Pharm exam 3 blk 7 part 3

sbentley's version from 2016-02-20 02:53

Section 1

Question Answer
What is the advantage of SSRIs over other AD classes Other anti-depressants have anti-muscarinic, antihistaminic and alpha adrenoceptor blocking actions, which may contribute to their toxicity. SSRIs are 5-HT selective and decrease ANS toxicity effects.
Why would you give a high loading dose of norfluoxetine (fluoxetines metabolite)Fluoxetine’s demethylated metabolite, norfluoxetine has a half-life of 7-9 days at steady state; Fluoxetine’s is slightly shorter.
List 2 symptoms of ‘Serotonin Syndrome’Serotonin Syndrome Sx = hyperthermia, muscle rigidity, myoclonus and rapid changes in mental status and vital signs
The class of drugs that are contraindicated with SSRIs because of Serotonin SyndromeMAO-I
Give the SSRI that inhibits microsomal enzymes least.Citalopram
Which SSRI is dosed differently than other ADs and how?Fluoxetine usually start with 20 mg/day and maintain for several weeks until the patient’s response can be determined
Apply one advantage for bupropion over SSRIs Improves attention and concentration more than SSRIs • Well tolerated by pts with orthostatic hypotension (alpha-receptor effect)
one tolerability advantage of bupropion over SSRIs No sexual dysfunction
What is the typical dosing regimen for tricyclic ADs (e.g., imipramine)Start low and increase by 25 mg every 2-3 weeks. o Inpatient → start ~100 mg/d o Outpatient → start 10-75 mg/d
Name three “adjunctive” therapies to antidepressants Lithium, thyroid hormones, atypical anti-psychotics (e.g., aripiprazole)
What two neurotransmitter systems are affected by tricyclics give side-effects and include one side effect resulting from eachAnticholinergic = ABCD → Anorexia, Blurry vision, Constipation/Confusion, Dry mouth, Sedation/Stasis of urine o Can’t see, can’t pee, can’t spit, can’t shit • Anti-alpha adrenergic = orthostatic hypotension • Anti-histaminergic = drowsy, lethargy
Name two ways to avoid tricyclic overdose Prescription < 1.25 g or 50 dose units of 25 mg, no refill. • entrust drug to relative
Give the reason patients should take amitryptiline at bed time.Administration of the entire daily dose at bedtime may reduce daytime sedation

Section 2

Question Answer
what should be looked for when prescribing SSRIs to children Warning = antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with Major Depressive Disorder (MDD).
how long should kids be monitored and which SSRI should be used Monitoring = children and adolescents taking SSRI medications should be closely monitored for any worsening in depression, emergence of suicidal thinking or behavior, or unusual changes in behavior, such as sleeplessness, agitation, or withdrawal from normal social situations. Close monitoring is especially important during the first four weeks of treatment. = prozac
List one pro and one con each for the N-methyl-D-aspartate receptor (NMDA)NMDA receptor hypothesis o Pros = glutamate is very important in brain (potential is great), many antidepressant treatments affect NMDA receptors long-term, preclinical data is positive o Cons = almost no clinical evidence that NMDA antagonists are effective antidepressants
List one pro and one con each for corticotropin-releasing factor (CRF) theories.CRF hypothesis o Pros = CMST long has been a test of depression, CRF associated with control of GI system, CRF antagonists associated with reduced sleep, small clinical trial o Cons = no extensive clinical trials
Give the condition that anti-depressants are often used for but for which bupropion should not be usedBupropion should not be used for panic or OCD as it may worsen panic and OCD (remember it seems to act on dopamine systems).
a chronic disturbance of mood involving depressed mood for most of the day more days than not, for at least two years. Dysthymia (or Depressive Neurosis)
poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.Symptoms associated with Dysthymia

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