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2014-03-27 16:56:43
medications mood disorders

medications for mood disorders
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  1. a disorder characterized by a sad or desponent mood is called:

    list the symptoms of this disorder: (4)

    • symptoms:
    • lack of energy
    • sleep disturbances
    • abnormal eating patterns
    • feelings of dspair, guilt, or hopelessness
  2. list the criteria for diagnosis of a major depressive disorder:
    a depressed affect plus at least 5 of the following symptoms lasting for a minimum of 2 weeks

    • symptoms
    • difficulty sleeping/ too much sleep
    • extremely tired; w/o energy
    • abnormal eating patterns
    • vague physical symptoms (GI pain, joint/muscle pain, headacheS)
    • inability to concentrate/make decisions
    • feeling of guilt,despair,misery, lack self worth
    • obsessed with death
    • avoiding psychosocial/interpersonal interaction
    • lack of intrest in personal appearance/sex
    • delusions/hallucinations
  3. women can experience intense mood shifts associated with hormonal shifts during which times:
    • mnestrual cycle
    • pregnancy
    • childbirth
    • menopause
  4. depression can by mimiced by a variety of medical and neurological disorders such as:
    thyroid gland problems
  5. during inital health exams, make inquries abou which 3 lifestyle habits:
    • alcohol use
    • drug use
    • thoughts about death or suicide
  6. the black box warning on antidepressants issused to closely monitor for adults and children taking antidepressants for signs of:
    suicide, espically at the begining of tx
  7. list the 2 basic mechanisms of drug actions:
    • slowing the reuptake of serotonin and NE
    • blocking the enzymatic breakdown of NE
  8. the class of antidepressants that act by inhibiting the presynamptic reuptake of both NE and serotonin are:
  9. TCA's produce fewer side effects, and are less dangerous than:
    MAO inhibitors
  10. the most common side effect of TCA's is ___________ due to alpha1 blockage on blood vessels:
    the most common side effect of TCA's is orhtostatic hypotension due to alpha1 blockage on blood vessels:
  11. a frequent complaint at the initation of TCA therapy is:

    though, pts. become tolerant to this effect after several weeks of tx.
    a frequent complaint at the initation of TCA therapy is: sedation
  12. what is the half life of TCA's used to tx depression.

    the effect of this half life is that it increases the risk of side effects, espcially for pts. with which type of situation:
    • TCAs have a long half life
    • increases risk of side effects, especially for pts. with delayed excretion
  13. TCA's present with anticholinergic side effects,  list (6):

    how can these effect be lessened:

    what is the disadvantage of these anticholinergic effects:
    • dry mouth
    • constipation
    • urinary retention
    • excesive perspriation
    • blurred vision
    • tachycardia

    the effects are less severe if the drug is gradually increased to the terapeutic dose over 2-3 weeks

    disadvantage: makes compliance more difficult
  14. it often takes a month for TCA's to reach therapetuic levels, but before that level is reached, pts. have more energy but little relief from depressive symptoms.. so its a window of increased risk of:
    • suicide risk
    • requires more frequent monitoring for such
  15. list (6) TCA contraindications:
    • recent MI
    • heart block
    • dysrhythmia
    • some seizure disorders
    • urniary retention
    • benign prostatic hypertrophy
  16. what is the pregnancy catetgory of TCAs:
    • pregnancy category C or D
    • contraindicated in breast feeding women
  17. there are many rx-rx interactions for TCAs:

    what would cause sedation:
    • concurrent use of other CNS depressants, including alcohol may cause sedation
  18. there are many rx-rx interactions for TCAs:

    many drugs increase blood leves of TCAs by:

    what could increase TCA clearence:
    • many drugs increase blood leves of TCAs by: inhibiting the metabolism of the TCA
    • an increase in TCA clearence: caused by cigaretts
  19. what is an important contraindication for TCAs in regards to the use of MAOI's:
    pts should not use TCAs within 14 days of discontinuing MAOI's
  20. list (6) instructions for pt. care while they are on TCAs
    • tell the pt it takes ~ 1 month to achieve full theraputic effects
    • warn pt. about anticholinergic effects
    • dont stop taking TCAs abruptly
    • dont take TCAs with alcohol/other CNS depressants
    • change position slowly/dont drive: until level of sedation is known
    • if TCAs are sedating the pt, take the med at HS
  21. drugs the slow the reuptake of serotnoin into presynpaptic nerve terminals are called:
  22. Nerves with serotonin receptors are found in high concentration in which (4) structures:

    list the important body fxns these structures regulate:
    • hypothalamaus
    • limbic system
    • medulla
    • spinal cord

    • body fxns:
    • sleep
    • pain perception
    • emotional states
  23. what is the chemical name for serotonin:
  24. whereas the TCA class inhibits the reuptake of both NE and serotonin into the presynaptic nerve terminals, what to the SSRI's target:
    SSRIs selectively target serotonin
  25. Normally serotonin is released from post-synaptic receptors after interacting with them, and is reabsorbed by the pre-synaptic receptor, what is the fxn of the SSRIs:
    SSRIs block that reuptake and make post-synaptic receptors more sensitive to serotonin
  26. is the therapetuic response of SSRIs more or less quick than that of TCAs
    SSRI's are more quick than TCAs
  27. one of the most common side effects of SSRIs relates to sexual dysfxn, list (4) of the side effects:

    list (5) other common side efffects of SSRIs:
    • sexual dsyfxn side effects
    • decreased libido
    • unable to reach orgasm
    • delayed ejaculation
    • impotence

    • other side effects
    • nausea
    • headache
    • weight gain
    • anxiety
    • insomnia
  28. this may occur when the pt. is taking another med. that affects the metabolism, synthesis, or reuptake of serotonin, causing serotonin to accumulate in the body:
    serotonin syndrome (SES)
  29. serotonin syndrom can occur with the concurrent adminstration with, list at least (3)
    • MAOIs
    • TCAs
    • lithium
    • tramadol
    • meperidine
    • fentanyl
    • the antiemetic cetoclopramide
    • triptans used for migranes
  30. what are the s/sx of serotonin syndrome:
    • mental status changes (confusion, anxiety, restlessness)
    • hypertension
    • tremors
    • sweating
    • hyperpyrexia
    • ataxia
  31. what is the pregnancy category for SSRIs:
    pregnancy category C
  32. one of the rx-rx interactions of SSRIs is that there is extensisve protein binding with other meds, this should be avoided to decrease the riske of:
    decrease risk of toxicitity and increased blood concetration leading to increased bleeding
  33. the therapetuic actions of SSRIs take maximum effect after how long:
    several weeks, at least 5 weeks
  34. with the SSRIs Remeron and trazodone being the exception, when should SSRIs be administered:
    SSRIs should be taken in the AM to prevent insomnia

    take this meds with food to prevent GI upset including nausea
  35. the group of drugs that inhibits monoamine oxidase, the enzyme that terminates the actions of NT's such as dopamine, NE, epinephrine, and serotonine are called:
  36. b/c of the rx-rx and food-drug interactions, hepatotoxicity, and the development of safter antidepressants,  who are MAOIs reserved for:
    pts. who are not responsive to other antidepressant classes
  37. list (4) common side efffects that occur with MAOIs:
    • orthostatic hypotension
    • headache
    • insomnia
    • diarrhea

    • also...
    • anxiety
    • mania
    • delirium
    • seizures
    • dry mouth
    • nausea
    • decreased appetite
    • constipation
    • increased HR
  38. when an MAOI is used concurrently with other antidepressants or sympathomimetic drugs, what can occur:
    hypertensive crisis
  39. if an MAOI is given with antihypertensives, the pt. can experience:

    how do MAOIs interact with insuline:
    • with antihypertensives: severe hypotension
    • with insuline: potentiate the hypoglycemic effect
  40. interaction between MAOIs and food containing tyramine can cause:
    a hypertensive crisis

    tyramine is usually degraded by MAO in the intestings, if the pt takes an MAOI,  tryamine enters the blood stream in high concentrations and displaces NE with in the pre-synaptic nerves causing acute hypertension
  41. what are the symptoms of a acute hypertension as a result of MAOI and tyramine interactions:

    list 2 possible consequences as a result of this:

    what is the antidote for this crisis:
    • occiptial headache
    • stiff neck
    • flushing
    • palpitations
    • diaphoresis (sweating, persipring)
    • nausea

    • consequences
    • MI
    • CVA

    antidote: calcium channel blockers
  42. list (2) contraindications of MAOIs:

    list (3) things that can result from and OD of MAOIs:
    • contraindications
    • cardiovascular or cerebrovascular disease

    • OD
    • respiratory drepression
    • circulatory collapse
    • seizures
  43. what is the pregnancy category for MAOIs:
    • pregnancy category: C
    • contraindication: breast feeding women
  44. pt. care with the use of MAOIs should include instructions with the following:
    • report immediately:
    • severe HA, dizziness, paresthesias, slow or increased HR, CP, n/v, diaphoresis, slurred speech, extremem lethargy, ataxia

    • it may take up to 2 months to acheive terapeutic effect
    • list the forbidden foods/fluids
    • tell the provider before taking any other drugs
    • avoid caffenine
    • wear a bracelet indicating MAOI use
    • do not stop abruptly, could lead to rebound HTN
  45. a disorder characterized by depressive stages, and also manic stages of high psychomotor activity and irritability is called:
    bipolar disorder
  46. the symptoms of mania, are generally the opposite of depressive symptoms:
    • grandiosity
    • decreased need for sleep
    • increased talkativeness
    • flight of ideas
    • distractibility
    • incrased goal-directed activity
    • excessive involvement in pleasureable activities
  47. the traditional tx of bipolar disorder has been:

    list 3 other drugs used for the tx of mania:
    lithium (eskalith)

    • tx of mania:
    • valproic acid (depakote, depankene)
    • carbamazepine (tegretol)
    • lamotrigine (lamictal)
  48. lithium has a narrow therapeutic incex and is monitored via serum levels:

    at the begining of tx:
    throughout the tx:
    • at the begining of tx: every 1 - 3 days
    • throughout the tx: every 2-3 months
  49. lithium acts like sodium in the body, so conditions in which sodium is lost (excessive sweating, dehydration) can cause:
    lithium toxicity

    serum sodium leves will be monitored along with lithium levels
  50. lithium overdose can be tx'ed with:
  51. list 4 baseline studies done prior to starting lithium:
    • renal
    • cardiac
    • thyroid
    • electolytes
  52. list 2 meds that are added to the tx of lithium during the depression phases of bipolar:

    list 2 meds that are added to the tx o lithium during the manic phases of bipolar:
    • depression phase:
    • TCAs
    • bupropion (welbutriz, zyban)

    • manic phase:
    • benzodiazepine
    • antipsychotic (zyprexa)
  53. what is the pregnancy category for lithium:
    pregnancy category: D
  54. how is overdoes of bipolar tx'ed:
    hemodialysis and lyte correction
  55. pts. on lithium should NOT restrict the intake of ____ or the result will be decreased excretion of lithium:
    should NOT restrict the intake of sodium
  56. what is the therapeutic range of lithium:
    0.6 - 1.4 mEg/L
  57. list (6) side effects of lithium (eskalith):
    • dizziness
    • fatigue
    • difficulty with short term memory
    • nausea, diarrhea, vomiting
    • dehydration (Li+ blocks ADH so dehydration is more likely)
    • hypothyroidism
  58. list (6) contraindications of lithium (eskalith):
    • severe cardiovascular disease
    • dehydration
    • renal disease
    • hyponatremia
    • severe debility
    • pregnancy, nursing mothers, kids < 12
  59. pt. teaching for lithium (eskalith) should include instructions for the following:
    • don't stop taking it abruptly
    • avoid dehydration
    • report immediately: decreased or increase UOP, significant weight loss or gain, diarrhea
    • take it with food to decrease GI discomfort
    • avoid caffine because it has a diuretic effect and thus causes the kidenys to spare Li+ thus increasing Li+ levels
  60. list the NTs that the following meds affect:

    • TCAs: NE/serotonin
    • MAOIs: mao, the enzyme that breaks down NE, epinephrine, dopamine, and serotonin
    • SSRIs: serotonin