Pharm for Mood Disorders

Question 1

What are the indications for antidepressants?

Answer 1

1. Depression
2. Anxiety
3. Insomnia
4. PMS
5. Smokin cessation
6. Eating disorders
7. OCD

Question 2

What drug is used for smoking cessation?

Answer 2

Zyban/Wellbutrin

Question 3

What drug is used for OCD?

Answer 3

Luvox

Question 4

What are 1st generation antidepressants?

Answer 4

1. Tricyclic Antidepressants (TCA)

2. Monoamine oxidase inhibitors (MAOI’s)

Question 5

What are 2nd generation antidepressants?

Answer 5

1. SSRIs

2. Usually first choice

Question 6

What must occur when switching from a 1st generation to a second generation antidepressant?

Answer 6

Must have a washout period

Question 7

What is the first line class of drugs for treating depression? Why?

Answer 7

1. SSRIs

2. Low side effects, low lethal potential

Question 8

How long does it take SSRIs to take effect?

Answer 8

May take up to four weeks for full effect

Question 9

How are SSRIs absorbed and metabolized?

Answer 9

Absorption: GI
Metabolism: Liver

Question 10

What is the MOA of SSRIs? What is their peak and half life?

Answer 10

1. Blocks reuptake of Serotonin at pre-synaptic neuron
2. Peaks 4-6 hr
3. Long half life = once daily dosing

Question 11

What drugs are in the SSRI class?

Answer 11

1. Celexa (citalopram)
2. Lexapro (escitalopram)
3. Luvox (Fluvoxamine)
4. Paxil (paroxetine)
5. Prozac (fluoxetine)
6. Zoloft (sertraline)
7. Viibryd (vilazodone)

Question 12

What are the general se of antidepressants?

Answer 12

1. Orthostatic hypotension
2. Blood dyscrasia
   A. Agranulocytosis
3. Cardiac changes
   A. Base line EKG
4. Sedation
5. wt gain
6. Sexual dysfunction
   A. Decreased libido
   B. Anorgasmia
   C. Erectile Dysfunction
   D. Priapism
   E. Retrograde ejaculation
7. Serotonin Syndrome

Question 13

What is serotonin syndrome?

Answer 13

1. Rapid increase in serotonin
2. Too much too fast
3. Begins hours to days after initial dose
4. Potentially lethal
5. Autonomic instability
   A. Tachycardia
   B. Increased BP
   C. Increased temp
   D. Sweating
   E. Shivering
   F. Change in mental Status
   G. Anxiety restlessness
   H. Tremors
   I. Muscular spasms
   J. dec coordination

Question 14

How is serotonin syndrome treated?

Answer 14

1. Supportive treatment
2. Antipyretics
3. Cooling measures
4. Temporary withdrawal of drug
5. Antianxiety medication
   A. Valium – Spasms
   B. Ativan - Restlessness

Question 15

How are antidepressants started and stopped? Why?

Answer 15

1. Taper to start or stop

2. Never discontinue abruptly bc:
A. Nausea
B. Lightheaded
C. Dizzy
D. Fatigue
E. Flu-like symptoms
F. Paresthesia

Question 16

When are atypical antidepressants used for mood disorders?

Answer 16

1. Used when client has inadequate response to SSRI
2. Used when side effects are present with SSRI
3. Block reuptake of different neuroreceptors than SSRI

Question 17

What are examples of atypical antidepressants?

Answer 17

1. Effexor (venlafaxine)
2. Remeron (mirtazapine)
3. Wellbutrin (bupropion)
4. Desyrel (trazodone)
5. Cymbalta (duloxetine)
6. Pristique (desvenlafaxiine)

Question 18

What are examples of TCAs?

Answer 18

1. Anafranil (clomipramine)
2. Elavil (amitriptyline)
3. Sinequan (doxepin)
4. Tofranil (imipraamine)

Question 19

What are examples of other cyclic antidepressants?

Answer 19

1. Pamelor
2. Aventyl (nortriptyline)
3. Norpramin (dsipramine)
4. Vivactil (protriptyline)

Question 20

What are the SE and contraindications for TCA?

Answer 20

1. Start low and Go slow
2. Do not use with glaucoma
3. Anticholinergic SE’s can be severe
4. Cardiac arrhythmias
5. Baseline EKG
6. Blurred vision
   7.

Question 21

Why shouldn’t ETOH and TCAs be mixed?

Answer 21

Both TCA and ETOH are CNS inhibitors
Depressed brain stem = Depressed vital functions

VERY LETHAL Combination

Question 22

What are the anticholinergic SE of TCAs?

Answer 22

1. Can’t see
2. Can’t pee
3. Can’t spit
4. Can’t ________ (Constipated)

Question 23

What is the 3rd line for antidepressant meds?

Answer 23

Monoamine oxidase inhibitors (MAOI’s)

Question 24

How are MOAis absorbed and metabolized?

Answer 24

1. Absorbed GI
2. Metabolized in liver
3. MAOI’s last 10 days in body

Question 25

What are examples of MOAIs?

Answer 25

1. Nardil (phenelzine) 2. Parnate (tranylcypromine) 3. Emsam patch (selequiline)

Question 26

What advantage does Emsam have over nardil and Parnate?

Answer 26

1. Both have dietary restrictions | 2. Emsam Bypasses liver and gut, Goes directly into cells, and has No dietary restrictions 6mg or less

Question 27

What are the SE of MAOIs?

Answer 27

1. Peripheral edema 2. Muscle Weakness 3. Forgetfulness 4. Hypertensive Crisis

Question 28

What is the pathophys of an MAOI HTN crisis?

Answer 28

1. Monoamine oxidase (MAO) metabolizes (breaks down) neurotransmitters A. Seratonin B. Norepinephrine C. Tyramine 2. These neurotransmitters are vasoconstrictors 3. MAOI = Inhibit the breakdown of the neurotransmitters 4. Vasoconstrictors build up 5. Increased vasoconstrictors = hypertensive crisis

Question 29

What are the sxs of an MAOI htn crisis?

Answer 29

1. Headache 2. Stiff neck 3. Tachycardia 4. Flushed & Clammy 5. Chest pain/tightness 6. Nosebleeds 7. Dilated Pupils 8. Coma 9. Death

Question 30

How is MAOI HTN crisis treated?

Answer 30

Procardia 10 mg p.o. Rapid absorption dec BP in 10-15” Monitor q 15” until stable

Question 31

What dietary restrictions are necessary when on an MAOI?

Answer 31

1. Dec Fermented or aged food 2. Deli meats 3. Yeast products 4. Fava beans 5. Sauerkraut 6. Organ meats 7. Red wines

Question 32

What drugs do MAOIs interact with?

Answer 32

1. All other Antidepressants 2. Buspar 3. Demerol 4. OTC allergy/cold meds 5. OTC diet meds 6. Stimulants

Question 33

How long does it take MAOIs to take effect?

Answer 33

2-4 weeks to be effective