Thyroidism, Depression, and Digoxin
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Thyroidism, Depression, and Digoxin
What does it mean when drugs have a Narrow Therapeutic Index?
It is a drug in which small changes in the dose and/or blood concentration could potentially result in clinically important changes in drug efficacy or safety
What do drugs with Narrow Therapeutic Indexes require frequently?
Adjustments in the dose of the drug and careful patient monitoring irrespective of whether the drug is brand or generic product
What is the "Orange Book"?
Approved drugs with therapeutic Equivalence Evaluations
What is the rule associated with Narrow Therapeutic Indexes?
Rx must be refilled with the same drug product that the pharmacist last dispensed (same manufacturer, no generics if brand was dispensed previously)
Therapeutic range is also known as:
What does Digoxin do chemically and what type of medication is it?
It inhibits the sodium-potassium ATPase; it's an antiarrhythmic medication
What is Digoxin used for?
CHF, a fib, a flutter
What are some of the adverse effects of Digoxin?
Nausea, vomiting, anorexia, blurred/yellow vision
What does the thyroid gland do?
helps regulate temperature and basal rate through the use of thyroid hormones
What is hyPERthyroidism?
when there is too much of the thyroid hormone produced
What is hyPOthyroidism?
When too little thyroid hormone is produced
What are some symptoms of hypERthyroidism?
irritability/nervousness, muscle weakness/tremors, infrequent or scant menstrual periods, weight loss, sleep disturbances, enlarged thyroid gland, vision problems or eye irritation, heat sensitivity
What are some symptoms of hyPOthyroidism?
fatigue, weight gain, depression, cold intolerance, elevated cholesterol levels, heart disease, and infertility
What is the generic for Synthroid, Levoxyl?
What are some of the adverse side effects of Synthroid?
hypoglycemia, insomnia, tachycardia, anxiety
What is some patient education associated with Synthroid?
do not discontinue without consulting a physician
What is major depression?
a disease with certain characteristic signs and symptoms that interferes with the ability to work, sleep, eat, and enjoy once pleasurable activities.
What is the DSM-IV?
a manual that provides diagnostic criteria for mental disorders including depression
How do anti-depressant medications work?
by slowing down the removal of certain chemicals in the brain (neurotransmitters)
Why are neurotransmitters needed?
for normal brain function and for mood control
What are some major neurotransmitters in the body?
Dopamine, GABA, Norepinephrine, Serotonin
What is the role of GABA in the body?
it is the major inhibitory neurotransmitter in the brain
What are neurotransmitters produced by?
nerve cells in the brain
What are neurotransmitters used by and how are they used>
They are used by nerves to communicate with one another
What can low levels of neurotransmitters cause?
What two actions can neurotransmitters complete once released into space surrounding the nerve?
1. Either travels across space and attaches to receptors of another nerve or 2. Attaches to receptors on the nerve thatr produced it (recycled and released again or degraded)--> known as reuptake
What does blocking the reuptake cause?
higher levels of neurotransmitters so that messages can be communicated
What are some diseases associated with neurotransmitter malfunction?
depression, autism, ADD, ADHD, anxiety
What does SSRI stand for?
Selective Serotonin Reuptake Inhibitors
How do SSRIs work?
they inhibit the removal of serotonin from the brain which increases the amount of serotonin in the brain
SSRI's are often used early in...
How long does it take before full effect is seen with SSRIs?
What are some indications for SSRIs?
major depression, anxiety disorders, panic disorders, obsessive-compulsive disorders, social phobias, and eating disorders
What are some adverse effects of SSRIs?
nausea, drowsiness, headache, changes in weight and appetite, changes in sexual behavior, increased feelings of depression and anxiety, tremors, and increased sweating
What is some patient education associated with SSRIs?
take as directed, may take 3-4 weeks before full effect, avoid alcohol, may impair cognitive and motor performance
Are SSRIs addictive?
No, your body cannot become physically addictive
What is the required box warning on SSRI's in the US about?
increased suicide risk in children and young adults
In May 2007, what age was the warning extended to?
What is the drug class and brand name for citalopram?
What is the drug class and brand name for escitalopram?
What is the drug class and brand names for fluoxetine?
SSRI; Prozac and Sarafem
What is the drug class and brand names for paroxetine?
SSRI, Paxil and Paxil CR
What is the drug class and brand name for sertraline?
What is the drug class and what are the brand names for Digoxin?
Inotropic Agent; Lanoxin, Lanoxicaps, Digitek