Podcast
Questions and Answers
What is the primary goal during the first 6-8 weeks of antidepressant therapy?
What is the primary goal during the first 6-8 weeks of antidepressant therapy?
- To obtain full recovery from depression
- To obtain a response to drug therapy and improve the patient's symptoms (correct)
- To define non-response to antidepressant drug therapy
- To maintain the effective dose for 8-14 months
What is the recommended duration for maintaining antidepressant drug therapy after remission of depressive symptoms?
What is the recommended duration for maintaining antidepressant drug therapy after remission of depressive symptoms?
- 8-14 months (correct)
- 1-2 years
- 6-12 months
- 6-8 weeks
What is the definition of therapeutic non-response to antidepressant drug therapy?
What is the definition of therapeutic non-response to antidepressant drug therapy?
- Failure to respond to at least 12 weeks of therapy
- Failure to respond to at least 6 weeks of therapy (correct)
- Failure to respond to at least 3 weeks of therapy
- Failure to respond to at least 3 months of therapy
What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?
What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?
What is the etiology of depression?
What is the etiology of depression?
What is the role of dosage optimization in antidepressant therapy?
What is the role of dosage optimization in antidepressant therapy?
What is the term for the first 6-8 weeks of antidepressant therapy?
What is the term for the first 6-8 weeks of antidepressant therapy?
Which of the following is an example of an older generation antidepressant?
Which of the following is an example of an older generation antidepressant?
What is the primary indication for newer-generation antidepressants?
What is the primary indication for newer-generation antidepressants?
What is a characteristic of schizophrenia?
What is a characteristic of schizophrenia?
What is the mechanism of action for antipsychotic drugs?
What is the mechanism of action for antipsychotic drugs?
Why do patients taking antidepressant drugs need to be patient and faithful with dosing?
Why do patients taking antidepressant drugs need to be patient and faithful with dosing?
What is a hallmark of psychosis?
What is a hallmark of psychosis?
What type of disorder is often associated with excessive dopaminergic activity in the brain?
What type of disorder is often associated with excessive dopaminergic activity in the brain?
What is the primary goal of drug therapy for psychotic illness?
What is the primary goal of drug therapy for psychotic illness?
Why is patient assessment and response carefully evaluated in psychotic illness?
Why is patient assessment and response carefully evaluated in psychotic illness?
What is characteristic of manic depressive illness?
What is characteristic of manic depressive illness?
What is the primary basis for selecting an antipsychotic for a patient?
What is the primary basis for selecting an antipsychotic for a patient?
What is a key difference between atypical and conventional antipsychotics?
What is a key difference between atypical and conventional antipsychotics?
Which of the following is NOT an atypical antipsychotic?
Which of the following is NOT an atypical antipsychotic?
What do all antipsychotics have in common?
What do all antipsychotics have in common?
What is the mechanism of action of older antipsychotics such as phenothiazines?
What is the mechanism of action of older antipsychotics such as phenothiazines?
What is the advantage of atypical antipsychotics compared to conventional antipsychotics?
What is the advantage of atypical antipsychotics compared to conventional antipsychotics?
What brain areas are associated with the mechanisms of action of antipsychotics?
What brain areas are associated with the mechanisms of action of antipsychotics?
What is a major disadvantage of using Monoamine Oxidase Inhibitors (MAOIs)?
What is a major disadvantage of using Monoamine Oxidase Inhibitors (MAOIs)?
What is the primary mechanism of action of Tricyclic Antidepressants (TCAs)?
What is the primary mechanism of action of Tricyclic Antidepressants (TCAs)?
What is a common indication for the use of Tricyclic Antidepressants (TCAs)?
What is a common indication for the use of Tricyclic Antidepressants (TCAs)?
What is a contraindication for the use of Tricyclic Antidepressants (TCAs)?
What is a contraindication for the use of Tricyclic Antidepressants (TCAs)?
What is a common adverse effect of Tricyclic Antidepressants (TCAs)?
What is a common adverse effect of Tricyclic Antidepressants (TCAs)?
What is a characteristic of Mirtazapine, a Tetracyclic Antidepressant?
What is a characteristic of Mirtazapine, a Tetracyclic Antidepressant?
What is the class of antidepressants that includes Citalopram, Escitalopram, and Fluoxetine?
What is the class of antidepressants that includes Citalopram, Escitalopram, and Fluoxetine?
What is the class of antidepressants that includes Duloxetine and Venlafaxine?
What is the class of antidepressants that includes Duloxetine and Venlafaxine?
What is a possible explanation for lithium's effectiveness in treating bipolar disorder?
What is a possible explanation for lithium's effectiveness in treating bipolar disorder?
Which of the following medications may be used in conjunction with lithium to regulate mood or achieve stability in manic or hypomanic patients?
Which of the following medications may be used in conjunction with lithium to regulate mood or achieve stability in manic or hypomanic patients?
What is a common adverse effect of the medications used to treat mania and hypomania?
What is a common adverse effect of the medications used to treat mania and hypomania?
Why is it important to advise patients to change positions slowly?
Why is it important to advise patients to change positions slowly?
What is the importance of providing simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected?
What is the importance of providing simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected?
Why should only small amounts of medications be dispensed at a time?
Why should only small amounts of medications be dispensed at a time?
What is the consequence of simultaneous use of these drugs with alcohol or other CNS depressants?
What is the consequence of simultaneous use of these drugs with alcohol or other CNS depressants?
What is the importance of the combination of drug therapy and psychotherapy?
What is the importance of the combination of drug therapy and psychotherapy?
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
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Description
This quiz covers the basics of antipsychotics and antidepressants, including their effects on neurotransmitters and the etiology of depression.
