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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