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Nursing Pharmacology > Module 14b - Part 2 > Flashcards

Module 14b - Part 2 Flashcards

1
Q

For a diagnosis, at least _____ of some massive list must occur for at least __ weeks.

A

5 symptoms

2 weeks

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2
Q

Depression is classified into two major types, what are they?

A

Exogenous

Endogenous

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3
Q

_________ depression is triggered by external stimuli, whereas _________ depression may or may not be related to external events

A

Exogenous

Endogenous

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4
Q

Prolonged grieving coupled with excessive guilt.

A

Pathological grief

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5
Q

What treatment modality is more effective to treat pathological grief?

A

Psychotherapy > drugs

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6
Q

Prolonged depression following failure or rejection. Common symptoms include hypersomnia and hyperphagia.

A

Adjustment disorder

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7
Q

What is the most effective treatment modality for treating adjustment disorder?

A

Psychotherapy > drugs

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8
Q

What are the two depression types within exogenous depression?
What treatment modality is best for exogenous depression?

A

Pathological grief
Adjustment disorder
Psychotherapy

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9
Q

What are the different depressive types within endogenous depression?

A 
Major depression
Severe depression
Atypical depression
Dysthymia
Seasonal Affective Disorder
Postpartum depression
Bipolar disorder
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10
Q

Common symptoms include anhedonia and lack of response to positive stimuli. Symptoms are usually worse in the morning, and insomnia and weight loss are also typical.

A

Major depression

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11
Q

Similar symptoms to major depression with the addition of severe suicidal ideation and psychoses

A

Severe depression

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12
Q

The patient’s mood is regularly low but symptoms are not as severe as major depression.

A

Dysthymia

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13
Q

Mild or moderate symptoms of depression related to the lack of sunlight. Usually only affects people in the winter months.

A

Seasonal affective disorder

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14
Q

Alternating periods of elevated or irritable mood and periods of depression

A

Bipolar disorder

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15
Q

Moderate to severe depression in women after they given birth. Usually occurs within ___ months of delivery but may occur __ year after birth.

A

Postpartum depression

w/in 3 months - 1 year

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16
Q

Similar symptoms to major depression but patients also have the atypical symptoms of hypersomnia and hyperphagia. Patients are usually obese.

A

Atypical depression

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17
Q

This endogenous depressive type responds better to psychotherapy than drugs.

A

Dysthymia

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18
Q

Describe the major hypothesis for the biochemical basis of depression.

A

Monoamine hypothesis

States that altered monoamine release, receptor sensitivity, or postsynaptic function lead to symptoms of depression

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19
Q

Why is the efficacy of antidepressants difficult to assess?

A

Since it takes months for effects to occur

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20
Q

Results from placebo controlled CTs also suggests that as much as 40% of the effects of antidepressants may be due to the _______ ________.

A

placebo effect

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21
Q

Antidepressant drugs mediate their effects by one of two major mechanisms. What are they?

A

Inhibiting monoamine reuptake

Inhibiting monoamine metabolism

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22
Q

What are the four major classes of drugs used to treat depression?

A

TCAs
SSRIs
MAOIs
SSRIs/NSRIs

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23
Q

What is the mechanism of action of TCAs?

A

Prevent the reuptake of both serotonin and NE

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24
Q

What are the adverse effects of TCAs?

A

ASS WOD (Think TCA = techoic ass+ids [acids] —> ASS workout of the day)

Anticholinergic effects
Sedation
Orthostatic hypotension
Decreased seizure threshold
Cardiac toxicity
Weight gain
Sexual dysfunction
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25
Q

Describe the mechanism of action of SSRIs.

A

Block the reuptake of serotonin.

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26
Q

Why would SSRIs be used over TCAS if they only block serotonin, rather than serotonin and NE?

A

Thought to have similar efficacy to TCAs, but the incidence of side effects is lower

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27
Q

Most commonly used treatment of depression and most commonly used in major depression.

A

SSRIs

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28
Q

What are the adverse effects of SSRIs?

A 
IWSS (i [don't] want Serotonin Syndrome)
Insomnia
Weight gain
Sexual dysfunction
Serotonin syndrome
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29
Q

Increased serotonin transmission can result in agitation, confusion, anxiety, hallucinations and incoordination.
Symptoms may occur within __ days of initial therapy and disappear when the drug is stopped.

A

Serotonin syndrome

3

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30
Q

Same mechanism of action as TCAs.

A

SNRIs - selective serotonin/NE reuptake inhibitors

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31
Q

What is the main advantage of SNRIs?

A

Faster onset of action

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32
Q

What are the adverse effects of SNRIs?

A

NDS (sNris –> Nintendo DS)

Nausea, diastolic HTN, sexual dysfunction

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33
Q

Enzyme that inactivates monoamine NTs.

A

Mononamine oxidase

34
Q

What are the two major types of MAO, and what do each oxidize?

A

MAO-A - serotonin and NE

MOA-B - dopamine

35
Q

MAO inhibitors inactivate which MAO subtype?

A

Both - non-selective

36
Q

MAO inhihbitors are useful in the treatment of these depression types.

A

Atypical and Dysthymia (the weird ones)

37
Q

MAO inhibitors mediate their effects by inhibiting the metabolism of monoamines in the __-_______ neuron.

A

pre-synaptic

38
Q

What are the adverse effects of MAO inhibitors?

A

HI AOA (HI American Orthopedic Association)
Hypertensive crisis (tyramine containing foods)
Insomnia
Agitation
Orthostatic hypotension
Anxiety

39
Q

Severe illness characterized by recurrent fluctuations between episodes of mania and depression

A

Bipolar disorder

40
Q

What are the three major groups of drugs used to treat bipolar disorder?

A

Mood stabilizers
Antipsychotics
Antidepressants

41
Q

What are the benefits of patients using mood stabilizers to treat bipolar disorder.

A

1 - Relieve symptoms during manic OR depressive episodes
2 - Prevent recurrence of manic or depressive episodes
3 - Do not worsen symptoms of mania or depression and do not alter the rate of cycling

42
Q

The primary drugs used as mood stabilizers.

A 
Lithium
Valproic acid (anti-epileptic)
43
Q

Although the mechanism of action of lithium is not clear, what do we believe it does?

A

Alter the uptake and release of glutamate

Block the binding of serotonin

44
Q

Lithium has a ______ therapeutic range and plasma concentrations may be altered by _____.

A

narrow

sodium

45
Q

Drugs that increase sodium loss from the body (i.e. ______) increase lithium concentrations and produce toxicity.
These toxic effects are?

A

diuretics
Gi upset, tremor, sedation, hypotension

GTSH
(Toxic - Thyroid stimulating hormone Gone)

46
Q

Used in bipolar disorder acutely to control symptoms during manic episodes and long term to stabilize mood.

A

Antipsychotics

47
Q

Why are antipsychotics even used to treat bipolar disorder, and which type is preferrable?

A

Show a benefit even in patient’s without psychotic symptoms

Atypical antipsychotics are preferred due to the lower incidence of EPS

48
Q

Used to treat depressive episodes of bipolar disorder. Always used in conjunction with _____ _______.

A

antidepressants

mood stabilizers

49
Q

Why are antidepressants not used alone in the treatment of bipolar disorder?

A

Thought that they may precipitate manic episodes

50
Q 
Which of the following is best in the treatment for bipolar disorder?
A) TCAs
B) SSRIs
C) SNRIs
D) All of the above
A

D - there is no evidence for which antidepressant works best

51
Q

Patient is overwhelmed with uncontrollable worrying. The hallmark is an unrealistic or excessive worry about several activities that lasts 6 months or longer

A

GAD

52
Q

An anxiety where the patient feels judged or a situational anxiety where escaping would be difficult or embarrassing.

A

Agoraphobia

53
Q

Anxiety in social situations. Patients may not be able to talk (or stop talking), eat in front of others, or use public washrooms

A

Social anxiety disorder

54
Q

Anxiety that occurs after experiencing a traumatic event. Symptoms may include re-experiencing the event and severe insomnia.

A

PTSD

55
Q

Symptoms are related to a specific fear

A

Simple phobia

56
Q

Patients have a sense of impending doom that is unrelated to stressors. They experience panic attacks, which are sudden in onset and may include symptoms like heart palpitations, chest pain, shortness of breath, dizziness

A

Panic disorder

57
Q

Often confused for a heart attack.

A

Panic attack

58
Q

What are the major classes of drugs used to treat anxiety?

A

Benzodiazepines
Buspirone
Antidepressants

59
Q

First line therapy for anxiety.

A

Benzodiazepines

60
Q

Act by potentiating the actions of GABA at the GABA receptor.

A

BDZs

61
Q

Describe the mechanism of action of BDZs.

A

BDZs bind to a different site on the GABA receptor, than GABA.
This causes an increased binding of GABA to its receptor.
This leads to opening a chloride channel, and a subsequent influx of chloride
This causes CNS depression

62
Q

Why are benzodiazepines safer than barbiturates?

A

Since they are not GABA agonists, there is a limit to how much CNS depression they may produce, unlike barbiturates

63
Q

BDZs are useful in treating these 5 things.

A 
Anxiety
seizures
insomnia
Alcohol withdrawal
Muscle spasm
64
Q

A higher dose of BDZ is used to treat _______, and a lower for _______.

A

insomnia

anxiety

65
Q

What are the adverse effects of BDZs?

A 
CAR TTW (Benz = car, Try to win - think race)
CNS depression
Anterograde amnesia
Respiratory depression
Teratogenic
Tolerance
Withdrawal
66
Q

Impaired memory of events that occur following dosing of BDZs.

A

Anterograde amnesia

67
Q

Describe tolerance in BDZ treatment and how withdrawal symptoms are minimized.

A

Tolerance does not occur to anxiolytic or sedative effects, but occurs to seizure effects.

Withdrawal is minimized by tapering down the concentration of drug slowly.

68
Q

BDZs are effective in treating these anxiety types.

A

GAD and SAD

69
Q

Not a CNS depressant and acts to treat anxiety in a mechanism distinct from BDZs.

A

Buspirone

70
Q

The likely mechanism of action of buspirone involves modulation of ________ and/or _________ neurotranmission.

A

serotinergic

Dopaminergic

71
Q

Since buspirone is not a CNS depressant, it is useful in treating anxiety in patients who use _______.

A

alcohol (unlike Benzos, where respiratory depression may occur)

72
Q

Buspirone:
- Shows no signs of _______ or physical ________
What is it’s major disadvantage?

A

tolerance, physical dependence
Major disadvantage is that its anxiolytic effects develop slowly - ineffective in treating symptoms that require immediate relief

73
Q

Buspirone is effective in the treatment of ______ but appears to be ineffective in the treatment of other anxiety types

A

GAD

74
Q

Although buspirone is well tolerated and non-sedating, what are some commonly reported side effects?

A

Dizziness, light-headedness, excitement

LED

75
Q

Which antidepressants are most effective in treating GAD?

A

SNRIs, SSRIs, buspirone

76
Q

Which antidepressants are most effective in treating Panic disorder/aographobia?

A

SSRIs, TCAs, MAOIs

SSRIs preferred

77
Q

Which antidepressants are most effective in treating OCD?

A

SSRIs are the first line therapy

78
Q

Which antidepressants are most effective in treating social anxiety disorder?

A

SSRIs are the first line of therapy

BDZs provide immediate relief

79
Q

Which antidepressants are most effective in treating PTSD?

A

No evidence for efficacy of any drug in treatment

80
Q

What must OCD patients also undergo with drug treatment?

A

Behavioural psychotherapy

81
Q

Why are SSRIs preferred over MAOIs and TCAs in the treatment of panic disorder/agoraphobia?

A

Better tolerated

Nursing Pharmacology (30 decks)

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