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PATHO > Thought And Mood > Flashcards

Thought And Mood Flashcards

1
Q

Antidepressants

A

SSRIs, SNRIs, tricyclic antidepressants, MAOIs

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2
Q

General considerations for antidepressants

A

Usually start with SSRIs/SNRIs bc safest; all have risk of SI, mental imbalance—assess suicide risk (may start meds in patient or daily checks if SI is present); monitor for 4-8 weeks for efficacy; can inc dose, switch drug or class, add second drug

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3
Q

SSRIs MOA

A

Inhibit Sr reuptake which keeps more Sr in the synapse and dec dep and anx sx

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4
Q

SSRI SE

A

Wt gain, GI (N/V/D, constipation, dry mouth), Dec sex drive; Sr sx—2-72 hours after tx—AMS, inc occurrence with MAOIs and other serotonergic drugs, withdrawal sx—dizzy, HA, sensory disturbance, tremor, anxiety, dysphoria; Suicidal risk, small risk of pulmonary HTN in neonates and abstinence syndrome during pregnancy

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5
Q

SSRI NC

A

May play with dose to Dec SE, can’t abruptly stop, be careful if pregnant, monitor suicidal risk

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6
Q

Fluoxetine (Prozac), sertraline (Zoloft), escitalapram (Lexapro) and NC

A

SSRI; 2nd gen drug; therapeutic benefit in 3-4 weeks, can’t take with MAOIs

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7
Q

Venlafazine (Effexor) MOA

A

SNRI; blocks reuptake of Sr and NOR uptake leaving more in the synapse

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8
Q

Venlafzine SE

A

Nausea, HA, anroexia, insomnia, somnolence, sexual dysfunction, w/d sx, sweat, blurred vision, inc LFTs with dulxetine—liver; CI with MAOIs

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9
Q

Amitriptyline (Elavil)

A

Tricyclic antidepressant

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10
Q

tricyclic antidepressants

A

More severe intx; used for long time, good efficacy, SE profile tolerable; more inexpensive; ASSOCIATED WITH FATAL OVERDOSES, can inc SI; also tx neuropathic pain and nocturnal enuresis

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11
Q

Tricyclic antidepressants MOA

A

Block reuptake of NOR and SR (monoamine transmitters), making more available in the synapse

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12
Q

Anticholinergic SE of TCAs

A

Hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter—get hot, dry mucus membranes, blurry vision, turn red, confusion

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13
Q

TCA SE

A

Sedation, orthostatic hypotension, sex dysfunction, cardiac toxicity; hypertensive crisis when given with MAOIs

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14
Q

Phenelzine (Nardil)

A

MAOIs; used for refractory depression (nothing else working); better for atypical depression (diff sx)

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15
Q

MAOI probs

A

Cause hypertensive crisis when taken with other drugs and tyramine

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16
Q

MAOI MOA

A

Inhibit monoamine oxidase which is found in liver, intestinal walls, and neuron terminals and usually converts NOR, 5HT, and Dp to inactive form; so MAO inc availability of NTs at the synapse

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17
Q

MAOI SE and NC

A

Food drug intx—tyramine rich foods like aged cheese, smoked meat, red wine, anything aged or smoked, can make you on edge, orthostatic hypotension, rapid inc in BP, stroke, coma when taken with tyramine or other intx drugs (ephedrine, antihypertensive SSRI, TCA, merperidine)

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18
Q

Bupropion (Wellbutrin)

A

Atypical antidepressant similar to amphetamine, stimulant effect, Dec appetite; 1-3 weeks for effect; unclear MOA

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19
Q

Bupropion SE

A

Seizure, agitation, HA, dry mouth, weight loss, GI upset, dizzy, tremor

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20
Q

Ketamine

A

Atypical antidepressant and painkiller; low dose—works for refractory depression and extreme depression—helps with SI

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21
Q

High dose ketamine SE

A

Perceptual disturbances—tripping/hallucinate, dissociation

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22
Q

Trazadone (Oleptro)

A

Second line agent of atypical antidepressant; blocks 5HT reuptake, minimal effectiveness in depression, often used to help with anxiety and insomnia

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23
Q

Benzodiazepines

A

Alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)

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24
Q

BDZs MOA and indications

A

Enhance inhibitory effects of GABA in the CNS—calming effect; for acute sx of GAD and panic disorders

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25
Q

BDZs SE

A

SLEEPY; CNS dep (Dec LOC), w/d sx, memory loss, resp dep—more common with IV use

26
Q

BDZs NC

A

Can’t use while preg (teratogenic), schedule 4 med—addiction concern and only rx short-term, be careful when taking with other meds that can impact CNS/dec LOC (Benadryl, alc, opioids, barbiturates); CYP says—avoid eating with grapefruit or fatty foods—can inhibit abs

27
Q

BDZs antidote

A

Flumazenil (Romazicon)

28
Q

NTs

A

Chemicals that enable the path of electrical transmission in the brain across synapses—neurotransmission

29
Q

Dopamine functions and associated conditions

A

Attention, motivation, pleasure, reward; Low levels associated with Parkinson’s (slow rxns, anergia) , anhedonia, depression and craving

30
Q

Serotonin functions and associated conditions

A

Low serotonin—OCD-like sx (obsession and compulsions), impulsivity—suicide, aggression, susc to enviro triggers, depression and craving

31
Q

GABA

A

Inhibitory NT (relaxes); dysfunction (low GABA)—anxiety especially panic disorder, MDD

32
Q

Norepinephrine

A

Excitatory NT—fight or flight response; excess—high anxiety, stress, hyperactivity; low—lack energy, focus motivation

33
Q

What conditions are you most likely to have with depression?

A

CAD (64% more likely to develop), disability, inc risk of suicide, family history—enviro, bio, psych function

34
Q

Leading cause of disability worldwide

A

Depression

35
Q

Depression diagnosis

A

Sx intense enough to cause distress and persistently impair psychosocial function with multiple sx (besides mood) and interfere with living

36
Q

Depression etiology

A

Situational depression, meds, chemical imbalance

37
Q

Sx of depression

A

Anhedonia, fatigue, restless, Dec conc, low self-esteem, sleep and appetite disturbance

38
Q

Depression tx

A

Meds (can take weeks to feel effects), CBT and talk therapy, support and education, deep brain stimulation therapy; works best when combines and individual to pt

39
Q

Panic disorder

A

Anticipatory anxiety (expectation of anxiety onset) and avoidance—personal strategy to increase feelings of control and Dec risk of panic attack

40
Q

Panic disorder etiology

A

Biopysch and physiological—genetics, family history; linked to early childhood stress

41
Q

Neuro chemical explanation for panic disorder

A

Overwhelming stress induces circulating stress hormones which stimulate glutamate (most abundant NT in body)—excess glutamate with panic

42
Q

Panic

A

Unexpected episodes of anxiety out of proportion with events going on around them; cyclical process of fear

43
Q

Panic attacks

A

Recurrent uncomfortable episodes of panic with sudden onset of sx like VS change, heart palpitations, SOA, dizzy, nausea, fear of losing control, tingling, chills/flush

44
Q

How many people with panic disorder also have depression?

A

50%

45
Q

Panic tx

A

CBT—dec fear thinking, antidepressants (SSRIs, SNRIs, BDZs (for acute sx/attack in the moment), MAOIs)

46
Q

Generalized anxiety disorder

A

Persistent feeling of anxiety or dread that interferes with how you live your life

47
Q

GAD timeline

A

Chronic; anxiety over 6 months

48
Q

GAD sx

A

Excessive, uncontrolled, unrealistic worries, muscle tension, autonomic hyperactivity, concentration problems

49
Q

Risk factors for GAD

A

Abuse and trauma, drug use

50
Q

GAD tx

A

CBT, antidepressants—SSRIs; BDZs, Buspirone—unknown MOA, no sedation/abuse; doesn’t worsen other drug effects, antioxyltic effect slows anxiety

51
Q

PTSD 3 core sx and MOA

A

Hyperarousal, avoidance of reminders, re-experiencing events; chronic activation of stress response in relation to exposure to potentially life-threatening events

52
Q

Other PTSD sx

A

Flashbacks, nightmares, emotional blunting, irritability, exaggerated startle

53
Q

PTSD causes

A

1 is rape; M—combat, neglect, abuse in childhood; F—sex molestation, physical attack, threatened with a weapon

54
Q

PTSD tx

A

Psychotherapy, CBT, exposure therapy, EMDR, SSRIs, SNRIs

55
Q

Social anxiety disorder

A

Intense fear of criticism by others, persistent fear of humiliation, negative evaluation of embarrassment by peers (embarrassment is worst that can happen) causing withdrawal from a situation or intense discomfort

56
Q

Social anxiety causes

A

Inherited, amygdala—fear response, learned environment

57
Q

Social anxiety tx

A

CBT, SSRIs, BDZs, propranolol (Dec HR)

58
Q

OCD

A

Repetitive unwanted thoughts/obsessions usually followed by repeated activities/rituals; time-consuming and maybe distressing to ind, friends, family

59
Q

Subtypes of OCD

A

Hoarding, contamination with cleaning, checking for safety, symmetry, w/o visible compulsions

60
Q

OCD tx

A

Hard to tx; SSRIs, TCAs, deep brain stimulation, EMDR

PATHO (32 decks)

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