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Clinical Medicine > Depression > Flashcards

Depression Flashcards

1
Q 
Floxetine 
Citalopram 
Escitalopram 
Paroxetine
Sertraline
A

SSRI’s

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2
Q

SSRI

MOA

A
  1. Block re-uptake of serotonin only
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3
Q

When do SSRIs peak in the body?

A

2-8 hrs

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4
Q

SSRI where food increases its absorption

A

Sertraline

sertraline is SO delicious

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5
Q

SSRI with LONGEST 1/2 life

A

Fluoxetine
→50 hrs
→Active metabolites in body for 10 days

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6
Q

SSRI that is a POTENT inhibitor of CYP-2D6

A
  1. Fluoxetine
  2. Paroxetine
    (interaction occurs w/ TCAs, antipsychotics, antiarrhythmics)
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7
Q

Hepatic impairment & SSRIs

A

Reduce dose of SSRI

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8
Q

Only SSRI approved for bulimia

A

Fluoxetine

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9
Q

Memorize the cart with the clinical utilities

A

Do it.

“Very important according to Dom”

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10
Q

2 SSRIs that are more sedating

A
  1. Paroxetine

2. Fluvoxamine

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11
Q

2 SSRIs that are more activating

A
  1. Fluoxetine

2. Sertraline

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12
Q

Loss of libido, delayed ejaculation, and anorgasmia, is common w/ ….

A

SSRI
ADR
(*consider switch to bupropion)

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13
Q

SSRI

Caution in children

A

Suicide

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14
Q

SSRIs approved in children to tx OCD

A
  1. Fluoxetine
  2. Sertraline
  3. Fluvoxamine
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15
Q

SSRIs approved in children to tx Depression

A
  1. Fluoxetine

2. Escitalopram

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16
Q

Does an SSRI overdose cause a cardiac arrythmia?

A

Nope

but can cause a QT prolongation

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17
Q

Seizures and SSRIs

A

SSRI can lower the seizure threshold

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18
Q

SSRI + MAOI or other serotonergic drug can cause…

A

Serotonin Syndrome

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19
Q

Hyperthermia, muscle rigidity, sweating, myoclonus (clonic muscle twitching), and changes in MS and VS

A

Sx of Serotonin Syndrome

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20
Q

SSRIs are contraidicated…

A

In presence of an MAOI

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21
Q

How do you stop an SSRI?

A

TAPER

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22
Q

Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran

A

SNRI

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23
Q

Block reuptake of both 5-HT and NE in CNS

A

SNRI

MOA

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24
Q

SNRI that is an active demethylated metabolite of another SNRI

A

Active metabolite: Desvenlafaxine

of Venlafaxine

25
Q

SNRI that is a moderate inhibitor of CYP 2D6?

A

Duloxetine

*gets metabolized in liver into inactive metabolites

26
Q

SNRI Use:

Block reuptake of both 5-HT and NE in CNS

A

Duloxetine

27
Q

SNRI Use:

GAD, panic disorder, social phobia

A

Venlafaxine

28
Q

SNRI Use of all

A

Depression

29
Q

SNRIs MOST likely to have more sexual dysfunction

A

Venlafaxine

Desvenlafaxine

30
Q

SNRI to avoid in liver dysfunction

A

Duloxetine

31
Q

Imipramine
Desipramine
Amitriptyline
Doxepin

A

TCA’s

32
Q

Potent inhibitors of NE and serotonin reuptake into presynaptic nerve terminals
Also block serotonergic, α-adrenergic, histaminia, and muscarinic receptors
Desipramine: more selective for NE reuptake

A

TCA’s

MOA

33
Q

Low & inconsistent bioavailability d/t variable 1st pass meatabolism

A

TCA’s

34
Q

Highly lipophilic/extreme fat solubility allows for easy penetration int CNS + has a long half life

A

TCA’s

35
Q

TCA
Metabolism
Elimination

A

Liver

Urine (inactive)

36
Q

No longer used to control bed wetting in children < 6 yo

A

Imipramine (a TCA)

Use

37
Q

Prevent migranes & tx chronic pain syndromes

A

Amitriptyline (a TCA)

Use

38
Q

Low dose to tx insominia

A

Doxepin (a TCA)

Use

39
Q

TCA

General use

A
  1. Mod-severe depression

2. Panic disorder

40
Q

ADR:

sudden death in children and adolescents (get EKG 1st)

A

Despiramine (a TCA)

41
Q 
Orthostatic hypertension
Tachycardia
Arrhythmias
Nausea
Drowsiness
Decreased sexual desire and inhibited ejaculation
Resting tremor
Manic episodes
A

TCA

ADR

42
Q

TCAs have a narrow _________ __________.

A

Therapeutic Dose

*can be deadly

43
Q

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline

A

MAOI

44
Q

Prevent inactivation of MAO-A and B in neuron→ excess NE, 5-HT, Dopamine in synapse

A

MAOI

MOA

45
Q

Length of MAOI washout

→When is it used ?

A

2 weeks

Used when switching from MAOI to another antidepressant

46
Q

MAOI

Utility

A
  1. Major depression unresponsive to drugs

2. Selegiline: Parkingson’s

47
Q

MAOI + Tyramine containing foods

A

AVOID b/c can lead to a HTN crisis

example: aged cheese, wine, fish or shrimp sauce etc

48
Q 
Orthostatic hypotension
Restlessness, drowsiness, dizziness
HA, constipation, N/V
Joint pain, dry mouth, peripheral edema
Rash, skin/mucous membrane hemorrhage
A

MAOI

ADR

49
Q

↑ norepinephrine and dopamine activity→ presynaptic release of catecholamines
& can also affect nicotinic receptors

A

Bupropion

MOA

50
Q

Bupropion

Use

A
  1. Major depresson

2. Smoking cessation

51
Q

Bupropion

ADR

A
  1. Lowers seizure threshold

2. CYP 2D6 inhibitor

52
Q 
N/V
Diarrhea
Diaphoresis 
Hyperreflexia
Bruxism
Sweat
Cogwheel rigidity
Tachycardia
A

Serotonin Syndrome Sx

53
Q

Serotonin Syndrome Tx

A
  1. Discontinue serotonergic agents
  2. Supportive care
  3. +/- use of benzo
  4. +/- Cyproheptadine serotonin antagonist
54
Q

Cyproheptadine
→Use
→Administration

A

Use: serotonin & histamine receptor antagonist
Admin: PO only

55
Q

Nefazodone
Trazodone
Vortioxetine

A

Serotonin Receptor Modulators

56
Q

Serotonin Receptor Modulators
Trazodone
Use

A

Major depression
Sedation
Hypnosis

57
Q

Serotonin Receptor Modulators
Vortioxetine
Use

A

Major depression

58
Q

Serotonin Receptor Modulators

ADR

A

Vortioxetine: GI, sexual dysfunction, careful with additive SERT agents
Serotonin syndrome

59
Q

Serotonin Receptor Modulators

Metabolism

A

→Trazodone and Nefazodone: short half lives, active metabolites
→Nefazodone: inhibits CYP3A4
→Vortioxetine: CYP2D6 metabolization and glucuronic acid conjugation

Clinical Medicine (6 decks)

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