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Pharmacology Test 2 > Depression > Flashcards

Depression Flashcards

(48 cards)

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1
Q

Depression

A
  1. Symptoms associated w/ depression include:
    - Sad, despondent mood, lack of energy
    - sleep disturbances, abnormal eating pattern
    - feelings of despair, guilt, hopelessness
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2
Q

Postpartum Depression

A

Intense mood changes associated w/ hormonal changes

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3
Q

Seasonal Affective Disorder (SAD)

A

Enhanced release of melatonin due to lower light levels

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4
Q

Psychotic Depression

A

Intense mood shifts; unusual behaviors

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5
Q

Major Depressive Disorder

-Dx

A

In order to dx depression, there must be a depressed affect + 5 of the following symptoms for a minimum of 2 weeks:

  1. difficulty sleeping or sleeping too much
  2. Extremely tired; w/out energy
  3. Vague physical symptoms
  4. Inability to concentrate or make decisions
  5. Feelings of despair, guilt, misery; lack of self worth
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6
Q

Treatment of Depression

A

Severe depressive illness requires both

MEDICATION & PSYCHOTHERAPY

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7
Q

Role of the Nurse

-Depression

A
  1. Rule out medical and neurologic causes
  2. Ask about alcohol and drug use; suicidal ideation
  3. Obtain family hx of depressive illness
  4. Obtain drug hx
  5. Obtain V/S, liver & renal function tests, cardiovascular status, body weight
  6. Monitor therapeutic blood levels
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8
Q

Anti-Depressant Drugs

-General Points

A

Depression is a chemical imbalance involving: Serotonin, Dopamine, Norepinephrine

  1. Avoid alcohol w/ meds
  2. Takes 1 to 4 weeks for therapeutic effect
  3. NEVER discontinue abruptly
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9
Q

Anti-depressants

-What to monitor??

A
  1. V/S
  2. Neuro and cardio status
  3. Underlying psychoses
  4. Liver function and hematologic status
  5. Pt safety
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10
Q

Foods Containing Tyramine

A
  1. Avocados, Bananas, Raisins
  2. Cheese
  3. Beer & wine
  4. Beef or chicken liver, Pepperoni
  5. Fava Beans
  6. Soy Sauce & Yeast
  7. CHOCOLATE
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11
Q

Tricyclic Antidepressants

-Mechanism of Action

A
  1. Decrease reabsorption of norepinephrine and serotonin
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12
Q

Tricyclic Anti-depressants

-Used For:

A
  1. Major depressive episodes
  2. Panic disorders
  3. OCD
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13
Q

Tricyclic Anti-depressants

-Examples

A
  1. amitriptyline (Elavil)

2. doxepin (Sinequan)

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14
Q

Tricyclic Anti-depressants

-Contraindications

A
  1. Severe coronary artery disease CAD
  2. Cardiac dysrhythmias
  3. BPH
  4. Narrow Angle Glaucoma
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15
Q

Tricyclic Antidepressants

-Adverse effects

A

OVERDOSE IS USUALLY LETHAL
(Sympathetic Effects)
1. Dry mouth, tremors, headache, weight gain
2. Urinary difficulty, constipation, blurred vision
3. Seizures

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16
Q

Tricyclic Anti-depressants

-Patient Teaching

A
  1. Takes 2-4 weeks to achieve therapeutic effect
  2. Orthostatic hypotension
  3. SUCK ON CANDY OR CHEW GUM FOR DRY MOUTH
  4. Administer at bed time
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17
Q

SSRI

A 
Selective Serotonin Reuptake Inhibitors 
(1st line medication)
1. Decreases REM sleep
2. Potentiates opioid analgesics 
3. Inhibit appetite 
4. DO NOT USE W/ MAOI's
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18
Q

SSRI

-Examples

A

Tolerated by Elderly due to fewer side effects

Prozac
Paxil
Zoloft
Celexa
Lexapro
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19
Q

SSRI

-Adverse effects

A

Very few undesirable effects

-Agitation, anxiousness, overstimulation, insomnia, jitteriness

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20
Q

SSRI

-Patient Teaching

Study These Flashcards
A
  1. Do not start w/in 2 weeks of MAOIs
  2. Avoid use of alcohol, OTC, and herbs
  3. Monitor liver function and seizure disorders
  4. Takes 1-4 weeks to achieve therapeutic effect
21
Q

MAOI

Study These Flashcards
A

Monoamine Oxidase Inhibitor
1. Very effective (Second line agents)

  1. Main drawback is HYPERTENSIVE CRISIS
22
Q

MAOI

-contraindications

Study These Flashcards
A
  1. Impaired Renal or Hepatic function
  2. CAD, CHF
  3. Hypertension
  4. Foods containing TYRAMINE & CAFFEINE
  5. Pregnancy and lactation
23
Q

MAOI

-Adverse effects

Study These Flashcards
A
  1. Orthostatic hypotension
  2. Weight gain, Edema
  3. Sexual dysfunction
  4. Foods high in TYRAMINE & CAFFEINE can lead to HYPERTENSIVE CRISIS
24
Q

MAOI

-Patient Teaching

Study These Flashcards
A
  1. Monitor for Suicidal Ideation
  2. Monitor for Hypertensive crisis
  3. Avoid foods high in tyramine and limit caffeine
  4. Avoid alcohol
  5. Change position slowly
  6. Takes 1-4 weeks to achieve therapeutic effect
25
Wellbutrin, Effexor | -Indications
1. Inhibits the reuptake of dopamine | 2. Blocks serotonin and norepinephrine reuptake
26
Wellbutrin, Effexor | -Contraindications
1. Hx of head trauma & CNS tumor 2. Seizure disorder 3. Heart attack or unstable angina 4. Hepatic or renal insufficiency 5. Pregnancy and Lactation
27
Wellbutrin, Effexor | -Adverse Effects
1. Nausea, decreased appetite, dry mouth, weight loss 2. Agitation and anxiety (CNS stimulation) 3. SEIZURE ACTIVITY 4. Headache, tremor, insomnia
28
Wellbutrin, Effexor | -Pt Teaching
1. Monitor for suicidal ideation | 2. Monitor for hypertensive crisis
29
Anxiolytics
1. Drugs having ability to relieve anxiety | 2. Used when anxiety begins to significantly affect daily activities
30
Classes of Med's used to treat: | -Anxiety & Sleep Disorders
1. Antidepressants 2. Benzodiazepines 3. Barbiturates 4. Nonbenzodiazepine/nonbarbiturate CNS depressants
31
CNS Agents used to treat Anxiety and Insomnia
2 Major Classes: - Benzodiazepines - Barbiturates
32
Sedatives
Ability to sedate or relax a patient
33
Hypnotics
ability to induce sleep
34
Sedative-hypnotic:
Calming effect at lower doses and sleep at higher doses
35
Anti-anxiety medication | -Cautions
1. Elderly 2. Suicidal Potential 3. Impaired renal or liver function
36
Insomnia
Acts of sleeping and waking synchronized to many different bodily functions Insomnia sometimes associated with anxiety
37
Short-term Insomnia
1. Short term or behavioral insomnia sometimes attributed to stress
38
Long-Term Insomnia
1. Long-term insomnia often caused by depression, manic disorders, chronic pain 2. NONPHARMACOLOGIC means should be attempted prior to drug therapy
39
Rebound Insomnia
- Caused by discontinuation of long-used sedative drug | - Older pt's more likely to experience medication-related sleep problems
40
Electroencephalogram (EEG)
Tool used for Dxing sleep disorders, seizure activity, depression, and dementia Identifies two types of sleep: 1. NREM 2. REM
41
Normal Sleep Pattern
Involves REM and NREM 1. Occur every 90 minutes 2. NREM sleep 4 stages 3. REM sleep follows NREM sleep 4. Dreams occur in REM sleep
42
NREM Stage 1
1. Stage of drowsiness lasts between 1 and 7 min | 2. Pt can be easily awakened
43
NREM stage 2
Pt can still be easily awakened | 45% to 55% of total sleep time
44
Stage 3 NREM
Move into or out of deeper sleep 2. Heart rate and BP fall 3. GI activity rises
45
NREM Stage 4
1. Deepest stage of sleep 2. Nightmares occur in children 3. Sleepwalking is also common in this stage 4. HR and BP remain LOW. GI activity remains high
46
REM Sleep
1. Characterized by eye movement and loss of muscle tone 2. Dreaming takes place 3. Mind is very active and resembles a normal waking state
47
Stage 4 NREM | -Sleep Deprivation
1. Pt's deprived of stage 4 NREM sleep experience depression, apathy and fatigue
48
REM sleep deprivation
Lack of REM sleep causes Sleep debt | -Pt becomes frightened, irritable, paranoid, and even emotionally disturbed

Pharmacology Test 2 (10 decks)

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