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NURS 7310 > Psychobiology of depressive disorders > Flashcards

Psychobiology of depressive disorders Flashcards

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1
Q

What five regions are consistently dysfunctional in most patients with depression?

A

dorsolateral prefrontal cortex, medial prefrontal cortex, orbital frontal cortex, anterior cingulate cortex, and hippocampus

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2
Q

Patients with depression have an excessive activity of BLANK and increased BLANK.

A

Patients with depression have an excessive activity of the Hypothalamic-pituitary-adrenal axis (HPA axis) and increased plasma cortisol levels.

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3
Q

Those with anhedonia or inability to feel pleasure suffer from impairment of

A

the reward system

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4
Q

Postmortem microscopic examinations have shown what happens to the brain in those with depressive disorders?

A

decreased cortical thickness as well as diminished neural size

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5
Q

What is BDNF

A

brain-derived neurotrophic factor a brain growth factor

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6
Q

Increased BDNF leads to

A

increased neurogenesis

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7
Q

What five things have been shown to have increases in BDNF and neurogenesis that treat depression?

A

antidepressants, lithium, stimulation treatments, estrogen, and exercise

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8
Q

A single IV administration of this drug can have a robust response in less than 2 hours in upward of 75% of the subjects-lasting several days to 2 weeks in relieving depression.

A

Ketamine

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9
Q

Diathesis

A

what you are born with, genetically determinants

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10
Q

Stress

A

What happens later, environmental determinants

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11
Q

When is a depressive improvement called a remission?

A

removal of essentially all symptoms. it is called remission for the first several months and then recovery if it is sustained for longer than 6 months.

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12
Q

When are depressive symptoms referred to as a relapse?

A

When depression returns before there is a full remission of symptoms or within the first several months following remission of symptoms

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13
Q

When are depressive symptoms referred to as a recurrence?

A

When depression returns after a patient has recovered

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14
Q

How many of depressed patients will remit during treatment with any antidepressant initially?

A

One third

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15
Q

What are the most common residual symptoms in patients who do not achieve remission?

A

insomnia, fatigue, painful physical complaints, problems concentrating, and lack of interest

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16
Q

What age group is the risk benefit ratio for antidepressants the most favorable?

A

adults 25-64

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17
Q

What age group is the risk benefit ratio for antidepressants the worst?

A

Ages 6-12

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18
Q

What age group has the an increased risk of suicide when on antidepressants?

A

19-24 and possibly children and adolescents

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19
Q

What age group may not respond as well to antidepressants and may experience more side effects?

A

65 and older

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20
Q

What hypothesis explains the delayed clinical affect of antidepressants as well as possibly anxiolytics (and additionally the development of tolerance to the acute side effects of antidepressant drugs)?

A

Changes in neurotransmitter receptor sensitivity may mediate the clinical effects of antidepressant drugs

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21
Q

What hypothesis explains the delayed clinical affect of antidepressants as well as possibly anxiolytics (and additionally the development of tolerance to the acute side effects of antidepressant drugs)?

A

Changes in neurotransmitter receptor sensitivity may mediate the clinical effects of antidepressant drugs

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22
Q

Name the six SSRIs?

A

Fluoxetine (Prozac), Sertraline (zoloft), Paroxetine (paxil), Fluvoxamine (Luvox), Citalopram (Celexa)/Escitalopram (Lexapro)

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23
Q

All six SSRIs have what same major pharmacologic feature in common?

A

Selective and potent inhibition of serotonin reuptake, also known as inhibition of serotonin transporter or SERT

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24
Q

The action of SSRIs occurs at

A

both the presynaptic axon terminal and at the somatodendritic end of the serotonin neuron

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25
Which new medication is a "SPARI" (Serotonin partial agonist/reuptake inhibitor)?
Vilazodone
26
Why would the predominance of 5HT1A be potentially significant in Vilazodone?
It may mitigate the sexual dysfunction
27
Prozac (Fluoxetine) | Mechanism of Action:
Prozac (Fluoxetine) | Mechanism of Action: SSRI (selectively blocks neuronal reuptake of serotonin which increases the concentration of 5HT
28
Prozac (Fluoxetine) | Approved Therapeutic use:
Approved Therapeutic use: Depression, bipolar, OCD, panic disorder, bulimia nervosa, and premenstrual dysphoric disorder
29
Prozac (Fluoxetine) | Off label therapeutic use:
Off label therapeutic use: social phobia, generalized anxiety disorder, PTSD
30
Prozac (Fluoxetine) | pharmacokinetics:
pharmacokinetics: hepatic metabolism by CYP2D6, half life of 2 days
31
Prozac (Fluoxetine) | Adverse Effects:
Adverse Effects: Sexual dysfunction, weight gain, serotonin syndrome, during pregnancy causes NAS and PPHN, overall low risk for teratogenicity
32
Prozac (Fluoxetine) | Important Drug reactions:
Important Drug reactions: MAOIs, tricyclic antidepressants, lithium, antiplatelet drugs, and anticoagulants.
33
Prozac (Fluoxetine) | Availability:
Availability: 20/5mL liquid, 10, 20, 60 mg tablets, 90 mg delayed release, 10, 20, 40 mg capsules
34
Prozac (Fluoxetine) | Initial dose:
Initial dose: 20 mg
35
Prozac (Fluoxetine) | Maintenance dose:
Maintenance dose: 20-80
36
Prozac (Fluoxetine) | Approach to discontinuing:
Approach to discontinuing: taper over 1-3 weeks
37
Prozac (Fluoxetine) | Approach to switching meds:
Approach to switching meds: takes 4 weeks to get out of system
38
Venlafaxine (Effexor) | Mechanism of action
Inhibits the reuptake of both serotonin and norepinephrine
39
Venlafaxine (Effexor) | Approved therapeutic use:
major depression, generalized anxiety disorder, social anxiety disorder, and panic disorder
40
Venlafaxine (Effexor) | Off label use:
ADHD, fibromyalgia, diabetic neuropathy, complex pain syndromes, hot flashes, migraine prevention, PTSD< OCD, premenstrual dysphoric disorder
41
Venlafaxine (Effexor) | pharmacokinetics
Processed through the liver with a half life of 5 hours for the drug and 11 hours for the metabolite
42
Venlafaxine (Effexor) | Adverse effects:
Nausea, headache, anorexia, nervousness, sweating, somnolence, and insomnia, dose related sustained diastolic hypertension, and sexual dysfunction. Neonatal withdrawal syndrome
43
Venlafaxine (Effexor) | Important drug reactions
hyponatremia with diuretics, MAOI contraindicated
44
Venlafaxine (Effexor) | Availability
25, 37,.5, 50, 75, 100 mg tablets 37. 5, 75, 150, 225 mg extended release tablets 37. 5, 75, 150 mg extended release capsules
45
Venlafaxine (Effexor) | Initial dosing
37.5 mg-75 mg
46
Venlafaxine (Effexor) | Maintenance dosing
75 mg-375 mg
47
Venlafaxine (Effexor) | Discontinuing:
Taper over 2-4 weeks
48
Venlafaxine (Effexor) | Switching
MAOI should be discontinued at least 14 days prior to starting Venlafaxine. Venlafaxine should be discontinued 7 days prior before starting the MAOI
49
What are the four SNRIs?
Venlafaxine (effexor), Desvenlafxine (Pristiq), Duloxetine (cymbalta), Milnacipran (Savella)
50
What are the signs and symptoms of serotonin syndrome?
It begins 2-72 hours after treatment onset and include altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration), incoordination, myoclonus, hyperreflexia, excessive sweating, tremor and fever.
51
Bupropion (Wellbutrin, Zyban) | Mechanism of action
inhibits the reuptake of both dopamine and norepinephrine
52
Bupropion (Wellbutrin, Zyban) | Approved therapeutic use:
Major depression, seasonal affect disorder, and smoking cessation
53
Bupropion (Wellbutrin, Zyban) | Off label use:
neuropathic pain, depressive episodes in bipolar, management of ADHD
54
Bupropion (Wellbutrin, Zyban) | Pharmacokinetics:
hepatic metabolism primarily by CYP2B6 and half life 8-24 hours
55
Bupropion (Wellbutrin, Zyban) | Adverse Reactions:
agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, and tachycardia. SEIZURES, do not use in patients with psychotic disorders
56
Bupropion (Wellbutrin, Zyban) | Important drug reactions:
Do not combine with sertraline, fluoxetine, paroxetine or MAOIs
57
Bupropion (Wellbutrin, Zyban) | Initial dosing
200 mg
58
Bupropion (Wellbutrin, Zyban) | Maintenance dosing
300-450 mg
59
Bupropion (Wellbutrin, Zyban) | Discontinuing:
Taper over 1-2 weeks
60
Bupropion (Wellbutrin, Zyban) | Switching
Stop MAOIs at least 2 weeks prior to starting bupropion
61
Bupropion (Wellbutrin, Zyban) | Switching
Stop MAOIs at least 2 weeks prior to starting bupropion
62
Trazadone | Mechanism of action
At moderate to high doses it is a 5HT2A/5HT2C antagonism with SERT and at low doses it is a 5HT2A antagonist, H1 histaminic and alpha 1 adrenergic receptors
63
Trazadone | Approved therapeutic actions
at moderate to high doses it is an antidepressant. At low doses it is for insomnia
64
Trazadone | Availability
50, 100, 150, 300 mg tablets | 150 and 300 mg XR
65
Trazadone | initial dosing
200 OR 150 XR
66
Trazadone maintenance dosing
150-600 OR 150-375 XR
67
Trazadone | Adverse Effects
daytime grogginess and postural hypotension
68
Phenelzine (Nardil) | Mechanism of Action
Irreversible enzyme inhibitors of Monoamine Oxidase (Increasing 5HT, NE, and DA)
69
Phenelzine (Nardil) | Approved therapeutic use:
Depression
70
Phenelzine (Nardil) | Off label uses
treatment-resistant depression, panic disorder, obsessive-compulsive disorder, and social anxiety disorder
71
Phenelzine (Nardil) | Adverse Reactions
Central nervous system stimulation (anxiety, insomnia, agitation, hypomania, mania), Orthostatic hypotension, hypertensive crisis from dietary tyramine
72
Phenelzine (Nardil) | Important drug reactions
Indirect-acting sympathomimetic agents, epinephrine, NE, and dopamine, tricyclic antidepressants, SSRIs, antihypertensives
73
What types of food have tyramine?
avocados, anything fermented or over ripe, figs, bananas, aged, smoked meats, liver, spoiled meats, dried, cured fish, all cheeses, yeast, beers, wine, shrimp paste, soy sauce
74
Phenelzine (Nardil) | Availability
15 mg tablets
75
Phenelzine (Nardil) | Initial dosing
45 mg
76
Phenelzine (Nardil) | Maintenance dosing
60-90 mg
77
Phenelzine (Nardil) | Discontinuing
taper
78
Phenelzine (Nardil) | Switching
at least 14 days before switching to a different medication
79
Imipramine (Tofranil) | Mechanism of Action
Block both serotonin and norepinephrine reuptake and have antagonist actions at 5HT2A and 5HT2C
80
Imipramine (Tofranil) | Adverse reaction
Agitation, insomnia, diaphroesisanticholinergic, sedation, hypotension, seizure toxicity, CARDIAC toxicity, weight gain and sexual dysfunction
81
Imipramine (Tofranil) | Availability
10, 25, 50 mg tablets | 75, 100, 125, 150 mg tablets
82
Imipramine (Tofranil) | Initial dose:
25-50 mg
83
Imipramine (Tofranil) | Maintenance dose
100-200 mgs
84
Imipramine (Tofranil) | Approved therapeutic uses:
Depression
85
Imipramine (Tofranil) | Off label uses
neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD
86
Imipramine (Tofranil) | Important drug reactions
MAOI, direct acting sympathomimetic drugs (epinephrine, dopamine), indirect acting sympathomimetic drugs (ephedrine and amphetamine), anticholinergic agents, CNS system depressants (alcohol, antihistamines, opioids, and barbiturates)
87
Imipramine (Tofranil) | discontinuing
taper
88
Imipramine (Tofranil) switching
half life is 19 hours (out of system in 3-5 days)

NURS 7310 (15 decks)

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