Depression alzheimer s
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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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Depression alzheimer s

Depression & Alzheimer's

NAPLEX

p. 109


Depression alzheimer s

  • 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


Antidepressant selection factors

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


Depression alzheimer s

  • 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


Depression alzheimer s

  • 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


Depression alzheimer s

Antidepressants (cont’d)


Depression alzheimer s

  • Antidepressants (cont’d)

    Monoamine Oxidase (MAO) Inhibitors

    - effective in refractory depression

    • Isocarboxazid (Marplan)

    • Phenelzine sulfate (Nardil)

    • Tranylcypromine sulfate (Parnate)


Depression alzheimer s

  • 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


Depression alzheimer s

  • Antidepressants (cont’d)

    Substances to be avoided when using MAO inhibitors (cont’d)

    Medications

    • Phenylpropanolamine

    • Pseudoephedrine

    • Meperidine (Demerol)

    • Methyldopa (Aldomet)

    • Morphine

    •Reserpine


Alzheimer s drugs

Alzheimer's Drugs

NAPLEX

p. 118


Depression alzheimer s

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)


Cholinesterase inhibitors dosing

Cholinesterase Inhibitors Dosing

  • Dose dependent side effects require titration

  • Start low and take in steps to avoid side effects


Depression alzheimer s

Drugs for Alzheimer’s Disease

Adverse Effects

  • Cholinesterase inhibitors:

  • • Hepatotoxicity

  • • Cholinergic effects (N/D, anorexia, salivation)

  • • Bradycardia

  • • Headache

  • Glutamate antagonists

  • • Hypertension

  • • Tachycardia

  • • Insomnia


Depression alzheimer s

A prescription is presented for galatamine (Razadyne). The patient is most likely being treated for:

  • Alzheimer's

  • Nocturnal enuresis

  • Manic-depressive illness

  • ADHD

  • Insomnia


Depression alzheimer s

A prescription is presented for galatamine (Reminyl). The patient is most likely being treated for:

  • Alzheimer's

  • Nocturnal enuresis

  • Manic-depressive illness

  • ADHD

  • Insomnia


Depression alzheimer s

Orthostatic hypotension is characterized by which of the following symptoms?

  • Peripheral vasoconstriction

  • Increased urination

  • Urinary retention

  • Dizziness

  • Dry mouth


Depression alzheimer s

Orthostatic hypotension is characterized by which of the following symptoms?

  • Peripheral vasoconstriction

  • Increased urination

  • Urinary retention

  • Dizziness

  • Dry mouth


Depression alzheimer s

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


Depression alzheimer s

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


Depression alzheimer s

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


Depression alzheimer s

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


Depression alzheimer s

  • What is considered an optimal augmentation approach to someone not responding to SSRI therapy?

    IAdd Lithium 600mg BID

    IIAdd Cytomel 25mcg/day

    IIIAdd Bupropion 150mg/day

  • I only

  • III only

  • I & II only

  • II & III only

  • I, II, III


Depression alzheimer s

  • What is considered an optimal augmentation approach to someone not responding to SSRI therapy?

    IAdd Lithium 600mg BID

    IIAdd Cytomel 25mcg/day

    IIIAdd Bupropion 150mg/day

  • I only

  • III only

  • I & II only

  • II & III only

  • I, II, III


Good luck

Good Luck!

You will all do great!


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