40 Questions
What is the primary goal during the first 6-8 weeks of antidepressant therapy?
To obtain a response to drug therapy and improve the patient's symptoms
What is the recommended duration for maintaining antidepressant drug therapy after remission of depressive symptoms?
8-14 months
What is the definition of therapeutic non-response to antidepressant drug therapy?
Failure to respond to at least 6 weeks of therapy
What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?
Increasing the levels of serotonin, dopamine, and norepinephrine concentrations in the CNS
What is the etiology of depression?
Unknown
What is the role of dosage optimization in antidepressant therapy?
To carefully upward titrate the medication dose for several weeks
What is the term for the first 6-8 weeks of antidepressant therapy?
Acute phase
Which of the following is an example of an older generation antidepressant?
Tricyclic antidepressant (TCA) drugs
What is the primary indication for newer-generation antidepressants?
Depression
What is a characteristic of schizophrenia?
All of the above
What is the mechanism of action for antipsychotic drugs?
Reducing dopaminergic activity in the brain
Why do patients taking antidepressant drugs need to be patient and faithful with dosing?
Because they may not see immediate results
What is a hallmark of psychosis?
Loss of contact with reality
What type of disorder is often associated with excessive dopaminergic activity in the brain?
Psychotic illness
What is the primary goal of drug therapy for psychotic illness?
To reduce dopaminergic activity in the brain
Why is patient assessment and response carefully evaluated in psychotic illness?
Because there are no diagnostic laboratory tests available
What is characteristic of manic depressive illness?
Periods of extreme overactivity and excitement
What is the primary basis for selecting an antipsychotic for a patient?
The patient's tolerance and need to minimize adverse effects
What is a key difference between atypical and conventional antipsychotics?
Adverse effects
Which of the following is NOT an atypical antipsychotic?
Haloperidol
What do all antipsychotics have in common?
Blockage of dopamine receptors in the brain
What is the mechanism of action of older antipsychotics such as phenothiazines?
Blockage of dopamine receptors postsynaptically
What is the advantage of atypical antipsychotics compared to conventional antipsychotics?
Improved efficacy and safety profiles
What brain areas are associated with the mechanisms of action of antipsychotics?
Limbic system and basal ganglia
What is a major disadvantage of using Monoamine Oxidase Inhibitors (MAOIs)?
Their ability to cause a hypertensive crisis with certain foods and beverages
What is the primary mechanism of action of Tricyclic Antidepressants (TCAs)?
Blocking presynaptic reuptake of serotonin and norepinephrine
What is a common indication for the use of Tricyclic Antidepressants (TCAs)?
Treating neuropathic pain syndromes
What is a contraindication for the use of Tricyclic Antidepressants (TCAs)?
All of the above
What is a common adverse effect of Tricyclic Antidepressants (TCAs)?
Constipation
What is a characteristic of Mirtazapine, a Tetracyclic Antidepressant?
Associated with sedation due to histamine H1 receptor activity
What is the class of antidepressants that includes Citalopram, Escitalopram, and Fluoxetine?
Selective Serotonin Reuptake Inhibitors (SSRIs)
What is the class of antidepressants that includes Duloxetine and Venlafaxine?
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
What is a possible explanation for lithium's effectiveness in treating bipolar disorder?
It potentiates serotonergic neurotransmission
Which of the following medications may be used in conjunction with lithium to regulate mood or achieve stability in manic or hypomanic patients?
All of the above
What is a common adverse effect of the medications used to treat mania and hypomania?
Postural hypotension
Why is it important to advise patients to change positions slowly?
To prevent postural hypotension and possible injury
What is the importance of providing simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected?
To increase patient adherence to medication
Why should only small amounts of medications be dispensed at a time?
To minimize the risk of suicide attempts
What is the consequence of simultaneous use of these drugs with alcohol or other CNS depressants?
It can lead to fatal consequences
What is the importance of the combination of drug therapy and psychotherapy?
To help patients learn and acquire more effective coping skills
Study Notes
Depression
- Affective disorder characterized by intense sadness and duration beyond what is warranted by the event that triggered it
- Uncertain etiology, but evidence suggests a reduction in neurotransmitters like serotonin and norepinephrine at neuron junctions in the brain
Antidepressants
- Increase levels of serotonin, dopamine, and norepinephrine in the CNS
- Early and aggressive treatment increases chances of full remission
- Primary goals of the first 6-8 weeks of therapy: obtain a response to drug therapy and improve symptoms
- Recommended to maintain effective dose for an additional 8-14 months after remission
Types of Antidepressants
- Older generation:
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Newer generation:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin norepinephrine reuptake inhibitors (SNRIs)
- Miscellaneous
Monoamine Oxidase Inhibitors (MAOIs)
- Isocarboxazid, phenelzine, and tranylcypromine
- Rarely used due to newer, safer drugs being available
- Disadvantages: potential to cause hypertensive crisis when taken with substances containing tyramine
Tricyclic Antidepressants (TCAs)
- Amitriptyline, clomipramine, and imipramine
- Mechanism of action: correcting imbalance in neurotransmitter concentrations by blocking presynaptic reuptake
- Indications: originally used to treat depression, now used to treat neuropathic pain syndromes and insomnia
- Contraindications: known drug allergy, pregnancy, acute or chronic cardiac problems, and history of seizures
- Adverse effects: constipation, urinary retention, disturbances in cardiac conduction, hypotension, and sexual dysfunction
Tetracyclic Antidepressants
- Maprotiline and mirtazapine
- Mirtazapine: associated with sedation, dosed once daily at bedtime, and increases appetite
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Citalopram, escitalopram, fluoxetine, paroxetine, and sertraline
- Mechanism of action: increasing serotonin levels in the CNS
- Indications: depression, bipolar disorder, eating disorders, and obsessive-compulsive disorder
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
- Duloxetine and venlafaxine
- Associated with fewer and less severe systemic adverse effects compared to older-generation antidepressants
Antipsychotic Drugs
- Mental disorders: caused by inherent dysfunction in the brain leading to abnormal thought processes and responses
- Psychosis: severe mental disorder impairing mental function and daily activities
- Dopamine hypothesis: psychotic illness grows out of excessive dopaminergic activity in the brain
Types of Antipsychotics
- Older generation (conventional antipsychotics):
- Thioridazine, trifluoperazine, chlorpromazine, and haloperidol
- Newer generation (atypical antipsychotics):
- Clozapine, olanzapine, risperidone, and aripiprazole
- Mechanism of action: blocking dopamine receptors in the brain, decreasing dopamine concentration in the CNS
Adverse Effects of Antipsychotics
- CNS effects: drowsiness, neuroleptic malignant syndrome, and extrapyramidal symptoms
- Cardiovascular effects: postural hypotension and electrocardiogram changes
Lithium
- Effective in alleviating symptoms of acute mania and maintenance treatment of bipolar disorder
- Mechanism of action: potentiates serotonergic neurotransmission
- Requires blood level monitoring due to narrow therapeutic range
- Often used in conjunction with other medications like benzodiazepines, antipsychotic drugs, antiepileptic drugs, and dopamine receptor agonists
Nursing Implications
- Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected
- Advise patients to avoid abrupt withdrawal, change positions slowly, and minimize the risk of suicide attempts
- Emphasize the combination of drug therapy and psychotherapy to acquire effective coping skills
This quiz covers the basics of antipsychotics and antidepressants, including their effects on neurotransmitters and the etiology of depression.
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