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Block 8 Week 1 Colt > Antidepressants and Mood Stabilizers - Craviso > Flashcards

Antidepressants and Mood Stabilizers - Craviso Flashcards

1
Q

currently available drugs to treat depression are based on what theory of depression?

A

monoamine theory

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2
Q

T/F: all antidepressants cause immediate effects on synaptic monoamine levels

A

true

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3
Q

Despite an immediate increase in synaptic monoamine levels, why is there a delay of several weeks for antidepressants to have the desired effect?

A

slow increase in the expression of BDNF that promotes synaptogenesis

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4
Q

What percent of patients are refractory to multiple different antidepressants?

A

20%

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5
Q

What are the four major classes of antidpressants?

A
  1. SSRIs
  2. SNRIs
  3. Other new antidpressants
  4. MAOIs
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6
Q

SNRI block the uptake of what two amines?

A

5HT and NE

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7
Q

older tricyclic antidepressants are antagonists against (one/several) receptors

A

several

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8
Q

Newer antidepressants inhibit reuptake of what amine?

A

dopamine

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9
Q

MAOIs inhibit the metabolism of what two amines?

A

5-ht and NE

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10
Q

What are the firstline SSRIs?

A 
FLUOXETINE (Prozac; Prozac Weekly)
	SERTRALINE (Zoloft)
	PAROXETINE (Paxil)
	CITALOPRAM (Celexa) 
	ESCITALOPRAM (Lexapro)
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11
Q

how are SSRIs metabolized?

A

CYP450 in the liver

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12
Q

which SSRIs are the potent inhibitors of CYP2D6?

A

fluoxetine and paroxetine

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13
Q

which SSRIs are the low level inhibitors of CYP2D6?

A

citalopram and escitalopram

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14
Q

What are the major SE of taking SSRIs?

A 
significant sexual dysfunction
GI disturbances
insomnia, restlessness
anorexia or wt. loss early on or wt. gain with long term use
QT prolongation with citalopram
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15
Q

T/F; SSRIs have a withdrawal syndrome

A

true; nausea, dizziness, anxiety, tremor, and palpiations

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16
Q

Use of which SSRI during pregnancy is linked to an increased risk of cardiovascular malformations in the fetus?

A

paroxetine

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17
Q

5-HT syndrome is seen with (SSRIs/MAOIs) that enhane 5-HT transmission

A

MAOIs

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18
Q

What is the only antidepressant approved for use in children?

A

fluoxetine

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19
Q

which SSRI is approved for use in adolescents?

A

escitalopram

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20
Q

why is the use of antidepressants limited in children?

A

risk of increasing SI

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21
Q

Which SSRI is sued for SAD?

A

paroxetine

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22
Q

Which SSRI is used as a migraine prophylactic?

A

fluoxetine

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23
Q

Which SSRI is used for PMS and PMDD and hot flashes?

A

paroxetine

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24
Q

Which SSRI is used for bulimia nervosa?

A

fluoxextine

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25
Q

Which newer, selective SNRI is the firstline druge that blocks NE and 5ht reuptake as well as weakly blocking DM reuptake?

A

Effexor

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26
Q

What are the side effects of SNRIs?

A

same as SSRIs;

dose related increase in BP

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27
Q

What are the additional uses of SNRIs?

A

Tx of neuropathic pain

anxiety disorders

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28
Q

Pristiq is a metabolite of which SNRI?

A

Effexor

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29
Q

Cymbalta is contraindicated in pts with what dz?

A

chronic liver disease or hepatic insufficiency

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30
Q

What are the additional uses of cymbalta?

A

fibromyalgia
Diabetic peripheral neuropathy
long term Tx of GAD

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31
Q

What are the common TCA’s?

A

Nortriptyline
Imipramine
Amitriptyline

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32
Q

Why are TCAs no longer used?

A
  1. can be fatal in overdose
  2. are cardiotoxic
  3. have a propensity to lower seizure threshold
  4. have significant antagonist activity at several types of neurotransmitter receptors
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33
Q

WHich TCA is a migraine prophylactic?

A

amitriptyline

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34
Q

When do you use TCAs?

A

pt is refractory to common antidepressants

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35
Q

What are the three receptor types that TCAs block?

A
  1. mACh
  2. a 1
  3. H1
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36
Q

what are the SE associated with blocking mACh receptors?

A

sedation, cognitive impairment, confusion, delirium, blurred
vision, dry mouth, tachycardia, urinary retention

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37
Q

what are the SE associated with blocking a1 receptors?

A

orthostatic hypotension, sedation

38
Q

what are the side effects associated with blocking H1 receptors?

A

sedation

39
Q

At therapeutic doses all TCAs can cause what SE?

A

lowering of seizure threshold
sexual dysfunction
weight gain

40
Q

T/F: at toxic doses, ALL TCAs are cardiotoxic and OD is fatal

A

true

41
Q

T/F: some pts develop cardiotoxicity to TCAs at therapeutic doses

A

true

42
Q

what are the mechanisms of TCAs being cardiotoxic?

A

QT prolongation
ventricular block
arrhythmias
ventricular tachycardia

43
Q

What is the MOA of TCA causing death via OD?

A

hyperpyrexia, hypertension and tachycardia, arrhythmias, severe anticholinergic effects and convulsions

44
Q

What types of drugs have interactions with TCAs?

A

MAOIs
Anticholinergics and antihistamines
CNS depressants

45
Q

what happens when you take MAOIs with tCAs?

A

severe HTN, serotonin syndrome

46
Q

what happens when you take anticholinergics or antihistamines with TCAs?

A

additive effects due to blockade of mACh and H1 receptors

47
Q

What happens when you take CNS depressants with TCAs?

A

more sedation

48
Q

what is the only antidepressant that works by blocking dopamine reuptake?

A

Buproprion (wellbutrin)

49
Q

What are some of the SE of wellbutrin?

A

insomnia
dose related seizure
contraindicated in seizure and eating disorders (electrolyte imbalance)
precipitate psychotic episodes`

50
Q

T/F: wellbutrin has fewer sexual SE

A

true

51
Q

What is the sustained release formula of wellbutrin used in smoking cessation>

A

Zyban

52
Q

Remeron is an antagonist of (a1/a2) receptors that mediate negative feedback for NE and 5ht release

A

a2

53
Q

T/F: remeron has sexual SE equal to SSRIs

A

false, like wellbutrin

54
Q

Trazodone blocks 5ht reuptake by blcoking 5ht2 receptors and 5ht1(a/b) partially

A

5ht1a

55
Q

What are the strange side effects of trazodone?

A

sig. drowsiness
GI upset
orthostatic htn
PRIAPISM

56
Q

Vibryd is a hydbrid SSRI and partial agonist of (blank) receptor

A

5ht1a
no wt. gain
no sexual side effects

57
Q

MAO-a metabolizes (NE and 5-ht / Dopamine)

A

MAO-a = 5-ht and NE

58
Q

MAO-b metabolizes (NE and 5-ht / Dopamine)

A

dopamine

59
Q

Why are MAOIs a last choice?

A

risk of hypertensive crisis

60
Q

What degenerative disease do you use MAOIs to treat?

A

parkinsons

61
Q

Selegeline is a (reversible/irreversible) MAOI

A

reversible

62
Q

Phenelzine is a (reversible/irreversible) MAOI

A

irreversible

63
Q

why is selegiline given as a transdermal patch?

A

bypasses the gut and lowers the risk of HTN crisis via tyramine

64
Q

MAOI’s have side effects with what drugs?

A
  1. indirect acting sympathomimetics and tyramine coantianing foods
  2. SSRIs and 5 ht- receptor agonists causing serotonin sydrome
65
Q

What are the characteristics of a manic episode?

A

1.exaggerated optimism and self-confidence
2. decreased sleep without experiencing fatigue
3. grandiose delusions, inflated sense of self-importance
4. excessive irritability; aggressive behavior
5. racing speech, flight of ideas
impulsiveness, poor judgment
6. easily distracted
7. reckless behavior

66
Q

How many full cycles is considered rapid cycling in bipolar?

A

4 full cycles

67
Q

Eskalith is lithium (carbonate/citrate)

A

carbonate

68
Q

Cibalith is lithium (carbonate/citrate)

A

citrate

69
Q

What is the firstline drug for mania?

A

lithium

70
Q

Pts with bipolar disorder can experience what when taking SSRIs?

A

mood swings

71
Q

T/F: pts with bipolar disorder may initially need an SSRI along with their lithium

A

true

72
Q

T/F: lithium is not effective for rapid cyclers

A

true

73
Q

Lithium effects are (immediate/build over time)

A

build over time

74
Q

This drug causes the inhibition of recycling of inositol substrates

A

lithium

75
Q

This drug alters the function of GPCRs assc’d with B-adrenergic and M1ACh receptors

A

lithium

76
Q

Lithium distributes into (blood volume/total body water volume)

A

total body water

77
Q

How soon does normal lithium reach peak plasma? Slow release?

A

Normal; 1-2 hours

slow release: 4 hours

78
Q

How is lithium eliminated?

A

via the kidney; half life of 20-24 hours

79
Q

Renal clearance of lithium is proportional to (blank)

A

plasma concentration

80
Q

Dehydration, CHF, renal dz, old age can all (inc/dec) lithium levels

A

increase

81
Q

Na depletion may cause sig. lithium (excretion/retention)

A

retention

82
Q

Lithium clearance is (inc/dec) by loop and thiazide diuretics, NSAIDS, and ACE inhibitors

A

decreased

83
Q

lithium clearance is (inc/dec) by osmotic diuretics, acetazolamide, caffeine, and theophylline

A

increased

84
Q

What are the SE of lithium?

A 
drowsiness, slowed mentation, forgetfulness
GI distrubances
Polyuria and thirst
wt. gain
mild tremor in fingers
85
Q

What are the major complications of long term lithium use?

A

interstitial nephritis

depression of thyroid function (via iodine interference)

86
Q

Can lithium be used during pregnancy?

A

not during first trimester or during breastfeeding

87
Q

lithium has a (high/low) therapeutic index

A

low

88
Q

Above 2.5 mEq/L lithium SE inlcude….

A

ataxia
gross tremor
cardiac arrhythmias
coma and convulsion

89
Q

T/F: lithium tox can be seen at any blood levels

A

true

90
Q

What is an anti-epileptic drug that is first line for mania and mixed states?

A 
valproic acid (depakote)
or
carbamazepine (tegretol)
or
lamotrigine
91
Q

What are the atypical antipsychotics?

A 
QUETIAPINE (Seroquel)
	OLANZAPINE (Zyprexa)
	RISPERIDONE (Risperdal)
	ARIPIPRAZOLE (Abilify)
	LURASIDONE (Latuda) – bipolar depression only 
	ASENAPINE (Saphris)
92
Q

T/F: lorazepam and clonazepam can be used for treating acute mania

A

true

Block 8 Week 1 Colt (10 decks)

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