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BHM II > Pharm 18 > Flashcards

Pharm 18 Flashcards

1
Q

List MC to least common antidepressants used

A

SSRIs are MC

SNRIs (2nd MC)

Miscellaneous (2nd MC)

Tricyclic (TCA) (Common but rarely use for depression)

Monoamine oxidase inhibitors (MAO-Is) (Least common d/t MOST ASEs)

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2
Q

Who are the most risk for depression and death of despair?

A

40-59 yr old white American women.

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3
Q

Time course of therapy (including onset of action of antidepressants) for most patients with depression

A

Initial :6-12 wks for symptoms remission.

  • Medications typical take 4 wks to “kick in”
  • 8 wks to determine efficacy

Continuous phase: 4-9 mo after symptom remission

Optional/relapse prevention: 12-36 mos

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4
Q

Long term effects of reuptake inhibitors

A

Increased synaptic concentrations of 5-HT

Down regulation of presynaptic auto receptors

Increase the firing rate of raphe neurons

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5
Q

Why are SSRIs are usually the preferred first line antidepressant?

A

They are as effective as TCAs but cause fewer autonomic ASEs and less sedation.

Safer in regards to OD.

Less cardiac arrhythmias and less likely to induce a seizure

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6
Q

ASEs for SSRIs when discontinued rapidly

A

Dizziness, nausea, fatigue, muscle aches, chills, anxiety, irritability, paresthesia, insomnia, electric shock phenomena.

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7
Q

Common clinical applications for TCA

A

MDD (unipolar)
Insomnia
Neuropathy
Migraine prevention

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8
Q

Common clinical applications for misc. antidepressants

A

MDD
Seasonal affective disorder
Smoking cessation (Bupropion)
Cognitive dysfunction w/ depression

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9
Q

Unique applications of Nefazodone

A

Only indicated for depression

Less rates of sexual dysfunction

May be added with other meds to counteract the sexual dysfunction

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10
Q

Unique applications of Bupropion

A

Seasonal affective disorder

Smoking cessation

Less risk for sexual dysfunction

Stimulant properties

Add to SSRI: decrease SSRI dose + bupropion

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11
Q

Unique applications of Mirtazapine

A

“tricyclic antidepressant”

Fewer anticholinergic, sexual dysfunction, CV and GI effects

More sedating and more weight gain= good to use in older pts w/ eating/ weight issues

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12
Q

Unique applications of Trazodone

A

Insomnia but only FDA approved for depression

ASE: Priapism

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13
Q

Black box warning(s) present on all antidepressant drugs

A

Antidepressants (under age 24) can increase risk for suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders.

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14
Q

Recall the names of the non-selective monoamine oxidase inhibitors used for depression

A

Phenelzine
Tranylcypromine
Isocarboxazid

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15
Q

Why have MAO-I fallen out of favor for tx of depression?

A

Cannot use: SSRIs, TCAs, SNRIs, etc. within 14 days of MAO-I

Cannot use: dextromethorphan, pseudoephedrine, tramadol, meperidine, etc.

Ingestion of Tyramine food = hypertensive crisis.

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16
Q

Serotonin syndrome risk factors

A

multiple serotonergic drugs used at once

ex. SSRI + Tramadol + sumatriptan

17
Q

S/s of serotonin syndrome

A

Hyperlexia, muscle spasms of lower limbs, diarrhea, confusion

18
Q

3 MC used to assist pts w/ tobacco cessation?

A

Nicotine replacement products

Bupropion

Varenicline

19
Q

Which tabacco cessation is most effective?

A

Varenicline

20
Q

Black box warning of bupropion?

A

Neuropsychiatric changes in behavior, hostility, agitation, depressed mood, and suicide related events.

contraindicated for pts with seizures

21
Q

Inhaled nicotine ASES

A

nasal irritation, throat irritation, rhinitis.

Contraindicated in pts with reactive airway disease

22
Q

Nicotine gum ASEs

A

Gastric and esophageal irritation

Contraindicated in TMJ disease, dentures, or inadequate dentation.

23
Q

Nicotine patch ASEs

A

Skin irritations and GI disturbances

If worn at night=vivid dreams and insomnia occur

24
Q

Bupropion ASEs

A

Insomnia, agitation, dry mouth, and HA

25
Q

Bupropion trade name for smoking cessation?

A

Zyban

26
Q

OTC nicotine patches dosing for step 1

A

21 mg

start with step 1 for pts that smoke more than 10 cig a day.

6 wk long tx

27
Q

OTC nicotine patches dosing for step 2

A

14mg

start with step 2 if pt smoked less than 10 cigs a day

2 wk long tx

28
Q

OTC nicotine patches dosing for step 3

A

7mg

2 wk long tx

29
Q

Name all the SSRIs

A 
Citalopram
Escitalopram 
Fluoxetine 
Fluvoxamine 
Paroxetine
Sertraline (Zoloft®).
30
Q

CYP enzymes inhibited by Nefazodone

A

3A4

31
Q

CYP enzymes inhibited by Fluoxetine

A

2D6

32
Q

CYP enzymes inhibited by Paroxetine

A

2D6

33
Q

MC ASE for SSRI

A

Sexual dysfunction

34
Q

Varenciline dosing day 1-3

A

0.5mg QD

35
Q

Varenciline dosing day 4-7

A

0.5 mg BID

36
Q

Varenciline dosing week 2-12

A

1.0 Mg BID

BHM II (5 decks)

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