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| 1. What is the mechanism of action of the SSRIs? |
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Definition
| The SSRIs act by inhibiting the reuptake of serotonin in the neuronal synapse by blocking the 5HT transporter. This allows for an increased amount of serotonin available for use in the body. |
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| 2. What can occur if an SSRI is given with another serotonergic medication? List some examples of serotonergic medications. |
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Definition
| If an SSRI is given with another serotonergic medication, an increase amount of serotonin is present in the neuronal synapse. This can lead to serotonin syndrome. This is characterized by nausea, diarrhea, chills, sweating, hyperthermia, hypertension, myoclonic jerking, tremor, agitation, ataxia, disorientation, confusion, delirium and death. Examples of serotonergic medications are: other SSRIs and those antidepressants that effect serotonin, 5HT-1agonists (triptans), tramadol (Ultram), ergotamine, MAOIs. |
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| 3. Due to its mechanism of action, what common adverse effects of the TCAs do patients commonly experience? |
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Definition
| TCAs act on various neurotransmitters. They block the reuptake of serotonin and norepinephrine. Also, they block muscarinic cholinergic receptors, histamine receptors and alpha 1 adrenergic receptors. For this reason, they have a larger side effect profile. Often they may experience dry mouth, constipation, nausea, vomiting, sedation, blurred vision, hypotension, and urinary retention. |
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4. Why do MAOIs have so many drug and food interactions?
MAOIs irreversibly inhibit the enzyme monoamine oxidase inhibitor, which is responsible for the metabolism of norepinephrine, serotonin and dopamine. |
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Definition
| These drugs are nonspecific to all of the neurotransmitters. There are two types of MAOs, A and B. MAO A inhibition is linked to antidepressant actions and hypertensive side effects of MAOIs. MAO B inhibition is linked to prevention of the progression of Parkinson’s disease. These are B specific and have no antidepressant effects. Any drugs or medications that cause an increase in blood pressure can cause a hypertensive crisis with the administration of MAOIs. This is due to the increase in the release of NE and the inability of MAO to destroy it. Those include foods containing tyramine, sympathomimetics, and stimulants such as caffeine. Symptoms of hypertensive crisis are: headache, stiff or sore neck, dilated pupils, sweating, heart palpitations, chest pain and tachycardia. |
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| 5. Why is bupropion contraindicated in those patients with a history of bulimia and anorexia? |
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Definition
| Bupropion is a norepinephrine and dopamine reuptake inhibitor. Bulimia and anorexia can lower the seizure threshold making a patient more susceptible to seizures. An adverse effect of bupropion is the risk of seizures. |
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| 6. Discuss the causes of elevated and decreased lithium levels. What adverse effects would one see with lithium toxicity? |
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Definition
Elevated lithium levels are caused by SSRIs, NSAIDs, ACE inhibitors, thiazide and loop diuretics, some antibiotics, and hyponatremia. Decreased lithium levels are caused by theophylline and high sodium intake.
Lithium toxicity can present with: course tremors of hands that impairs function, ataxia, stupor, muscle weakness, hyperreflexia, arrhythmias, nausea, vomiting, polyuria, seizures, coma, and death. |
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| 7. What are the differences in the typical and atypical antipsychotics? |
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Definition
Typicals-older medications-contain high and low potency medications, increased risk of EPS (especially with high potency) and increased anticholinergic adverse reactions (especially with low potency).
Atypicals-newer medications, fewer side effects (fewer anticholinergic effects), decreased risk of EPS. |
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Term
| 8. Because clozapine can cause fatal agranulocytosis, what should you monitor when using this medication? |
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Definition
| CBC-this medication is not generally used anymore due to the high incidence of agranulocytosis and the availability of newer, safer antipsychotics. |
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| 9. Antipsychotics can cause EPS and tardive dyskinesia. What would you observe in patients with these reactions? |
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Definition
EPS-tremors, chorea-involuntary muscular twitching of limbs and/or facial muscles, athetosis-slow irregular movements of upper extremities, involuntary, dystonia-impaired muscle tone, with antipsychotics have facial grimace and torticollis.
Tardive dyskinesia-slow rhythmical, automatic movements either generalized or in single muscle groups-irreversible and involuntary. |
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| 10. What are the adverse effects of the stimulant medications used to treat ADD/ADHD? |
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Definition
| Insomnia, restlessness, irritability, euphoria, headache, dizziness, tremor, motor tics (contraindicated in those with tic disorders), anorexia, abdominal discomfort, weight loss, tachycardia, palpitations, blood pressure changes, arrhythmias, potential for growth suppression |
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| 11. What other non-pharmacological treatment modalities should be included in the treatment plan for patients with ADD/ADHD? |
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Definition
| Behavioral modifications and environmental adjustments |
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| 12. Which type of medication should you consider in a patient that has difficulty falling asleep? |
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Definition
| Short acting agents as they will work initially then wear off as the night progresses. |
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| 13. Your patient has chronic hepatitis but is suffering from insomnia. What must you consider when prescribing the hypnotic agents? |
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Definition
| If your patient has a severe liver disorder then these medications are contraindicated. If their liver disease is mild to moderate, precaution is used and dosage reduction is warranted. |
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Term
| 14. Which of the hypnotics is indicated for chronic insomnia? |
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Definition
| The hypnotic agents that are indicated for chronic insomnia are eszopiclone(Lunestaâ) and ramelteon (Rozeremâ). Rozerem ® is not a controlled substance so dependence and withdrawal symptoms are less of an issue. |
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