Exam 2; Anti-Depressants and Lithium

Question 1

This is 60% of all depressions; normal response to a loss or problem; usually limited in time

Answer 1

reactive depression

Question 2

This is 40% of all depressions; no clear correlation with life events

Answer 2

endogenous depression

Question 3

What are the two types of endogenous depression

Answer 3

uni-polar

bi-polar

Question 4

What are some symptoms of depression

Answer 4

depressed mood
decrease interest in life in general
sleep disturbances
appetite changes
loss of energy
feeling of worthlessness/denial of past accomplishments
guilt

Question 5

What are two symptoms of severe depression

Answer 5

psychological pain
suicidal tendencies; recurrent thoughts of death
loss of cognitive function

Question 6

What are two factors that can cause depression

Answer 6

heredity and environmental factors

Question 7

What is the biochemical basis of depression

Answer 7

depletion of neurotransmitters in the CNS (NE and SHT)

Question 8

This treatment of depression is used primarily when the patient is not responsive to drug treatments

Answer 8

electroconvulsive treatment; shock therapy

Question 9

What are five conditions that anti-depressants can be used to treat

Answer 9

depression
bulimia
OCD
panic attacks
ADD

Question 10

What are the two mechanisms behind anti-depressants

Answer 10

prevent NE or SHT re-uptake

prevent neurotransmitter breakdown

Question 11

What are two first generation NE re-uptake inhibitors; tricyclic anti-depressants

Answer 11

imipramine

amitriptyline

Question 12

What are the second generation SSRIs (selective serotonin re-uptake inhibitors); inhibiting SHT re-uptake in the CNS

Answer 12

fluoxetine
sertraline
paroxetine
fluvoxamine
citalopram
escitalopram
vilazodone
vortioxetine

Question 13

What are the third generation SNRIs; inhibiting the re-uptake of SHT and NE

Answer 13

Venlafaxine
duloxetine
milnacipram
desvenlafaxine

Question 14

What are three other anti-depressants

Answer 14

buproprion
nefazodone
mirtazapine

Question 15

Which class of anti-depressants is more likely to have side effects

Answer 15

the first generation; acts on multiple receptors

Question 16

What are four symptoms of first generation anti-depressants

Answer 16

sedation
weight gain
anticholinergic effects; arrthymias, hypotension, α1 blockade

Question 17

What are four side effects of second generation anti-depressants

Answer 17

GI upset
insomnia
headache
decreased libido

Question 18

What are some side effects of third generation anti-depressants

Answer 18

just like second generation plus cardiovascular stimulation

Question 19

What is the therapeutic index of anti-depressants

Answer 19

fairly low; 5-6 (5-6 times the recommended dose to be toxic

first generation more toxic than second generation

Question 20

What happens to someone who takes a massive overdose of anti-depressants

Answer 20

seizures
respiratory depression
cardiac arrthymias
renal failure

Question 21

The difference between first, second, and third generation, is mainly what

Answer 21

pharmacokinetic

Question 22

What is the half like of anti-depressants like

Answer 22

very long; stays in the body a long time after you take them

Question 23

What are anti-depressants metabolized by

Answer 23

P450

Question 24

The effects of anti-depressants are synergistic with what

Answer 24

ethanol; will see unwanted effects

Question 25

These three anti-depressants inhibit the metabolism of NE and SHT

Answer 25

tranylcyrpromine phenelzine isocarboxazid

Question 26

What is the metabolism of MAO inhibitors

Answer 26

irreversibly inhibit the metabolism of SHT and NE; slow onset

Question 27

What are the CNS effects of MAO inhibitors

Answer 27

insomnia agitation hallucinations seizures

Question 28

What are three non-CNS effects of MAO inhibitors

Answer 28

liver toxicity weight gain hypotension

Question 29

This interacts poorly with MAO inhibitors

Answer 29

indirect acting amines like amphetamines

Question 30

What is the mechanism behind the poor interaction of indirect acting amines and MAO inhibitors

Answer 30

amphetamines cause an increase in NE, the MAO inhibitor will inhibit the metabolism on NE, resulting in a huge excess of NE and the inability to break it down = hypertensive crisis

Question 31

Certain foods that contain this will lead to hypertensive crisis similar to that of taking MAO and ampthetamines

Answer 31

food containing the indirect acting amine; tyramine | aged cheeses, wines, smoked food

Question 32

What is it that the FDA warns about involving anti-depressants

Answer 32

all anti-depressants will increase the risk of suicide in children and adolescents; depression with a manic phase will be much worse

Question 33

This is probably hereditary condition type of depression

Answer 33

bipolar (manic) depression

Question 34

What are some symptoms of manic depression

Answer 34

``` euphoria increased motor and sexual activity flight of ideas decreased sleep poor judgment social intrusiveness tantrums ```

Question 35

What is the percentage of those with manic depression that attempt suicide

Answer 35

25-50% | mostly in conjunction with drug/alcohol abuse

Question 36

What are three treatments for those with manic depression

Answer 36

electroconvulsive therapy anti-psychotic drugs lithium

Question 37

What are two anti-psychotic drugs used to treat manic depression

Answer 37

phenothiazine | haloperidol

Question 38

This is the most effective at treating manic depression; used prophylactically

Answer 38

lithium; 70% success in patients

Question 39

What is the mechanism of action of lithium

Answer 39

alters glutamate metabolism decreases NE release alters SHT

Question 40

What is the therapeutic index of lithium

Answer 40

very low; <2

Question 41

What are six side effects of taking lithium short term

Answer 41

``` tremors increased thirst increased urine production edema weight gain nystagmus ```

Question 42

What are two side effects of taking lithium long term

Answer 42

rengal damage | hypothyroid

Question 43

What are three symptoms of taking lithium at a toxic level

Answer 43

nausea delirium coma

Question 44

These are five mood stabilizers to treat bipolar; all are anti-seizure

Answer 44

``` valproic acid carbamazepine lamotripene acetazolamide aripriprazole ```