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pharm quiz 4.1
Depression
| Question | Answer |
|---|---|
| Classifications of Depression | Adjustment disorder with depressed mood, Major depressive disorder (seasonal onset, postpartum, premenstrual dysphoric disorder), Depression with bipolar disorder |
| How long do depressive symptoms have to be present for depression to be clinically diagnosed? | 2+ weeks |
| What percent of the population will develop depression serious enough to warrant treatment sometime in their life? | 30% |
| At any given time, about what percent of the population is depressed? and how many of those seek help? | 5%; 1/3 |
| Is depression hereditary or environmental? | There are indications that both are strong influences |
| What is thought to be the cause of depression? | (not known for sure) involves the CNS's norepinephrine, dopamine, and/or serotonin |
| Is depression treatable? | Highly treatable |
| What are the drugs of choice for treating depression? | Selective Serotonin Re-uptake Inhibitors (SSRIs) or newer antidepressants |
| How long does it take for depression treatment to take noticeable effect? After how long should another antidepressant be trialed when the first isn't producing effect? | 6-8 weeks, after 8 weeks is when a different drug should be trialed |
| Treatment may be tapered after how long if symptoms have been treated well? | 6-12 months |
| Serotonin/Norepinephrine Re-uptake Inhibitors (S/NRIs) *examples*- 3 | Duloxetine (Cybalta) Venlafaxine (E flexor) Desvenlafaxine (Pristiq) |
| Adverse effects of Duloxetine (Cymbalta)-8 | insomnia, nervousness, dry mouth, anorexia, mild CV effects, sexual dysfunction, sweating, HTN |
| What else, besides depression, has the FDA approved Duloxetine (Cymbalta) to treat? | Approved to treat Fibromyalgia pain |
| Adverse effects of Venlafaxine (E Flexor) and Desvenlafaxine (Pristiq)- 9 | insomnia, nervousness, sexual dysfunction, serotonin syndrome, dry mouth, anorexia, mild CV effects (HTN, tachycardia) |
| What are two risks of using Venlafaxine (E Flexor) and Desvenlafaxine (Pristiq)? | Can cause physical dependence and when taken off, the pt can suffer withdrawal symptoms |
| Selective Serotonin Reuptake Inhibitors (SSRIs) *examples*- 6 | fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), fluvoxamine (Luvox), escitalopram (Lexapro®) |
| SSRIs Mechanism of Action | -Inhibit re-uptake of serotonin into CNS nerve terminals, initially rising the concentrations of serotonin in the CNS -Selective: little effect on NE or Dopamine -Low affinity for histaminic, chlorinergic, or alpha receptors |
| SSRIs Adverse Effects | Nausea, headache, insomnia & nervousness, akathisia, sexual dysfunction, serotonin syndrome, and physical dependence & withdrawal symptoms |
| When should an SSRI be dosed? | In the morning |
| What is serotonin syndrome? | Symptoms of serotonin syndrome can occur without warning & include: hypotension or hypertension, agitation, muscle tightness & twitching, hyperthermia, shivering, tachycardia & other arrhythmias, seizures, coma and death. |
| SSRI drug interactions | -Serotonin Syndrome with TCAs, MAO-inhibitors and other antidepressants during changing between classes -Various SSRIs have liver interactions with other drugs |
| How can drug interaction induced serotonin syndrome be avoided when changing between classes of antidepressants? | Wait 2-3 weeks (5 half lives of last dose)before administering the new drug |
| Other therapeutic uses of SSRIs besides antidepressant? -11 | Generalized anxiety disorder; phobic disorders; OCD; premenstrual dysphoric disorder; bulimia; Tourette’s syndrome; bipolar disorder; ADHD; diabetic peripheral neuropathy pain; post-herpetic neuralgia (shingles pain); migraine prophylaxis |
| Miscellaneous Antidepressants *examples* -3 | Bupropion (Wellbutrin, Zyban), Mirtazepine (Remeron), Trazodone (Desyrel) |
| Mechanism of action for Bupropion (Wellbutrin, Zyban) | dopamine. Mono-therapy or with an SSRI. Smoking cessation |
| Adverse Effects of Bupropion (Wellbutrin, Zyban) -7 | dry mouth, weight loss, constipation, HA, insomnia, agitation, & seizure |
| What are two positives of using Bupropion (Wellbutrin, Zyban)? | It does not cause problems with sedation or sexual dysfunction. |
| Mechanism of action for Mirtazepine (Remeron)? | Presynaptic 2-adrenergic blocker, increases CNS norepinephrine & serotonin |
| Adverse effects of Mirtazepine (Remeron)? -7 | weight gain, somnolence, constipation, dry mouth, HTN, dizziness, confusion |
| When should Mirtazepine (Remeron) or Trazodone (Desyrel) be taken? | Should be taken at bedtime due to sedation |
| Mechanism of action for Trazodone (Desyrel)? | Combined serotonin reuptake inhibitor and serotonin-2 antagonist. |
| What is Trazodone (Desyrel) often used for besides depression? | Also used to treat insomnia associated with SSRIs |
| Rare adverse effect of Trazodone (Desyrel)? | priapism |
| First-line Tricyclic Antidepressants (TCAs) *examples* 3 | desipramine (Norpramine), nortriptyline (Pamelor), protriptyline (Vivactil) |
| Other TCAs *examples* -5 | amitriptyline (Elavil), doxepin (Sinequan). clomipramine (Anafranil), imipramine (Tofranil), trimipramine (Surmontil) |
| TCA Mechanism of Action | -Inhibit re-uptake of NE, dopamine, and serotonin into CNS nerve terminals, initially increasing concentrations of these neurotransmitters in the CNS -Non-selective, increased adverse effects |
| What is a pharmacokinetic aspect of TCAs | Narrow therapeutic window, overdoses can be fatal, variable first-pass liver metabolism, long half-lives. |
| Adverse Effects of TCAs -14 | -use with caution in elderly, men w/ BPH,&cardiac disease,Weight gain,sexual dysfunction,may lower seizure threshold,Dry mouth,blurred vision,urinary retention,constipation,tachycardia,confusion,Cardiac over-stimulation,Sedation & drowsiness, OHTN |
| Drug Interactions of TCAs -4 | MAO-Is (HTN), Adrenergic agonists (CV adverse effects), Anticholinergics (additive anti-slud), CNS depressants (additive sedation), Potential p450 interactions, |
| Other uses of TCAs -6 | Generalized anxiety disorder; phobic disorders; obsessive-compulsive disorder (OCD) Neuropathic pain: diabetic peripheral neuropathy pain; post-herpetic neuralgia (shingles pain); migraine prophylaxis |
| Monoamine Oxidase Inhibitors (MAO-Is) *examples* -2 | phenelzine (Nardil) tranylcypromine (Parnate) |
| MAO-Is Mechanism of Action? | -Inhibit MAO-A (inactivates NE, serotonin, and tyrmine) and MAO-B (inactivates dopamine) enzymes present in liver, intestines, and some nerve terminals, leading to increased concentration of those neurotransmitters in the CNS |
| Adverse Effects of MAO-Is? -4 | Orthostatic hypotension, dizziness, sexual dysfunction, sleep disturbance |
| Food interactions with MAO-Is? -2 | Hypertensive Crisis from Tyramine containing foods (Cheese, liver, figs, smoked meat) and Hypertensive Crisis from foods containing vasopressors (chocolate, ginseng, and caffeine) |
| Drug interactions with MAO-Is? -3 | Hypertensive Crisis can occur with Ephedrine, Serotonin Syndrome can occur with SSRIs & perhaps TCAs, and Hyperpyrexia (excessive body temperature) can occur with Meperidine (Demerol) or dextromethorphan containing cough suppressant |
Created by:
hcress08
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