Anxiety/Depression
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| 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
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| Which type of anxiety disorder displays symptoms of apprehension, worry, irritability, difficulty concentrating, insomnia, and ANS complaints | Generalized Anxiety disorders
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| which type of anxiety disorder displays shortlived, recurrent, unpredictable episodes of intense anxiety | Panic Disorder
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| how many people who have OCD will develop major depression some time in their lives | 2/3
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| 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)
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| This disorder may be part of panic disorders and include things like AGORAPHOBIA, SOCIAL PHOBIAS OR SOCIAL ANXIETY DISORDER, PERFORMANCE ANXIETY, ETC. | Phobic Disorder
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| What is the general treatment used for Anxiety Disorders | Chronic = daily doses of antidepressants of buspirone
Acute= benzodiazepines for quickest relief
Antidepressants + Benzodiazepine = common
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| Which drug is used specifically for anxiety only and is NOT an antidepressant or benzodiazepine | Buspirone (Buspar)
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| What is the Mechanism of action of Buspirone (Buspar)? | unknown, but has effect on serotonin like the SSIRs and a slow onset of action
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| What is the criteria for diagnosis of clinical depression | symptoms present daily for >2 weeks
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| How effective is treatment of depression | 60-70%
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| 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
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| What factors are involved in the risk of developing depression | hereditary and situational (social triggers)
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| What is believed to be the cause of depression | Unknown, but invovles CNS monoamines norepinephrine, dopamine, and/or serotonin
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| What is the treatment for depression | Selected medication based on adverse effects, cost, and past medical history
Drug of Choice: SSRIs or Newer Antidepressants
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| 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
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| What are the common Serotonin/Norepinephrine Reuptake Inhibitors (S/NRIs) used as antidepressants? | Duloxetine (Cymbalta), Vanlafaxine (Effexor), Desvenlafaxine (Pristiq)
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| What are the adverse effects of S/NRIs? | Insomnia, nervousness, dry mouth, anorexia, mild CV effects, sexual dysfunction, sweating, HTN
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| What disease is the S/NRI, Duloxetine (cymbalta) FDA approved to treat? | Fibromyalgia
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| What patient population is the S/NRI Desvenlafaxine (Pristiq) also effective in treating? | Severe depression and pts. refractory to other agents (diabetic, limb amputee)
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| What are the common SSRIs (Selective Serotonin Reuptake Inhibitors | fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Paroxetine (Paxil)
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| 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
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| Which Antidepressants have less cardiac side effects and are used most commonly? S/NRIs or SSRIs? | SSRI
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| What are the adverse effects of SSRIs | Nausea, insomnia & nervousness, akathisia, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms
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| Which drug is most likely to cause Orthostatic hypotension, sedation, and anticholinergic SEs, SSRIs or TCA's? | TCA's
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| What are the symptoms of Serotonin Syndrome | Hypotension, Hypertension, agitation, muscle tightness & twitching, hyperthermia, shivering, tachycardia & other arrhythmias, seizures, coma and death
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| 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
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| 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
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| Which antidepressant is often prescribed to treat insomnia? | Trazodone (Desyrel)
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| Whchi Antidepressant is used for smoking cessation and does not cause prblems w/ sedation or sexual dysfunction | Bupropion (wellbutrin, Zyban)
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| 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
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| Which Antidepressant causes weight gain and is taken at bedtime due to dedation? | Mirtazepine (Remeron)
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| What are the common Monoamine Oxidase Inhibitors (MAO-Is) | Phenelzine (Nardil) & tranylcypromine (Parnate)
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| 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
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| What are the adverse effects of MAO-Is? | Orthostatic hypotention, dizziness, sexual dysfunction, sleep disturbance
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| 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
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| 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
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| How must one d/c Tricyclic Antidepressants (TCAs)? | Do not go off these pills alone!!! They will cause severe rebound HTN
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| Do TCA's cause addiction | NO!
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| Are TCA's fast acting or slow acting drugs | They take a while to kick in
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| What is the most commonly used TCA | Amitriptyline (Elavil)
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| What is the MoA of the antidepressants Tricyclic Antidepressants (TCA's) | increase concentration of norepinephrine, dopamine, and serotonin in CNS increase concetrations
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| 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
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| 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
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| What population is at risk for adverse effects with TCAs | elderly men w/ BPH, cardiac disease patients,
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| What drug interactions can occur with TCA's | MAO-Is, epinephrine and oral decongestants, anticholinergics like antihistamines, CNS depressants, Potential p-450,
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| Do TCA's cause depression? | No, they are a CNS depressant which means they cause sedation, drowsiness, slowed though processes, etc.
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| What are other uses of TCAs other than antidepressants | anxiety disorder, phobic disorder, OCD, neuropathic pain, ADHD (same as SSRIs)
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| Why do TCA's cause Anticholinergic side effects? | they block Muscarinic receptors
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