1 / 28

Depression & Alzheimer's

Depression & Alzheimer's. NAPLEX. p. 109. Antidepressants Types of depression • Major depressive disorder, single episode • Major depressive disorder, recurrent • Dysthymic disorder • Dysthymic disorder, not otherwise specified

arissa
Télécharger la présentation

Depression & Alzheimer's

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Depression & Alzheimer's NAPLEX p. 109

  2. Antidepressants Types of depression • Major depressive disorder, single episode • Major depressive disorder, recurrent • Dysthymic disorder • Dysthymic disorder, not otherwise specified • Secondary mood disorder due to nonpsychiatric medical condition Biochemical basis of endogenous depression – reduced / imbalance of NE / 5-HT in CNS Drug selection/adequate therapeutic trial

  3. Antidepressant Selection Factors • Patient factors • Age, comorbid conditions, medication profile, preference, previous successes and failures of specific agents • Other factors • Cost, convenience, adverse-effect profile, safety • Typical response rate: 4 to 6 weeks • Adequate trail is 6 month on effective dose

  4. Antidepressants (cont’d) Common Adverse Effects by Receptor Subtype • H-1 receptor blockade: Sedation, drowsiness, weight gain • Acetylcholine blockade: dry mouth, blurred vision, tachycardia, constipation, urinary retention, memory impairment • Norepinephrine blockade: Tremors, jitteriness, tachycardia, diaphoresis, HTN, erectile dysfunction • 5-HT blockade: sexual dysfunction, N/V/D, anorexia, anxiety, asthenia, insomnia, EPS

  5. Antidepressants (cont’d) Common Adverse Effects by Receptor Subtype • 5-HT2 blockade: sexual dysfunction, hypotension • Alpha-1 blockade: orthostasis, drowsiness • Alpha-2 blockade: priapism • Withdrawal syndrome: Flu-like syndromes, dizziness, adverse GI effects, paresthesias, mood, appetite, and sleep changes

  6. Antidepressants (cont’d)

  7. Antidepressants (cont’d) Monoamine Oxidase (MAO) Inhibitors - effective in refractory depression • Isocarboxazid (Marplan) • Phenelzine sulfate (Nardil) • Tranylcypromine sulfate (Parnate)

  8. Antidepressants (cont’d) Substances to be avoided when using MAO inhibitors Food with Tyramine Content • Aged cheeses • Sauerkraut • Smoked aged, or pickled meat or fish • Yeast extracts • Fava beans • Beer, red wine • Avocados • Meat extracts

  9. Antidepressants (cont’d) Substances to be avoided when using MAO inhibitors (cont’d) Medications • Phenylpropanolamine • Pseudoephedrine • Meperidine (Demerol) • Methyldopa (Aldomet) • Morphine •Reserpine

  10. Alzheimer's Drugs NAPLEX p. 118

  11. Drugs for Alzheimer’s Disease • Cholinesterase inhibitors: all enhance cholinergic activity • • Donepezil (Aricept) • • Galantamine (Razadyne) (Reminyl – D/C)) • • Rivastigmine (Exelon) • - Exelon patch approved 7-2007 • Glutamate antagonists • • Memantine (Namenda) • Miscellaneous agents • • Vitamin E • • Selegiline (Eldepryl)

  12. Cholinesterase Inhibitors Dosing • Dose dependent side effects require titration • Start low and take in steps to avoid side effects

  13. Drugs for Alzheimer’s Disease Adverse Effects • Cholinesterase inhibitors: • • Hepatotoxicity • • Cholinergic effects (N/D, anorexia, salivation) • • Bradycardia • • Headache • Glutamate antagonists • • Hypertension • • Tachycardia • • Insomnia

  14. A prescription is presented for galatamine (Razadyne). The patient is most likely being treated for: • Alzheimer's • Nocturnal enuresis • Manic-depressive illness • ADHD • Insomnia

  15. A prescription is presented for galatamine (Reminyl). The patient is most likely being treated for: • Alzheimer's • Nocturnal enuresis • Manic-depressive illness • ADHD • Insomnia

  16. Orthostatic hypotension is characterized by which of the following symptoms? • Peripheral vasoconstriction • Increased urination • Urinary retention • Dizziness • Dry mouth

  17. Orthostatic hypotension is characterized by which of the following symptoms? • Peripheral vasoconstriction • Increased urination • Urinary retention • Dizziness • Dry mouth

  18. Which SSRI(s) is not required to be tapered when discontinued? I Fluoxetine (Prozac) II Paroxetine (Paxil) III Sertaline (Zoloft) • I only • III only • I & II only • II & III only • I, II, III

  19. Which SSRI(s) is not required to be tapered when discontinued? I Fluoxetine (Prozac) II Paroxetine (Paxil) III Sertaline (Zoloft) • I only • III only • I & II only • II & III only • I, II, III

  20. How long is an adequate continuation of an antidepressant before considering a different agent? I. 4 weeks II. 2 months III. 6 months • I only • III only • I & II only • II & III only • I, II, III

  21. How long is an adequate continuation of an antidepressant before considering a different agent? I. 4 weeks II. 2 months III. 6 months • I only • III only • I & II only • II & III only • I, II, III

  22. What is considered an optimal augmentation approach to someone not responding to SSRI therapy? I Add Lithium 600mg BID II Add Cytomel 25mcg/day III Add Bupropion 150mg/day • I only • III only • I & II only • II & III only • I, II, III

  23. What is considered an optimal augmentation approach to someone not responding to SSRI therapy? I Add Lithium 600mg BID II Add Cytomel 25mcg/day III Add Bupropion 150mg/day • I only • III only • I & II only • II & III only • I, II, III

  24. Good Luck! You will all do great!

More Related