs (Monoamine Oxidase Inhibitors)?

Inhibit MAO enzymes
- thereby increasing the concentration of those amine

32

What is the prototype druge for MAOIs?

Phenelzine (Nardil)

33

What is Phenelzine (Nardil) used for?

Treating depression

34

Describe the pharmacodynamics of Phenelzine (Nardil)

Increases the concentration of dopamine, NE, and serotonin within the neuronal synapse

35

What are the two contraindications for Phenelzine (Nardil)?

- Decreased liver function
- Congestive heart failure

36

What are some adverse effects of Phenelzine (Nardil)?

- Liver damage
- Anticholinergic effects
- Agranulocytosis
- Leukopenia
- Thrombocytopenia
- Sexual dysfunction

37

What action is taken to maximize the therapeutic effect of Phenelzine (Nardil)?

Platelet MAO enzyme activity (B subtype) is usually measured before and during therapy

38

How can we minimize the adverse effects of Phenelzine (Nardil)?

- Numerous dietary and medication restrictions
- Monitor for symptoms of hypertensive crisis

39

What is involved in patient education for Phenelzine (Nardil)?

- Do not eat food with high tyramine content
- Avoid alcohol
- Do NOT stop medication

40

During episodes of mania, what is a patient treated with?

Mood-stabilizing medication

41

What is the basic action of mood stabilizer medications?

Decreases the extreme range of mood experienced by the patient

42

What is the prototype drug for mood stabilizers?

Lithium carbonate (Eskalith)

43

What is the action of Lithium carbonate (Eskalith)?

Primary action is to prevent extreme mood swings

44

Describe the pharmacodynamics of Lithium carbonate (Eskalith)

- Competes with calcium, magnesium, potassium, and sodium in body tissues and at binding sites
- alters sodium transport in nerve and muscle cells

45

What are the two contraindications when using Lithium carbonate (Eskalith)?

- Severe cardiovascular disease
- Renal disease

46

What are the adverse effects of Lithium carbonate (Eskalith)?

- Coarse hand tremor
- Severe GI upset
- Blurred vision
- Drowsiness
- Confusion

47

True or False:
It is important to assess for dehydration when taking Lithium carbonate, as it increases the risk of toxicity

True

48

What are the three drug classes that are antidepressants?

1. Selective serotonin reuptake inhibitors (SSRIs)
2. Tricyclic antidepressants
3. Monoamine oxidase inhibitors (MAOIs)

49

In order to be diagnosed with major depressive disorder, what must have had occurred for the patient?

Within a two week period:
- manifest a depressed (or tearful) mood/diminished interest or lack of pleasure in all activities for most of the day
- must cause impairment at work or other social functions

50

If a patient has a decreased level of serotonin, what are they at risk of?

DEPRESSION!
- also ... increased risk of suicide

51

True or False:
Dysthymia and major depression have many common symptoms, including depressed mood, sleep disturbance, low energy and poor concentration

True

52

Define bipolar disorder

A disorder that causes shifts between low and elevated moods
- affects energy, activity levels, sleep, thought process, and judgement

53

What is mania?

A characteristic symptom of bipolar disorder
- diagnosed when a person has an elevated or irritable mood lasting at least 1 week (and at least 3 or more specific symptoms)

54

True or False:
Bipolar disorder has a genetic component

True

55

What is the typical lag time before an antidepressant drug starts to work?

10 days to 4 weeks

56

Why do antidepressant drugs take so long to become therapeutic?

B/c they produce changes pre- and post-synaptically
- a decrease in sensitivity is a process that takes a while to occur (down-regulation)

57

Explain why suicidal patients are MORE likely to try to commit suicide after starting antidepressant medication?

It is theorized that the medication gives them more energy
= more energy to act on their suicidal thoughts

58

What drug class is first used for treating depression?

SSRIs
- selective serotonin reuptake inhibitors

59

What needs to be done if you are switching from one antidepressant to another? (Example: switching from an SSRI to an MAOI)

A washout period mush occur
- between 7 - 14 days

60

True or False:
Compared to tricyclics, SSRIs have more adverse anticholinergic and cardiovascular effects

False
- SSRIs have FEWER adverse effects

61

True or False:
Sertraline is highly bound to plasma proteins

True
- therefore, if it is administered with another drug that is highly protein bound, it can lead to increased concentrations in circulation

62

What is the life-threatening event that can occur when taking Sertraline?

Serotonin syndrome

63

What is serotonin syndrome?

Over-activation of the central serotonin receptors

64

What is the mnemonic for symptoms when a patient stops an SSRI treatment? What does it stand for?

F = Flu-like
L = light-headedness
U = uneasiness/restlessness
S = sleep and sensory disturbances
H = Headache

65

What does Serotonin and Norepinephrine reuptake inhibitors (SNRIs) do?

Blocks the reuptake of BOTH serotonin and NE with differing selectivity

66

True or False:
SSRIs and SNRIs have similar risks and the possibility of serotonin syndrome

True

67

True or False:
It is okay to use an SSRI or an SNRI with an MAOI concurrently

FALSE!
- it is strictly contraindicated to use an SNRI or an SSRI with an MAOI (without a washout period)

68

Why are secondary amine tricyclics preferred over tertiary amine tricyclics?

B/c tertiary amines have a very narrow therapeutic index
- overdosing can be toxic and fatal

69

What is the action of tricyclics?

Enhance the activity of norepinephrine and serotonin by blocking neuronal reuptake of these neurotransmitters

70

Why are tricyclics not considered a first-choice treatment for depression?

B/c of the potential for cardiovascular toxicity

71

What is Nortiptyline used for?

Relieving symptoms of depression
- off-label: analgesia for phantom limb pain and chronic pain

72

True or False:
Nortriptyline increases the concentration of NE in circulation

True

73

What are the three major pharmacologic actions of Nortriptyline?

1. Blocking the amine pump
2. Sedation
3. Peripheral and central anticholinergic action

74

True or False:
Photosensitivity may develop as a result of Nortriptyline therapy

True

75

What is the black box warning for Nortriptyline?

May increase the risk of suicidal thoughts or behaviours in children, adolescents, and young adults

76

What is the monoamine oxidase (MAO) enzyme system responsible for?

Metabolizing amines
(such as dopamine, E, NE, and serotonin)

77

When are MAOIs (monoamine oxidase inhibiors) used?

When patients are unresponsive to other antidepressant pharmacotherapy

78

What is the prototype MAOI drug?

Phenelzine (Nardil)

79

What is Phenelzie (Nardil) used to treat?

Depression
- that is unresponsive to other drug therapy or treatments

80

What is the action of Phenelzine?

Increases concentration of dopamine, E, NE and serotonin within the neuronal synapse
- inhibits monoamine oxidase

81

What are some example of tyamine-rich foods that should be avoided when taking Phenelzine?

- sausages, salamis
- broad bean pods (fava beans)
- all beers on tap
- concentrated yeast extract
- sauerkraut
- most soybean products

82

Why are patients told to avoid foods that are rich in tyamine when taking Phenelzine?

Increases the risk of a hypertensive crisis

83

What drug category is used to treat a person that has been diagnosed with bipolar disorder and is experiencing a manic episode?

Mood stabilizers

84

What is the basic action of mood stabilizers?

Decreases the extreme range of mood experienced by the patient

85

What is the prototype drug for mood stabilizers?

Lithium carbonate (Eskalith)

86

What is the therapeutic drug range of Lithium carbonate (Eskalith)?

0.6 - 1.2 mEq/L

87

True or False:
Lithium carbonate has a narrow therapeutic index

True
- serum drug levels of lithium must be monitored closely