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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

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Depression & Alzheimer's

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  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!

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