Term
Major Depression
clinical features |
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Definition
| Depressed mood, loss of pleasure or interest in all or nearly all of one's usual activities and past times. Characterized by insomnia/hypersomnia, anorexia/hyperphasgia, mental slow/loss of concentration, guilt, worthlessness, helplessness, death/sucidal thoughts, suicidal behaviors. |
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Term
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Definition
| s/s present most of day, nearly every day >2wks |
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Term
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Definition
-complex & incomplete understanding
-can be 'out of blue'
-stressful events
-factors that contribute to vulnerability:genetic, difficult childhood, chronic low self-esteem
-monamine deficiency hypothesis-defiecient in serotonin, NE or both |
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Term
Major depression
tx modalities |
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Definition
Pharmacotherapy
Depression specific psychotherapy
Somatic therapy (ECT, transcranial magnetic stimulation, light therapy, vagus nerve stimulation)
Aerobic exercise& resistance training |
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Term
Major Depression
Atypical features |
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Definition
| reactive mood, significant increase in appetite, wt gain, hypersomnia, heavy feelings in arms/legs, sensitive to interpersonal rejection |
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Term
Major presentation
Assessment |
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Definition
H&P:include medications (?side effect)
MMSE, Lab work (r/o electrolytes/hypothyroid other medical conditions)
Differential dx |
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Term
| Medical disorders associated w/Depression |
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Definition
| Endocrine disorders, deficiency states, infections, collagen disorders, metabolic disorders, CV disease, neurologic disorder, malignant disease |
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Term
| Psychiatric disorders associated w/depression |
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Definition
| alcoholism, anxiety, eating disorders, schizophrenia |
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Term
| Drug therapies associated w/depression |
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Definition
| Anti-hypertensives, hormonal therapy, acne therapy, other |
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Term
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Definition
Major depressive disorder
Dysthymic disorder |
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Term
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Definition
| Chronic depressed mood most days >2yrs, combined with 2 of the following: appetite or sleep disturbance, low energy, low self-esteem, hoplesness, poor concentration, indecisiveness. |
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Term
| Depression symptom pneumonic |
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Definition
SIG E CAPS
sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide |
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Term
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Definition
reduce/resolve problems
prevent relapse
facilitate to baseline
prevent suicide
improve QOL
normalize functionabl relationships
avoid/minimize adverse effect
reduce health care costs |
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Term
| Drug classes for depression |
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Definition
SSRI
SNRI
TCA
MAOI
mixed serotonin
mixed NE/DA reuptake inhibitors |
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Term
| Basic time course for antidepresants |
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Definition
| 1-3 wks to start working, max responses 12wks |
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Term
| Drug selection for antidepressants |
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Definition
Tolerability, safety, interactions, pt preferance, cost.
Can try a different one with in same class |
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Term
| Antidepressant choice for pt c/o fatigue |
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Definition
drug w/CNS stimulation
Prozac, Wellbutrin |
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Term
Antidepressant choice for pt c/o
insomnia |
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Definition
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Term
Antidepressant choice for pt c/o
sexual dysfunction, low libido |
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Definition
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Term
Antidepressant choice for pt c/o
Chronic pain |
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Definition
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Term
| Managing treatment in depression |
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Definition
Once started use 4-8 weeks before determining efficacy. Start low dose. Options if not effective:increase dose, switch within same class, switch to a different class, add a second drug.
Once in remission-cont 4-9mths symptom free, taper off. |
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Term
| Suicide risk with antidepressants |
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Definition
Increased when starting antidepressants and when dose increases.
Evaluate weekly x4wks, biweekly x4wks, x1 month, periodic |
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Term
| Treatment phases with antidepressants |
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Definition
| Acute, continuation, maintenance |
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Term
Antidepressants
Duration of treatment phases |
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Definition
Acute-6weeks
Continuation-6-9mths
Maintenance-3-5yrs, lifelong |
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Term
Antidepressants
Goals of treatment phases |
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Definition
Acute-resolve symptoms
Continuation-prevent relapse
Maintenance-prevent reoccurance in high risk pts |
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Term
| High risk patients for lifelong maintenance of depression |
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Definition
*first episode >50y/o
*>40y/o who have had 2+ episodes
*all ages with 3+ episodes |
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Term
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Definition
| Prozac, Zoloft, Celexa, Lexapro,Paxil, Luvox |
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Term
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Definition
| Block neuronal reuptake of serotonin increasing serotonin at synapses |
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Term
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Definition
| high protein bound, extensive hepatic metabolism CYP2D6, 1/2 life 2 days, 4wks to plateau |
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Term
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Definition
| sexual dysfunction, nausea, HA, CNS stimulation, nervous, insomnia, anxiety, wt. gain, serotonin syndrome, withdrawl symptoms with abrupt dc(less than others),increase suicide risk, EPS (akthisia most common), bruxism, hyponatremia, dizzy, fatigue, skin rash, diarrhea, excessive sweating. Teratogenic. |
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Term
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Definition
MAOIs(stop 14 days before start,wait 5wksafter prozac to start MAOI)
CYP2D6 drugs, TCAs, Lithium, antiplatelet & anticoags, tagament, ethanol, NSAIDs, TCAs, some antiHTN, warfarin, tryptophan, other serotonergic meds |
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Term
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Definition
| Na at baseline & periodic in elderly |
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Term
Prozac
minimizing side effects |
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Definition
| Manage sexual dysfunction-drug holidays (off on weekends), add yohimbine, Buspar, Wellbutrin, remeron, Viagra.Bruixism-switch class or use mouthgaurds and add Buspar |
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Term
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Definition
| absorption increase with food, high protein binding, extensive hepatic metabolism. 1/2 life 1 day.(side effects same as prozac) |
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Term
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Definition
| same as prozac + dry mouth, constipation, sedative (rather than excitatory), liver damage. |
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Term
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Definition
| Liver function baseline & weekly x1month |
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Term
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Definition
| Same as prozac, but fatigue/somnolence that fades after 5-6 wks. Has some anticholinergic effects. |
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Term
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Definition
| Celexa-paresthesias, dry mouth, tachycardia, orthostatic hypotension, QT prolongation (and all other of prozac) |
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Term
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Definition
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Term
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Definition
| 2-72hrs after tx onset. Altered mental status (agitated, confused, disoriented, anxiety, hallucinations, poor concentration_, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, fever, death |
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Term
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Definition
| Dizzy, HA, nausea, sensory disturbances, tremor, anxiety, dysphoria, days-weeks after stopping & last 1-3 weeks. |
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Term
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Definition
| Effexor, Pristiq, Cymbalta |
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Term
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Definition
| Block NE, serotonin, and DA reuptake. |
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Term
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Definition
| Nausea, HA, anorexia, nervous, sweating, somnolence, insomnia. Dose dependent wt loss, sustained DBP HTN, sexual dysfunction, mydriasis, hyponatremia, serotonin syndrome, teratogenic |
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Term
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Definition
| MAOIs within last 14 days of 7 days after withdrawl syndrome. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| MAOIs, Tagament, St. Johns Wart, Triptans, other antidepressants |
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Term
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Definition
| Dizzy, diarrhea/contispation, dry mouth, erectile dysfunction, decrease libido, seizures (and all of Effexor) |
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Term
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Definition
| take on empty stomach. high protein bound. CYP2D6, CYP1A2 metabolism |
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Term
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Definition
| decreased appetite, blurred vision, liver damage (and all of pristiq/effexor) |
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Term
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Definition
| Transaminases (ALT), eye exams for glaucoma |
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Term
Cymbalta
contraindications |
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Definition
| narrow-angle glaucoma, liver dysfunction, alcoholics, Cr Cl <30 |
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Term
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Definition
| Alcohol, MAOIs, CYP1A2 & CYP2D6 drugs, phenothiazines, other antidepressants, drugs that increase serotonin syndrome risk |
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Term
Tricylic Antidepressants
drug list |
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Definition
| Amitriptyline, clomipramine,desipramine, doxepin, imipramine, nortrptyline, protriptyline, trimipramine |
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Term
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Definition
| Block reuptake, of serotonin and norepinepherine. Block histamine and ACh. Potency varies between drugs. |
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Term
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Definition
| ANTICHOLINERGIC (except diaphoresis), ORTHOSTATIC HYPOTENSION, SEDATION,cardiac conduction delays, weight gain, excessive sweating, sexual dysfunction, seizure, hypomania, suicide risk |
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Term
TCA choice by pretx symptoms
insomnia
sedation
BPH, glaucoma
Contraindicated in urinary retention & glaucoma, seizure
highest cardiotoxic risk |
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Definition
insomnia-give doxepin
sedation-give desipramine
BPH,glaucoma-give nortriptyline
contra glaucoma/urine retention-doxepin
contra seizure-maprotiline
cardiotoxic-desipramine |
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Term
Anafril
additional side effect |
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Definition
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Term
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Definition
| slow rise/change position, caution in operating machinery/driving, sugar free candy for dry mouth, do not take 2 doses if miss one |
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Term
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Definition
| BP/P, orthostatics, EKG prior to tx and periodic. Some drugs have serum levels |
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Term
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Definition
| used for suicide attempts-do not give suicidal pts more than one week supply. Dysrhthmias, hyperthermia, flush, dry mouth, dilated pupils, early-confusion, agitation, hallucinations.Later seizure & coma |
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Term
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Definition
| gastric lavage, physostigmine, propranolol, lidocaine, phenytoin |
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Term
| Anticholinergic pneumonic |
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Definition
BUDCAT
Blurry vision, photophobia, ^IOP
Urinary retention
Dry mouth/reduced secretions
Constipation
Anhidrosis (absence of sweat)
Tachycardia |
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Term
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Definition
Class IA antiarrhythmics
tagament
QT prolongers
Several CYP 450 meds
MAOIs (can under close supervison)
direct & indirect sympathmoimetics
anticholinergics
CNS depressants |
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Term
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Definition
| Selegiline patch, Marplan, Nardil, Parnate |
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Term
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Definition
MAO, an enzyme in liver, intestine & some neuron terminals.
MAO neurons convert NE, serotonin,& DA to inactive. In liver & intestines, inactivates tyramine |
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Term
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Definition
| All MAOIs for depression are nonselective (effect neuron, liver, intestine). Antidepressant effect are from increasing NE and serotonin available for release. Can be reversible or irreversible. |
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Term
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Definition
1st line in atypical depression
2-3rd in other depression, bullimia, OCD, panic attacks |
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Term
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Definition
| CNS stimulation (anxiety, insomnia, agitation, hypomania, mania), orthostatic hypotension, hypotension, dizzy, lightheaded, anticholinergic, (?sedation), sexual dysfunction, HTN crisis with dietary tyramine, hepatocellular damage, wt. gain, edema |
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Term
HTN crisis with tyramine foods
s/s |
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Definition
| severe HA, tachycardia,palpitations, HTN, N/V, confusion, profuse sweating, stroke |
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Term
| Normal tyramine food metabolism |
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Definition
| MAO in intestine and liver inactivate before reaching general circulation |
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Term
| Tyramine effects in general circulation |
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Definition
| Stimulates release of accumulated NE, massive vasocontriction and intense heart stimulation |
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Term
Foods with tyramine
and tyramine-like foods to avoid |
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Definition
| yeast, cheese, avacodos, soybeans, salami, pepperoni, bologna, smoked meats, figs, bananas, aged fish/meat, liver, beer, Chianti Wine, protein dietary supplements, soups, shrimp paste, soy sauce, caffeine,chocolate, fava, ginseng |
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Term
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Definition
| IV vasodilator, sodium nitroprusside, phentolamine, labetalol, sl nifedipine |
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Term
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Definition
| A LOT, lots of OTC also. Pt teaching to notify prescriber before starting any new med-including OTC (ie cough/cold) |
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Term
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Definition
| 24h MAOI patch, no dietary restrict for 6mg, avoid in anesthetic comtaining sympathomimetics. Contraindicated in pheochromocytoma. May increase q2weeks |
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Term
| Changing therapies from/to MAOI |
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Definition
| wait 2 week from stopping MAOIs to start other antidepressants and vice versa. Wait 5 wks after Prozac to start MAOI. |
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Term
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Definition
similar structure to amphetamine. Stimulant actions & supresses appetite.
Antidepressant effects 1-3 weeks. Sexual dysfunction in SSRI pts and women w/hypoactive libido, SAD, major depressive, smoking cessation, neuropathy, ADHD |
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Term
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Definition
| r/t block dopamine &/or NE reuptake |
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Term
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Definition
| CYP2B6 hepatic metabolism, 1/2 life 8-24h |
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Term
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Definition
| seizures, agitation, HA, dry mouth, constipation, wt. loss, GI upset, dizzy, tremor, insomnia, blurred vision, tachycardia, psychotic, suicide risk |
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Term
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Definition
| Zoloft, prozac, paxil, MAOI, CYP2B6 |
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Term
Bupropion
minimizing seizure risk |
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Definition
| avoid dose >450mg/day, avoid rapid titration(<100/day >3-4days inbetween), avoid single dose >150mgavoid use in hx of seizures, head injury, CNS tumor, or with drugs that decrease seizure threshold |
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Term
Bupropion
Contraindications |
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Definition
| eating disorders, previous seizure hx. |
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Term
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Definition
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Term
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Definition
| Inhibits NE and serotonin reuptake |
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Term
Trazadone/nefazadone
side effects |
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Definition
| HA, drowsy, insomnia, agitation, dizzy, dry mouth, nausea, constipation, weakness, trazadone-priapism/prolonged clitoral erection & QT prolongation |
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Term
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Definition
Sleep
adjunct in depression |
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Term
Nefazone
uses/additional considerations |
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Definition
Antidepressant
Assoc w/Liver failure
Protein bound |
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Term
Trazadone/nefazadone
interactions |
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Definition
| 3A4 drugs, digoxin, MAOIs, warfarin, CNS depressants, St. Johns wort |
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Term
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Definition
| inhibits NE & serotonin reuptake by inhibiting receptors, avoids some serotonin receptors, block histamine |
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Term
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Definition
| sedation, increased cholesterol, constipation, dry mouth, increased appetite, wt. gain, dizzy |
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Term
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Definition
| daily HS, adjust for hepatic and renal impair |
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Term
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Definition
| MAOIs, clonidine, triptans, BZD, other antidepressants, CNS depressants |
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Term
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Definition
| Selective block serotonin reuptake and direct activation of serotonin receptors |
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Term
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Definition
| Take w/food, high protein bound, extensive hepatic metabolism |
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Term
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Definition
| diarrhea, nausea, dizzy, insomnia, sexual dysfunction,serotonin syndrome, hyponatremia, abnormal bleeding, increased suicide |
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Term
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Definition
| MAOIs, serotonergic drugs, CYP drugs, anticoags & antiplatelets |
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Term
Amoxapine
use/side effects |
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Definition
Antidepressant for psychotic depression.
anticholinergic, sedative, seizure, EPS, TD |
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Term
Ketamine
as an antidepressant |
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Definition
IV-quickly reduces depression and suicide, 40minute results last 10days
side effect-psychosis resolves in 40min, can cause cancer |
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Term
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Definition
| SSRI use, pheochomocytoma, HF, liver disease, severe renal impair, cerbrovascular disease, HTN, >60y/o |
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Term
ADVERSE EFFECTS
Remeron
Neazodone
Trazodone
Bupropion
MAOIs
Antidepressants |
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Definition
Neutropenia/agrulocytosis(avoid immunosuppressed)
Hepatic Failure
Priapism
Seizures
HTN crisis
Suicidality |
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