Wk 11 Antidepressant

Question 1

1. An antidepressant should be taken for what period of time?

Answer 1

At least 4-9 months after symptoms are under control.

Question 2

2. An antidepressant may take how many weeks to have an effect?

Answer 2

1-3 weeks

Question 3

3. Explain the effects of increasing the following neurotransmitters in the brain: serotonin, norepinephrine, and dopamine.

Answer 3

Serotonin – decreased anxiety and depression
Norepinephrine – increased energy
Dopamine – decreased cravings and dependence

Question 4

4. Why are selective serotonin reuptake inhibitors (SSRIs) frequently given first in depression?

Answer 4

Fewer side effects and safer in overdose

Question 5

5. How do selective serotonin reuptake inhibitors (SSRIs) affect sexual functioning?

Answer 5

Decrease libido.

Question 6

6. How much weight gain can be expected with selective serotonin reuptake inhibitors (SSRIs)?

Answer 6

20 pounds

Question 7

7. What herb can precipitate a serotonin syndrome?

Answer 7

St. John’s Wort

Question 8

8. Selective serotonin reuptake inhibitors (SSRIs) should not be used with what other antidepressant category?

Answer 8

Monoamine oxidase inhibitors (MAOIs)

Question 9

9. What are some symptoms of the Serotonin Syndrome?

Answer 9

Agitation, anxiety, incoordination, tremors, myoclonus, fever, shivering, tachycardia, hypertension, sweating, diarrhea

Question 10

10. Name two neurotransmitters which may be increased in the synapses by tricyclic antidepressants.

Answer 10

Serotonin, norepinephrine

Question 11

11. When can the maximal effects of tricyclic antidepressants be expected after the initial dose?

Answer 11

1-2 months

Question 12

12. List four major categories of adverse effects expected with tricyclic antidepressants.

Answer 12

Cardiac arrhythmias, orthostatic hypotension, sedation, and anticholinergic effects such as dry mouth, decreased tears, urinary retention, and constipation.

Question 13

13. What high-risk group of patients should not be given tricyclic antidepressants?

Answer 13

Suicidal patients

Question 14

14. What is the drug that increases acetylcholine in the synapse to counteract the anticholinergic effects seen in a tricyclic overdose?

Answer 14

Physostigmine

Question 15

15. What would you tell a patient who is complaining of the sedative effects of a tricyclic antidepressant?

Answer 15

Sedation will diminish with time

Question 16

16. What drug category absolutely cannot be given with tricyclic antidepressants?

Answer 16

Monoamine oxidase inhibitors (MAOIs)

Question 17

17. Tricyclics should be given at what time of day? Why? How is it given to the elderly to prevent cardiotoxic effects?

Answer 17

Bedtime due to sedation. BID.

Question 18

18. Bupropion (Wellbutrin) is used to counteract what side effect of selective serotonin reuptake inhibitors (SSRIs)?

Answer 18

Sexual dysfunction

Question 19

19. Which two neurotransmitters does buproprion (Wellbutrin) possibly increase?

Answer 19

Dopamine, norepinephrine

Question 20

20. A history of head trauma would preclude a patient from taking buproprion (Wellbutrin) due to a risk of what?

Answer 20

Seizures

Question 21

21. Buproprion (Wellbutrin) is used to help people stop what activity?

Answer 21

Smoking

Question 22

22. Monoamine oxidase inhibitors (MAOIs) increase what neurotransmitters?

Answer 22

Serotonin, norepinephrine, dopamine

Question 23

23. Monoamine oxidase inhibitors (MAOIs) are the first choice for what diagnosis?

Answer 23

Atypical depression

Question 24

24. The coadministration of meperidine (Demerol) and monoamine oxidase inhibitors (MAOIs) can cause what?

Answer 24

Hyperthermia

Question 25

25. The ingestion of tyramine-containing foods while taking a monoamine oxidase inhibitor (MAOI) can cause what?

Answer 25

Hypertensive crisis

Question 26

26. Name possible symptoms of a hypertensive crisis.

Answer 26

Severe headache, dizziness, high blood pressure, chest pain, tachycardia, nausea, vomiting, sweating

Question 27

27. How do low levels of sodium intake affect the pharmacokinetics of lithium?

Answer 27

Low sodium levels can inhibit the excretion of lithium

Question 28

28. How does lithium affect urination?

Answer 28

Causes polyuria

Question 29

29. How does lithium affect thyroid functioning?

Answer 29

Causes hypothyroidism by inhibiting the incorporation of iodine into the thyroid hormone.

Question 30

30. What neuromuscular side effect is common with lithium?

Answer 30

Fine tremor

Question 31

31. What are common side effects of divalproex sodium (Valproate)? Why is it not used in pregnancy?

Answer 31

Nausea, vomiting, diarrhea, indigestion, weight gain. Neural tube defects and delayed neurodevelopment.

Question 32

32. How does carbamazepine (Tegretol) affect the metabolism of other drugs? How does it affect contraception?

Answer 32

Induces hepatic enzymes that increase the clearance of other drugs. Metabolizes oral contraceptives too rapidly, need back-up contraception.

Question 33

33. Identify side effects caused by the decreased norepinephrine reuptake with SNRIs?

Answer 33

Nervousness, insomnia, anorexia and weight loss, sweating, tachycardia, hypertension, urinary retention, vertigo