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Major Depressive Disorder (MDD), TEAM MEMBERS GROUP 2 - Coggle Diagram
Major Depressive Disorder (MDD)
Drug Interaction
Serious
Tramadol + Meperidine
Increase the level of serotonin in the body
may cause
Seizures, respiratory distress, coma, and death
Meperidine + Fluoxetine
Increase the level of serotonin in the body
may cause
Confusion, delusion, and seizures, hypertension and tachycardia lead to shock
Fluoxetine + Propranolol
Fluoxetine affecting hepatic enzyme CYP2D6 metabolism
Can increase the plasma concentrations of propranolol
may cause
Hypotension, bradycardia, shortness of breath, weakness, fainting, and seizure
Moderate
Tramadol + Fluoxetine-
May increase serotonin levels in the blood
Rare but serious (monitor closely)
may cause
Altered consciousness, confusion, hallucinations, coma tachycardia, hyperthermia,
Fluoxetine inhibit hepatic enzyme CYP2D6 metabolism
Decrease the plasma concentrations of tramadol metabolites
may cause
Decrease the pain relieving effects of tramadol
Hydrochlorothiazide + Propranolol
Increase the risk of hyperglycemia and hypertriglyceridemia
For diabetes patients
Blood sugar may be increased
Decreases potassium in serum
may cause
Muscles feel weak, cramp, and arrhythmia.
Fluoxetine + Hydrochlorothiazide
Increase the risk of hyponatremia
may cause
Fainting, orthostatic hypotension, hypertension, tachycardia nausea, vomiting, headache, and lethargy.
No Interaction
Tramadol + Propranolol
Tramadol + Hydrochlorothiazide
Meperidine + Hydrochlorothiazide
Meperidine + Propranolol
Patient counselling :silhouettes:
Medication
Instruction and side effects
Hydrochlorothiazide
-Take 1 tab daily
-Frequent urination, diarrhea, lost of appetite, headache, hair loss
Propanolol
-Take 1 tab daily in the morning. Take with food and if possible, take it everyday at around the same time.
-Lightheadedness, tiredness, diarrhea and constipation
Meperidine
-Take 1 tab every 3-4 hours when needed
-Dizziness, mood changes, nausea, stomach cramps
Fluoxetine
-Take 1 tab daily in the morning. Can take with or without food.
-Dizziness, nausea, loss appetite (avoid driving after taking the med)
Tramadol
-Take 1 tab every 4-6 hours when needed
-Sleepiness, uncontrollable shaking in body parts, muscle tightness, indigestion
In case forgot to take the medication
Take the medication as soon as remembers
Just skip the dose if it is almost time for the next dose
In case of overdose
No need to take double of the dose to compensate the missed dose. If the patient accidentally take double the dose, call for emergency immediately.
Storage
Keep it in the container given with the cap tightly closed and out of children’s reach. Keep it at room temperature, away from light and moisture. Avoid keeping it in the bathroom.
Healthy eating
Take note of what she's eating
Reduce sodium intake
Take more vegetables, fruits and foods that contains high level of fibre
Limit the alcohol intake
Cut down the sugar intake or drink more plain water
Cut down caffeine
Psychotherapy
Conversing with a helpful individual about your ideas and feelings can help the patient feel better
Ease the stress
Learned how to focus on her thoughts
Developing new ways of reacting to situations and challenging her prejudices
Keeping a journal or use problem-solving strategies in certain scenarios
Control her emotions by jotting down
Talking to a trusted one may help in feeling security
Exercise
Reduces level of the body stress hormones
Stimulates the production of endorphins
Bring remarkable changes to the person's body and metabolism
Earn a sense of mastery and control of pride and self-confidence
Enjoy some solitude or to make friends and build network.
Increase serotonin production
Reduce resting heart rate, lower blood pressure, ease breathing and increase pain tolerance.
Go outdoors
Vacation with her friends or family to improve her mental health.
Reconnect with her loved ones
Evidence-based therapy, dialectical behavior therapy (DBT)
Distract from stress and release all of the burden or weight on the her shoulder
Absorbing nature with all of the sense and away from work.
Boost endorphins
Career planning
Make tiny improvements
Set daily to weekly goals to complete her task
Reach out to colleagues if her work is too much
Take breaks every few hours while working
Help the brain to mentally rest and recharge
Ask to be depromoted to reduce her stress
Ask for a few days break from the management
Managing sleeping schedule
7-9 hours of sleep
If still have trouble with sleeping schedule, seek for professionals assistance
Use congenital behavioral therapy (stimulus control therapy)
Avoid eating large meal or beverages before bedtime
Therapist help in prescribing sleeping pills
Spirituality
Stronger beliefs tend to cope up with stress and depression
Create positive thinking by fighting negative thoughts
Give strength mentally to handle the problems and teach her not to give up
Start having a positive outlook
Read or post any inspiring stories
Talk to someone who has recovered from depression and anxiety.
Process of offering important information, advice and assistance to help the patient understand on how to take the medication properly.
Health and lifestyle counselling are also included.
To improve the patient's condition
To help the patient to ujnderstand their own condition
Definition and importance
Past Medical History
Chronic Neck Pain
On medication
Tramadol
Mepridine
Uncomfortable during work
Due to accident
Cervical Spine
Depression
On medication
Fluoxetine
Depressive Episodes
Divorce
Moving to a new workplace
Extra Burden
Ebrahimian (2004) found that 57.5 percent of divorced women suffered from varied degrees of depression in a research of 113 divorced women.
Diagnosing
PRIME-MD
PHQ
Hypertension
On medication
Hydrochlorothiazide
Propanolol
Lack of nutrient due to lack of eaten
Overload of workload
Possible Correlation
Neck Pain + Depression
working conditions may modify the interaction of psychosocial factors with neck pain.
changed from the insula topology to the prefrontal area of weight-bearing pain management.
can predict which patient is at higher risk of developing psychological distress.
had dysfunction of autonomic nervous function and inflammation and activity hyperactivity of the hypothalamic-pituitary-adrenal (HPA).
Neck Pain + Hypertension
failure of overlapping systems modulating pain and blood pressure, it was expected that prevalence of hypertension would be increased.
develop which may narrowing the spine canal diameter, and so increase the pressure on the spinal cord lead to neurological and vascular changes.
signaling system between the brain and the neck is not working properly
Depression-hypertension
was attenuated after adjustment for traumatic life events (divorce).
depression, anxiety or stress will increase heart rate and blood pressure rise (hypertension),
calcium channels play a role in both the conditions.
CACNA1C, coding for a subunit of the L-type calcium channel, has been identified and replicated as a risk factor for depression
calcium channel dysfunction has emerged as one potential mechanism of comorbidity between mood disorders and hypertension.
Pathogenesis
Changes in Endocrine System related to depression
Glutamate
Increase in stress will cause increase in glutamate production
GABA
Low level of GABA is detected in depression which produce antidepressant effects
Glucocorticoid
Upon activation of HPA axis by the psychological stress, more GCs are released into the blood
Elevated concentrations of cortisol in the blood, saliva and urine
Bigger size of adrenal gland
Increased activity of adrenal gland
Vasopressin
Driving influence on HPA axis related to chronic psychological stress
Corticotropin Releasing factor
Elevated in patients with depression
Serotonin
Elevated levels of serotonin contribute to the antidepressant effect
Activates a series of signaling pathways including cAMP-PKA-CREB pathway to generate antidepressant effects
Life events that lead to depression
Was promoted to senior manager
Level of responsibility increased dramatically
Sleep disturbance
Poor diet
Lack motivation and interest to pursue recreational activities
Had depressive episodes after divorce
MANAGEMENT
Reduce Interaction by Drug Scheduling
Fluoxetine and Tramadol
This patient is struggling with her sleep schedule, so she is advised to take fluoxetine in the morning. Therefore tramadol can be taken at night.
Fluoxetine with meperidine
Fluoxetine needs to be taken in the morning, but can be taken sometime in between after meperidine is consumed, between the 3 to 4 hours
Tramadol and Meperidine
Tramadol can be taken in between the three to four hours after meperidine is consumed
Fluoxetine with propranolol:
If she is taking the standard release type, then she will be taking this medication anytime. Since she is advised to take fluoxetine in the morning, she can take propranolol at night.
If she is taking the sustained release type, it is advisable to take in the morning. However, it is still able to be taken at night so she can take fluoxetine in the morning.
Fluoxetine with hydrochlorothiazide
Hydrochlorothiazide is stated to be taken in the morning, but still can be taken four hours before bedtime, and fluoxetine can be taken in the morning.
Changing Drug
Lisinopril / Hydrochlorothiazide
These drugs are used to treat hypertension
Available brand names are Prinzide® and Zestoretic®
Lisinopril is classified as angiotensin-converting enzyme (ACE) inhibitors
The combination of these drugs comes in a tablet from which can be used orally
Hydrochlorothiazide is a diuretic drug which removes unwanted water and salt from the body through urine
This drug is taken once a day with or without food
This drug will reduce certain substances which tighten the blood vessels which allow the smooth blood flow
Escitalopram
This drug is mainly used to treat major depressive disorder and anxiety in adults.
This tablet can be taken once a day (10mg) at night with or without food.
Escitalopram is categorised under an antidepressant group which is known as selective serotonin reuptake inhibitors (SSRIs)
Tramadol and Acetaminophen
Acetaminophen- reduce pain and fever
This combination of the drug is available in tablet form which can be taken one tablet in the morning with or without food
Tramadol and acetaminophen drug combination is used to relieve severe pain
Tramadol- opioid analgesics which act on the central nervous system (brain) to relieve pain
Brand name is Ultracet
DRUG-FOOD INTERACTION
Tramadol and Escitalopram
Alcohol should be avoided while taking tramadol.
This is because alcohol can increase the nervous system
The side effects are dizziness, drowsiness and difficulty concentrating
Lisinopril
High potassium dietary and potassium supplements should be avoid because this can increase the potassium level in the blood
DRUG-DRUG INTERACTION
Tramadol +
Lisinopril / Hydrochlorothiazide
No interaction
Lisinopril / Hydrochlorothiazide +escitalopram
No interaction
Escitalopram + tramadol
Have interaction
TEAM MEMBERS
GROUP 2
MUHAMMAD HARITH BIN MOHD NOR
MUHAMMAD HASYIDAN ARIFFIN BIN ZAINAL
MUHAMMAD HAZEEM FATHURRAHMAN BIN MOHAMED
NABIL LUQMAN BIN ABDUL LATIF
NABILAH SABRINA BINTI MOHAMMAD RASHIDI
NIK NURNAILI ALIA BINTI NIK AB RASHID
SABHAH ZULAIKHA BINTI MOHAMMAD SAHRUL
SANGEETA A/P KUNASAKARAM
SHARIFAH ADTHREANA AL JUFRI BINTI SYED
SHEETALDEEP KAUR AUJLA A/P GURNAM SINGH
SHREESAVITA A/P GANESH
TIEW CHIAN WEI
TUTY FATHIAH BINTI FUAD SALIM
VARSHA A/P KARTHY GESU