Exam 4: Anti-Depressants Flashcards Preview

Pharmacology > Exam 4: Anti-Depressants > Flashcards

Flashcards in Exam 4: Anti-Depressants Deck (40):
1

Mood disorders affect ___-___% of Americans... Which sex is more affected?

women

2

________ depression – one or more prolonged episodes of depression measured in weeks

Unipolar

3

What are the 2 sub-types of unipolar depression?

Primary and Secondary

4

______ depression-The absence of clearly identifiable factors leading to the secondary affective state....“chemical imbalance”...Responds to antidepressant medications...Endogenous or Exogenous?

Primary...Endogenous

5

_______ 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?

Secondary...exogenous

6

_________ disorder... Characterized by recurrent wide SWINGS in mood from depression to mania... Usually treated with _____.

Manic-depressive..lithium

7

___% of adolescence and ___% of children show symptoms of depression.

8%.... 2%

8

What is a main concern for adolescents without treatment for depression?

self-medication w. drugs and alcohol

9

Women are ______ as more likely to experience depression as men.

2x

10

Causes of Depression-imbalance in __________..E.G.---low levels of _______.

neurotransmitters....SERO-TON-IN

11

Serotonin- elevates ____, helps you to fall ____ and have good quality sleep, acts on ______ center in brain to help you feel full after eating.

mood....asleep...saitey

12

Affective disorders are associated with ________ and ________ neurotransmission in the brain

noradrenergic and serotonergic

13

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

14

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.

weeks!...receptor

15

Why are women predisposed to fluctuating levels of serotonin? ______ lowers serotonin levels...._______ increases serotonin...estrogen fluctuations during puberty, pregnancy and menopause may trigger _______.

stress....estrogen...depression

16

comorbidity between anxiety disorders and major depression exceeds ___%

50%

17

How many classes of antidepressants are there? What are the ONLY 2 methods of action?

9...Inhibition of NT reuptake and enzymatic degradation

18

Selected mechanisms of action- _______ = increase synaptic serotonin and norepinephrine

tri-cyc-lics

19

Selected mechanisms of action- ________= increase synaptic norepinephrine

Tetracyclics

20

Selected mechanisms of action-_______ = block the degradation of norepinephrine, dopamine and serotonin

MAOIs

21

Selected mechanisms of action- _______ = increase synaptic serotonin

SSRIs

22

What is our example of a weak inhibitor of reuptake of
dopamine, norepinephrine, serotonin?

bu-pro-pion (Wellbutrin, Zyban)

23

Bu-pro-prion binds to alpha1 and alpha2 _________ receptors

adrenergic

24

Bu-pro-prion has increased risk for _______, alcohol lowers its threshold...also, risk for emergent _________
with concurrent nicotine patch use

seizures....hypertension

25

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

MAO

26

MAOIs are used for _______ depression as well as depression associated with these 3 common diseases....

atypical...Parkinsons, Alzheimers, & PTSD

27

CONTRAINDICATION FOR MAOIs in dentistry-take _____ prior to administering local anesthesia; caution with ________

BP....epi

28

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

vasoactive...catecholamines...tyramine

29

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*

30

_______ is the only drug approved for use in children with OCD.

Zoloft

31

SSRIs-Highest risk time for suicidal attempt is within ____ weeks of initiation of drug therapy

6 weeks

32

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)

33

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

ven-la-fax-ine...SSRI....MAJOR...xerostomia!!!!

34

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

map-ro-til-ine....norepi

35

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

36

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

37

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

INDUCES....INCREASES

38

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

39

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

orally....stomach...2..24..once

40

Adverse events of anti-depressants: ________ = watch for FALLING in older adults....sedation...dizziness...light-headedness-AKA-FAINTERS AND FALLERS

orthostatic hypotension...