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Anxiety/Depression

QuestionAnswer
Which anxiety disorder is associated with "re-experiencing" a traumatic event and decreased responsiveness or avoidance of current events associated with the trauma Posttraumatic Stress disorder
Which type of anxiety disorder displays symptoms of apprehension, worry, irritability, difficulty concentrating, insomnia, and ANS complaints Generalized Anxiety disorders
which type of anxiety disorder displays shortlived, recurrent, unpredictable episodes of intense anxiety Panic Disorder
how many people who have OCD will develop major depression some time in their lives 2/3
Which anxiety disorder includes recurring thought or compulsions that are recongnized as absurd but must be succumbed by the patient to alleviate anxiety Obsessive compulsive disorder (OCD)
This disorder may be part of panic disorders and include things like AGORAPHOBIA, SOCIAL PHOBIAS OR SOCIAL ANXIETY DISORDER, PERFORMANCE ANXIETY, ETC. Phobic Disorder
What is the general treatment used for Anxiety Disorders Chronic = daily doses of antidepressants of buspirone Acute= benzodiazepines for quickest relief Antidepressants + Benzodiazepine = common
Which drug is used specifically for anxiety only and is NOT an antidepressant or benzodiazepine Buspirone (Buspar)
What is the Mechanism of action of Buspirone (Buspar)? unknown, but has effect on serotonin like the SSIRs and a slow onset of action
What is the criteria for diagnosis of clinical depression symptoms present daily for >2 weeks
How effective is treatment of depression 60-70%
how many people suffer from depression and how many of those seek help 30% will develop depression sometime in life and only 1/3 will seek help
What factors are involved in the risk of developing depression hereditary and situational (social triggers)
What is believed to be the cause of depression Unknown, but invovles CNS monoamines norepinephrine, dopamine, and/or serotonin
What is the treatment for depression Selected medication based on adverse effects, cost, and past medical history Drug of Choice: SSRIs or Newer Antidepressants
How long is medication used to treat depression? indefinitely for some, but others may be able to taper off meds after 6-12 months of well treated symptoms
What are the common Serotonin/Norepinephrine Reuptake Inhibitors (S/NRIs) used as antidepressants? Duloxetine (Cymbalta), Vanlafaxine (Effexor), Desvenlafaxine (Pristiq)
What are the adverse effects of S/NRIs? Insomnia, nervousness, dry mouth, anorexia, mild CV effects, sexual dysfunction, sweating, HTN
What disease is the S/NRI, Duloxetine (cymbalta) FDA approved to treat? Fibromyalgia
What patient population is the S/NRI Desvenlafaxine (Pristiq) also effective in treating? Severe depression and pts. refractory to other agents (diabetic, limb amputee)
What are the common SSRIs (Selective Serotonin Reuptake Inhibitors fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Paroxetine (Paxil)
What is the MoA of the Selective Serotonin Reuptake Inhibitors (SSRIs) increase concentrations of serotonin and are selective having little effect on norepinephrine or dopamine and low affinity for histaminic, cholinergic, or alpha receptors
Which Antidepressants have less cardiac side effects and are used most commonly? S/NRIs or SSRIs? SSRI
What are the adverse effects of SSRIs Nausea, insomnia & nervousness, akathisia, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms
Which drug is most likely to cause Orthostatic hypotension, sedation, and anticholinergic SEs, SSRIs or TCA's? TCA's
What are the symptoms of Serotonin Syndrome Hypotension, Hypertension, agitation, muscle tightness & twitching, hyperthermia, shivering, tachycardia & other arrhythmias, seizures, coma and death
What are common Drug Interactions with SSRIs Serotonin syndrome may aoccure if combining w/ TCAs or MAO-inhibitors or chanign between classes of antidepressants. liver interactions w/ other drugs
what are some common therapeutic uses of SSRIs? Generalized anxiety, phobic disorders, OCD, Premenstrual Dysphoric disorder, bulimia, tourette's syndrom, bipolar, ADHD, neuropathic pain, diabetic peripheral neuropathy pain, post-herpetic neuralgia (shingles pain), migrain prevention
Which antidepressant is often prescribed to treat insomnia? Trazodone (Desyrel)
Whchi Antidepressant is used for smoking cessation and does not cause prblems w/ sedation or sexual dysfunction Bupropion (wellbutrin, Zyban)
what are the adverse effects of Bupropion (wellbutrin, Zyban) dry mouth, weight loss, constipation, HA, insomnia, agitation, and seizure No problems w/ sedation or sexual dysfunction
Which Antidepressant causes weight gain and is taken at bedtime due to dedation? Mirtazepine (Remeron)
What are the common Monoamine Oxidase Inhibitors (MAO-Is) Phenelzine (Nardil) & tranylcypromine (Parnate)
What is the MoA of MAO-Is? Block MAO-A and MAO-B in liver, intestines, and nerve terminals causing elevated monoamines, norepinephrine, serotonin, and tyramine (MOA-A), and dopamine (MAO-B) In CNS
What are the adverse effects of MAO-Is? Orthostatic hypotention, dizziness, sexual dysfunction, sleep disturbance
What foods cause hypertensive crisis when consumed with MAO-Is? food containing Tyramine: Cheese, liver, aged or smoked meats, soy sauce, figs, bananas, some imported wines and beers foods containing vasopressors: chocolate, ginseng, caffeine
What are common Drug Interactions that may occur with MAO-Is? Hypertensive Crisis with ephedrine, amphetamines, cocaine, pseudophedrine, TCAs & SSRIs Serotonin Syndrome with SSRIs and TCAs Hyperpyrexia with Meperidine or dextromethorphan containing cough suppressants
How must one d/c Tricyclic Antidepressants (TCAs)? Do not go off these pills alone!!! They will cause severe rebound HTN
Do TCA's cause addiction NO!
Are TCA's fast acting or slow acting drugs They take a while to kick in
What is the most commonly used TCA Amitriptyline (Elavil)
What is the MoA of the antidepressants Tricyclic Antidepressants (TCA's) increase concentration of norepinephrine, dopamine, and serotonin in CNS increase concetrations
Are TCA's selective to CNS receptors or nonselective? They are not selective and therefore have an increased number of adverse effects and a narrow therapuetic window
What are the adverse effects of TCAs? weight gain, sexual dysfunction, lower seizure thrshold, anticholinergic SE, cariovascular overstimulation, antihistamine SE (Sedatoin/drowsiness), orthostatic hypotention, physical dependence/withdrawls
What population is at risk for adverse effects with TCAs elderly men w/ BPH, cardiac disease patients,
What drug interactions can occur with TCA's MAO-Is, epinephrine and oral decongestants, anticholinergics like antihistamines, CNS depressants, Potential p-450,
Do TCA's cause depression? No, they are a CNS depressant which means they cause sedation, drowsiness, slowed though processes, etc.
What are other uses of TCAs other than antidepressants anxiety disorder, phobic disorder, OCD, neuropathic pain, ADHD (same as SSRIs)
Why do TCA's cause Anticholinergic side effects? they block Muscarinic receptors
Created by: aamoore2245
 

 



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