Flashcards in Exam 4: Anti-Depressants Deck (40):
Mood disorders affect ___-___% of Americans... Which sex is more affected?
________ depression – one or more prolonged episodes of depression measured in weeks
What are the 2 sub-types of unipolar depression?
Primary and Secondary
______ depression-The absence of clearly identifiable factors leading to the secondary affective state....“chemical imbalance”...Responds to antidepressant medications...Endogenous or Exogenous?
_______ depression-Chronologically occurs with preexisting nonaffective disorders; develops because of non affective disorders....Disease, trauma, chronic pain...Completely alleviated by treatment of non affective disorder...Endogenous or Exogenous?
_________ disorder... Characterized by recurrent wide SWINGS in mood from depression to mania... Usually treated with _____.
___% of adolescence and ___% of children show symptoms of depression.
What is a main concern for adolescents without treatment for depression?
self-medication w. drugs and alcohol
Women are ______ as more likely to experience depression as men.
Causes of Depression-imbalance in __________..E.G.---low levels of _______.
Serotonin- elevates ____, helps you to fall ____ and have good quality sleep, acts on ______ center in brain to help you feel full after eating.
Affective disorders are associated with ________ and ________ neurotransmission in the brain
noradrenergic and serotonergic
Biogenic Amine Hypothesis for Affective Disorders---Depression related to decreased levels of synaptically released __________ and/or ______ in the brain..._____ is a result of an EXCESS of these transmitters
norepinephrine and/or serotonin...mania
Biogenic Amine Hypothesis for Affective Disorders---A flaw...although antidepressants increase NT right away, it takes several _____ of Tx for any effect....but this might be to antidepressants improving _______ function.
Why are women predisposed to fluctuating levels of serotonin? ______ lowers serotonin levels...._______ increases serotonin...estrogen fluctuations during puberty, pregnancy and menopause may trigger _______.
comorbidity between anxiety disorders and major depression exceeds ___%
How many classes of antidepressants are there? What are the ONLY 2 methods of action?
9...Inhibition of NT reuptake and enzymatic degradation
Selected mechanisms of action- _______ = increase synaptic serotonin and norepinephrine
Selected mechanisms of action- ________= increase synaptic norepinephrine
Selected mechanisms of action-_______ = block the degradation of norepinephrine, dopamine and serotonin
Selected mechanisms of action- _______ = increase synaptic serotonin
What is our example of a weak inhibitor of reuptake of
dopamine, norepinephrine, serotonin?
bu-pro-pion (Wellbutrin, Zyban)
Bu-pro-prion binds to alpha1 and alpha2 _________ receptors
Bu-pro-prion has increased risk for _______, alcohol lowers its threshold...also, risk for emergent _________
with concurrent nicotine patch use
MAOIs: inhibit _______ which is an enzyme responsible for the metabolism of norepinephrine, serotonin and dopamine (outside of their storage vesicles) in the presynaptic nerve terminals
MAOIs are used for _______ depression as well as depression associated with these 3 common diseases....
atypical...Parkinsons, Alzheimers, & PTSD
CONTRAINDICATION FOR MAOIs in dentistry-take _____ prior to administering local anesthesia; caution with ________
MAOI adverse events with food! When patients ingest food containing ________ amines, they are not catabolized, but enter the bloodstream, and are then taken up by sympathetic nerve terminals...Causes release of endogenous ___________.....Results in hyperadrenergic crisis....Severe hypertension, fever, arrhythmias....Avoid _______ containing foods = follow strict diet (hard cheese, red wine) = poor compliance
What are three popular SSRIs? What are the two biggest market sellers?
Flu-Ox-Et-Ine (Prozac, Sarafam).....Par-ox-et-Ine (Paxil)*Big market seller*.....Ser-Tra-Line (Zoloft)*big market seller*
_______ is the only drug approved for use in children with OCD.
SSRIs-Highest risk time for suicidal attempt is within ____ weeks of initiation of drug therapy
What are the TWO Serotonin/Norepi Reuptake inhibitors to know? (Tx for MAJOR depression)
1. Dul-ox-et-ine (Cymbalta) 2.Ven-la-fax-ine (Effexor XR)
Effexor XR-Generic Name: _________....Therapeutic Category: ________...Use: _____ depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder; investigational for OCD, hot flashes, neuropathic pain, ADHD....Oral Complications: _______, stomatitis, loss of taste, taste alteration, tongue discoloration
Tetra-cyclics: name-________, onhibits reuptake of _______, depression, anxiety with depression,sedative effective on anxiety, dsythymic disorder (depressive neuroses)...investigational: bulimia, enuresis, pain, panic attacks, tension headache, cocaine withdrawal
TRI-cyclics: Block reuptake of ________ AND ________....Severe anxiety, panic attacks, phobias, OCD,
bulimia, chronic fatigue, sleep apnea...Adjunctive therapy for chronic pain, peripheral neuropathies (*________*)= exhibit analgesic properties...investigational for substance abuse-related disorders, ADHD...WARNING----Take _____ on patients prior to local anesthesia; caution with _________.
norepinephrine and serotonin...(*TRI-geminal neuralgia!!*)..BP...epi
What am I describing? Weed-like plant, Most widely studied herb with demonstrated efficacy, MANY drug interactions...CAN NOT take with prescription antidepressants
St. John's Wort
St. John's Wort interactions-Components implicated in bleeding: hypericin...Effect: ________ some cytochrome P450 liver enzymes and Reduces anticoagulant effect of warfarin (INCREASES/DECREASES???? clotting) and lowers the INR......Decreases effects of many medications...Multiple drug interactions
St. John's Wort interactions cont.-Many drug interaction....Renders oral _________ ineffective in some...General anesthetics = patient difficult to _____ some users....Increases photosensitivity of tetracyclines...Reduces effect of glucocorticoids....Decreased efficacy of anticoagulants...Discontinue ALL herbs ____ days prior to surgery!!!
contraceptives...awaken (yikes!)...14 days
Pharmokinetics of antidepressants-generally taken _____.....well absorbed from _______....reach maximal concentration in blood within __-4 hours after oral administration...half-life = more than ___ hours...._____ daily dosing, at bedtime...potency and efficacy are similar