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Pharmacology Test 3 > Neural System 4: Depression and Anxiety > Flashcards

Neural System 4: Depression and Anxiety Flashcards

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1
Q

what is depression?

A

mood disorder described as having the presence of 2 or more symptoms effecting:

  1. energy level
  2. sleep
  3. appetite
  4. self-esteem
  5. concentration
  6. decision-making
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2
Q

what are the 2 major categories of depression?

A
  1. major depressive disoder
  2. dysthymic disorder
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3
Q

what is major depression disorder?

A

symptoms for 2+ weeks

classified as mild, moderate, or severe

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4
Q

what is dysthymic disorder?

A

mild chronic depression

symptoms for 2+ months

can still have major depressive episodes

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5
Q

what are the symptoms typically for dysthymic disoder?

A

more cognitive features (low self-esteem)

affective (low mood)

social dysfuncction (social withdrawal)

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6
Q

what are the overall symptoms of depression?

A
  1. low mood
  2. lost of interest
  3. loss of motivation
  4. loss of libio
  5. feelings of helplessness, hopelessness
  6. sleep distrubances
  7. suicidal thoughts
  8. eating disturbance
  9. pessimism
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7
Q

Depression can increase your risk for what other diseases?

A
  1. reduced cardiovascular health (MI)
  2. osteoporosis, PUD, DM
  3. increased cortisol levels
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8
Q

Pathophysiology of Depression

A

exact pathogenesis not completely understood

Possible factors:

  1. Monoamine hypothesis
  2. receptor downregulation and changes in sensitivity
  3. Neuroplasticity hypothesis
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9
Q

what is the monoamine hypothesis?

A

deficiency or imbalance of monoamines leading to receptor downregulation and changes in sensitivity

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10
Q

what is neuroplasticity hypothesis?

A

neurohistological changes lead to changes in the hardwiring of the brain

Antidepressants reverse these changes

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11
Q

General MOA of antidepressants

A

inhibit reuptake of monoamines (5-HT or NE)

desensitizationof autoreceptors

enhance NE release

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12
Q

What is a risk in treatment of depression?

A

Serotonin Syndrom

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13
Q

Individuals undergoing Antidepressant therapy should be monitored for what?

A
  1. DDIs (cyp enzymes)
  2. BP/HR
  3. worsening depression (**red flag statement)
  4. serotonin syndrome
  5. boxed warnings
    • increased suicidal thoughts
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14
Q

What is Serotonin Syndrome?

A

accumulation of high levels of serotonin

classified as mild, moderate, severe, and life threatening

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15
Q

what are the symptoms of mild Serotonin Syndrome?

A
  1. HTN
  2. tachycardia
  3. tremor
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16
Q

what are the symptoms of moderate Serotonin Syndrome?

A

same as mild in addition to:

  1. hyperthermia (1040)
  2. hyperactive bowels
  3. mild agitation
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17
Q

what are the symptoms of severe Serotonin Syndrome?

A

all of the mild/moderate symptoms

hyperthermia (106 degrees)

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18
Q

what medication puts you at the highest risk of Serotonin Syndrome?

A

MAO Inhbitors

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19
Q

treatment for Serotonin Syndrome?

A
  1. Benzodiazepines
  2. Serotonin antagonist
  3. discontinuing serotonergic agents
  4. cardiac monitoring
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20
Q

what is the goal of Antidepressant Therapy (treating depression)?

A
  1. reduce acute symptoms
  2. return to baseline level of function
  3. prevent further episodes
  4. prevent suicide attempts
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21
Q

how long does it take after starting meds to see improvements in physical symptoms of depression ?

A

usually 2 weeks

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22
Q

how long does it take after starting meds to see improvements in emotional symptoms of depression?

A

usually 6-8 weeks

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23
Q

Drug Classes for Depression

A
  1. Selective Serotonin Reuptake Inhibitors (SSRI)
  2. Seretonin/NE Reuptake Inhibitors (SNRI)
  3. Atypical agents
  4. Tricyclic Antidepressants
  5. MAO Inhibitors
  6. Other
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24
Q

SSRI suffix

A

-pram

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25
SSRI Drugs
1. citalopram (Celexa) 2. escitalopram (Lexapro)
26
SSRI MOA
selectively inhibit 5-HT reuptake
27
SSRI AE
1. HA 2. N/V/D 3. insomnia 4. sexual side effects \*Rare = hyponatremia, bleeding
28
SSRI Indications
1. Depression 2. eating disorders 3. PTSD 4. anxiety 5. OCD 6. bipolar disorder 7. vasomotor menopausal symptoms
29
SNRI suffix
-ine
30
SNRI drugs
1. venlafaxine (Effexor) 2. duloxetine (Cymbalta)
31
SNRI MOA
inhibits 5-HT and NE reuptake
32
SNRI AE
1. HA 2. nausea 3. dry mouth 4. sweating 5. sexual dysfunction 6. insomnia
33
SNRI indications
1. depression 2. anxiety 3. OCD 4. panic disorder 5. PTSD 6. vasomotor menopausal symptoms 7. fibromyalgia 8. neuropathic pain
34
Atypical Agents used to treat Depression
Buproprion (Wellbutrin)
35
what is buproprion (Wellbutrin) used to treat in depression?
used as adjunct therapy to reduce sexual dysfunction
36
buproprion (Wellbutrin) MOA
inhibits reuptake of DA and NE
37
buproprion (Wellbutrin) AE
1. HA 2. nausea 3. insomnia 4. tremor 5. dry mouth 6. decreased appetite \*\*risks of seizures
38
buproprion (Wellbutrin) Indications
1. depression 2. ADHD 3. smoking cessation 4. weight loss
39
T/F: Tricyclic Antidepressants are cholinergic?
FALSE -\> they are anticholinergic
40
Tricyclic Antidepressants MOA
inhibits reuptake of 5-HT and NE. Creates receptor blockades for other NTs
41
Tricyclic Antidepressants AE
1. weight gain 2. sexual dysfunction 3. sedation 4. anticholinergic effects (ABCDs) \*\*risks = overdose (cardiac)
42
Tricyclic Antidepressants Indications
1. Depression 2. Neuropathic pain 3. migraine prevention 4. insomnia
43
MAO Inhibitors MOA
inhibits MAO enzyme = more monoamines
44
MAO Inhibitors AEs
1. OH 2. weight gain 3. sexual dysfunction
45
MAO Inhibitors Risks
Serotonin Sydrome Hypertenisve crisis
46
someone on an MAO Inhibitor should avoid what things to reduce their risk of hypertensive crisis?
1. tyramine containing foods (wine, beer, cheese) 2. sympathomimetic agents
47
MAO Inhibitors Indications
1. depression 2. Parkinson's Disease
48
Other agents used to treat depression?
1. alpha 2 antagonists 2. 2nd generation antipsychotics 3. Katamine (for highly trx resistant depression) * admin in providers office 4. Trazodone 5. Nefazodone
49
What medication is 1st line in treating depression?
SSRI due to efficacy and tolerability
50
what drug is 1st line for fibromyalgia and neuropathic pain?
SNRIs
51
Therapeutic Concerns for Antidepressant therapy
1. intermittent tx may diminish drug efficacy 2. monitor BP/HR 3. tremor and sedation will impact participation in PT
52
what is anxiety?
an appropriate response that becomes pathologic when out of proportionto the siutation
53
Somatic symptoms of anxiety?
1. muscle ache 2. GI issues 3. fatigue 4. restlessness
54
Psychological symptoms of anxiety
1. sleep disturbances 2. excessive worrying 3. poor concentration
55
Pathophysiology of anxiety
impacts the following regions of the brain 1. periaqueductal gray matter (PAG) 2. locus coeruleus 3. hypothalamus 4. limbic system * amygdala * hippocampus
56
what does stimulation of the PAG cause?
vascular effects of anxiety
57
what does stimulation of the locus coeruleus cause?
anxious behavior and panic
58
how is the hypothalamus involved in anxiety?
central to anxiety response (hypothalmus-pituitary-adrenal axis) secretes hormones involved in stress reaction
59
describe the limbic system's role in anxiety
1. amygdala is connected to area involved in anxiety 2. chronic stress (cortisol) reduces hippocampal volume
60
Neurochemistry of Anxiety
1. Monoamines = alpha 2 decrease sympathetic outflow to decrease anxiety 2. serotonergic system = releases serotonin 3. GABAergic system = inhibits release of GABA
61
drugs used to treat anxiety act where?
1. Serotonergic system 2. GABAergic system
62
Treatment of Anxiety
1. SSRIs 2. SNRI 3. Tricyclic Antidepressants 4. MAO Inhibitors 5. Propranolol 6. Benzodiazepines 7. buspirone (Buspar)
63
what is the 1st line treatment for anxiety?
SSRIs and SNRIs
64
what is used in maintenace treatment for anxiety?
Tricyclic antidepressants and MAO inhibitors
65
what is used for long-term treatment of anxiety?
propranolol = for panic attacks
66
how are benzodiazepine used to treat anxiety?
only for acute treatment
67
how is buspirone used to treat anxiety?
maintenance in generalized anxiety
68
Benzodiazepines drug
alprazolam (Xanax)
69
alprazolam (Xanax) MOA
binds BZD receptors ot enhance GABA inhibitory effects
70
alprazolam (Xanax) AEs
1. sedation 2. ataxia 3. memory problems \*\*high abuse potential
71
alprazolam (Xanax) Indications
1. spasticity 2. muscle spasms 3. acute anxiety 4. serotonin syndrome
72
buspirone (Buspar) MOA
unknown binds to 5-HT and DA receptors
73
buspirone (Buspar) AEs
1. dizziness 2. paradoxical anxiety (potentially)
74
buspirone (Buspar) indications
1. anxiety 2. panic disorders (less useful)
75
what are the advantages to using buspirone (Buspar)?
1. no abuse risk 2. no dependence 3. no withdrawal
76
what are the disadvantages of using buspirone (Buspar)?
1. DDIs (cyp enzymes) 2. onset = 3 weeks
77
Therapeutic concerns with drugs that treat anxiety
1. caution in elderly -\> BZDs increase fall risk 2. BZDs can interfere with sleep cycle (REM) 3. overall sedation will * limit PT participation * increase fall risk

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