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Block 8 Week 1 > Craviso: Antidepressants and Mood Stabilizers > Flashcards

Craviso: Antidepressants and Mood Stabilizers Flashcards

1
Q

actions confined to blocking 5-HT reuptake (first-line drugs)

A

SSRIs

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2
Q

newer “selective” inhibitors – actions confined to blocking NE and 5-HT reuptake (first-line drugs);
older, less selective inhibitors - tricyclics (TCAs) that exert antagonist effects on a variety of receptors

A

SNRIs (serotonin-norepinephrine reuptake inhibitors)

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3
Q

inhibit the metabolism of NE and 5-HT

A

Monoamine oxidase inhibitors

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4
Q

What are these?

FLUOXETINE (Prozac; Prozac Weekly)
SERTRALINE (Zoloft)
PAROXETINE (Paxil)
CITALOPRAM (Celexa) 
ESCITALOPRAM (Lexapro)
A

SSRIs

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5
Q

What is one major thing that you should consider when prescribing SSRIs?

A

SSRIs can be potent inhibitors of several cytop450’s (CYP2D6)

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6
Q

Which two SSRIs have high potential for inhibiting cytoP450s? Which two have low potential?

A

fluoxetine and paroxetine - high potential

citalopram and escitalopram - low potential

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7
Q

Adverse side effects of SSRIs?

A

significant sexual dysfunction, decreased libido
prominent GI disturbances
insomnia, restlessness
significant anorexia and weight loss with early treatment
significant weight gain with long-term use

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8
Q

This SSRI can cause QT prolongation

A

citalopram

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9
Q

This SSRI, if used during pregnancy, can be linked to an increase in cardiovascular malformations in the fetus

A

paroxetine

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10
Q

Two syndromes that you should be cautious of with patients taking SSRIs?

A

withdrawal syndrome after long-term use abruptly stopped;

5HT syndrome when used with MAO inhibitors or other drugs that increase 5HT

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11
Q

This is the only SSRI approved for use in children and adolescents

A

fluoxetine

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12
Q

SSRI approved for use in adolescence

A

escitalopram

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13
Q

SSRIs can be used for (blank) disorders

A

anxiety

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14
Q

What are two additional things that paroxetine can be used to treat?

A

seasonal affective disorder

PMS and PMDD, hot flashes

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15
Q

What are two additional things that fluoxetine can be used to treat?

A

bulimia nervosa

migraine prophylactic

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16
Q

This is a serotonin-norepinephrine reuptake inhibitor; blocks reuptake of both NE and 5HT and weakly DM

A

Venlafaxine

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17
Q

Adverse side effects of Venlafaxine?

A

similar to SSRI side effects;

can cause dose-related increase in blood pressure

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18
Q

Two additional uses for Venlafaxine?

A

anxiety disorders

treating neuropathic pain

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19
Q

This serotonin-norepinephrine reuptake inhibitor is contraindicated in those with chronic liver disease or hepatic insufficiency

A

Duloxetine

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20
Q

Additional uses for Duloxetine?

A

fibromyalgia
diabetic peripheral neuropathy
long-term treatment of generalized anxiety disorder

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21
Q

What are these? How do they work?

NORTRIPTYLINE (Aventyl, Pamelor)
IMIPRAMINE (Tofranil)
AMITRIPTYLINE (Elavil)

A

tricyclic antidepressants (TCAs); block the reuptake of both NE and 5HT

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22
Q

Nortriptyline mostly blocks the reuptake of (blank)

A

NE

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23
Q

Imipramine and amitriptyline mostly block the reuptake of (blank)

A

5HT

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24
Q

Major problems with TCAs?

Their use is confined to patients who do not respond or tolerate more widely-prescribed antidepressants

A

fatal if OD
cardiotoxic
lower seizure threshold
significant antagonist activity

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25
Q

Which 3 receptors do tricyclic antidepressants block? What effects does this cause?

A
  1. muscarinic ACh receptors - sedation, cognitive impairment, confusion, delirium, blurred vision, dry mouth, tachycardia
  2. alpha 1 adrenergic receptors - hypotension and sedation
  3. H1 receptors - sedation
26
Q

Tricyclic antidepressants can cause what three adverse effects at therapeutic doses?

A

lower seizure threshold
sexual dysfunction
weight gain

27
Q

Tricyclic antidepressants can cause what adverse effects at toxic doses?

A

cardiotoxicity (cardiac conduction delays, ventricular block, arrhythmias) **may occur at therapeutic dose
acute OD is often life-threatening due to hyperpyrexia, HTN, tachycardia, arrhythmias, etc

28
Q

Adverse drug-drug interactions can occur when TCAs are taken with what?

A

Monoamine oxidase inhibitors
anticholinergics and antihistamines
CNS depressants

29
Q

This is a dopamine reuptake inhibitor; also possibly blocks some reuptake of NE and 5HT

A

Bupropion

30
Q

Adverse effects of Bupropion?

A

restlessness, insomnia, anxiety
risk of seizure activity *contraindicated in pts with seizures and eating disorders
may precipitate psychotic episodes

31
Q

Bupropion is contraindicated in these patients…

A

pts with seizures and eating disorders

32
Q

Sustained release formulation of bupropion which is used as an aid in smoking cessation

A

Zyban

33
Q

antagonist of central presynaptic alpha2-adrenergic autoreceptors (receptors that mediate negative feedback for NE and 5-HT release);
blockade of 5-HT2 and 5-HT3 receptors

A

Mirtazapine

34
Q

Side effects of Mirtazapine?

A

sedation
dizziness
stimulates appetite, weight gain

35
Q

These two newer antidepressants are NOT commonly associated with sexual side effects

A

Mirtazapine

Bupropion

36
Q

blocks 5-HT reuptake

also acts an antagonist at 5-HT2 receptors and as a partial agonist at 5-HT1A receptors

A

Trazodone

37
Q

Adverse effects of Trazodone?

A

significant drowsiness and dizziness
GI upset
orthostatic hypotension
priapism

38
Q

Is a SSRI and a partial agonist at 5-HT1A receptors

A

Vilazodone

39
Q

Adverse effects of Vilazodone?

A

insomnia

GI disturbance

40
Q

blocks MAO, the enzyme in nerve terminals that converts the monoamine neurotransmitters NE, 5-HT and dopamine into inactive products

A

Monoamine oxidase inhibitors

41
Q

Why are MAOIs considered a last choice drug?

A

risk of hypertensive crisis in response to ingestion of certain foods containing tyramine

42
Q

Foods containing tyramine can cause (blank) in patients taking MAOIs

A

hypertensive crisis

43
Q

REVERSIBLE inhibitor of MAO;
available as a transdermal system (Ensam) - enables it to bypass the gut, thereby allowing inhibition of central MAO enzymes while reducing the chance of hypertensive reactions caused by tyramine

A

Selegiline

44
Q

IRREVERSIBLE inhibitor of MAO

A

Phenelzine

45
Q

Adverse effects of MAOIs?

A 
sexual dysfunction
CNS stimulation
sleep disturbances
weight gain
orthostatic hypotension
46
Q

MAOIs can cause drug interactions when taken with what?

A

indirect acting sympathomimetics
tyramine containing food
SSRIs and 5HT receptor agonists (too much 5HT –> 5HT syndrome)

47
Q

characterized by:
exaggerated optimism and self-confidence
decreased sleep without experiencing fatigue
grandiose delusions, inflated sense of self-importance
excessive irritability; aggressive behavior
racing speech, flight of ideas
impulsiveness, poor judgment
easily distracted
reckless behavior

A

manic episodes

48
Q

First line drug for acute mania, and long-term maintenance therapy to avert manic and depressive episodes in patients with bipolar disorder

Used to treat depression in an individual who has a history of bipolar disorder (better than antidepressants that can trigger mood swings)

A

Lithium

49
Q

Why is lithium preferred over antidepressants for treating the depression involved in bipolar disorder?

A

antidepressants can trigger mood swings!

50
Q

Is lithium effective for rapid cyclers? (>4 cycles of mania/depression in one year)

A

No!

51
Q

How is lithium cleared? What drugs can decrease lithium clearance? What drugs increase lithium clearance?

A

via the kidney;
loop and thiazide diuretics, NSAIDs and ACE inhibitors;
osmotic diuretics, acetazolamide, caffeine, theophylline

52
Q

Lithium can interfere with (blank) absorption and may promote (blank) depletion

A

Na+; Na+

53
Q

What adverse effects can lithium cause at therapeutic doses?

A

drowsiness, slow mentation, forgetfulness
GI distrubance
polyuria and thirst (decreased response of kidney to ADH)
weight gain
mild tremor

54
Q

What are two serious side effects with long-term use of Lithium?

A

degenerative changes in the kidney

depression of thyroid function

55
Q

Lithium should not be used during (blank) or (blank)

A

pregnancy; breast feeding

56
Q

Lithium has a (blank) therapeutic index so serum levels must be carefully monitored (always monitor for conditions that may decrease volume of distribution or renal clearance)

A

LOW

57
Q

At what blood level of lithium would you notice ataxia, gross tremor, cardiac arrhythmias, coma and convulsions?

A

> 2.5mEq/L

58
Q

What are these drugs used for?

Valproic Acid
Carbamazepine

A

antiepileptic drug (AED) for treating mania and mixed states

59
Q 
What are these?
QUETIAPINE (Seroquel)
OLANZAPINE (Zyprexa)
RISPERIDONE (Risperdal)
ARIPIPRAZOLE (Abilify)
LURASIDONE (Latuda) – bipolar depression only 
ASENAPINE (Saphris)
A

atypical antipsychotics

60
Q

What are these?

LORAZEPAM (Ativan) and CLONAZEPAM (Klonopin)

A

benzos

61
Q

Newer AED used for bipolar depression

A

Lamotrigine

Block 8 Week 1 (12 decks)

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