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89B Antidepressants Flashcards

(48 cards)

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1
Q

Definition of major depression

A

at least 2 weeks of … 1) sad/depressed 2) less pleasure from pleasurable activities

+/- weight gain; +/- somnia; psychomotor issues, low energy, worthlessness, decreased concentration, suicidal ideation

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2
Q

Monoamine hypothesis of depression

A

low NE and 5HT (and dopamine to some extent)

down regulation of receptors and excessive nt reuptake

increased nt destruction via MAO

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3
Q

Etiology of depression

A

1) biological factors (monoamine hypothesis)
2) Genetic factors
3) Psychosocial factors (stress)

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4
Q

Serotonin affect on frontal cortex, basal ganglia, limbic area, hypothalamus, brainstem, spinal cord, and GI

A

frontal cortex - mood

basal ganlia - movement

limbic - anxiety

hypothalamus - appetite

brainstem - regulates sleep

spinal cord - sexual response

GI - digestion

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5
Q

Dopamine

A

Part of reward system

working memory

low in depression

increased in mania and psychosis

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6
Q

nt synthesis pathway

A

tyrosin–>DA–>NE–>tryptophan–>5HT

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7
Q

General classes of antidepressants

A

SSRI - selective serotonin reuptake inhibitors

SNRI - serotonin NE reuptake inhibitors

DNRI - dopamine NE reuptake inhibitors

TCA - tricyclic antidressants (NE and 5HT receptors)

MAOI - monoamine oxidase inhibitors

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8
Q

SSRI overview

A

fewer side effects

all equally treat depression but have different side effects in different people

multiple other uses

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9
Q

Specific SSRIs

A

Fluoxetine

setraline

paroxetine

citalopram

escitalopram

fluvoxamine

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10
Q

fluoxetine

A

SSRI

“Prozac”

Interacts with carbamazepine, phenytoin, TCAs, diazepam

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11
Q

Setraline

A

SSRI

“Zoloft”

Interacts with warfarin

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12
Q

paroxetine

A

SSRI

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13
Q

escitalopram

A

SSRI

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14
Q

fluvoxamine

A

SSRI

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15
Q

SSRI side effects

A

sexual dysfunction

GI complaints

Nausea

Anorexia/weight gain

Diarrhea

anxiety

sedation/insomnia

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16
Q

SSRI black box warnings

A

Increased suididal behavior in children (to 25)

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17
Q

SSRI Withdrawal syndrome

A

headache

diarrhea

nausea

Tapper meds slowly or use longer acting med to taper

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18
Q

Serotonin Syndrome (hyperserotonergic state)

A

Jerking, restlessness, confusion, LOC, death

Higher SSRI doses or medication combinations (SSRI + TCA/SNRI/tryptophan/mirtazapine)

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19
Q

SSRI affect with bipolar patients

A

leads to mania

Use Lithium carbonate

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20
Q

What SSRI should be used with Prego chicks

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A

Zoloft (minimal tranfer to breastmilk)

21
Q

Treating depression with psychois

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A

SSRI + antipsychotic (abilify)

22
Q

Metabolism of SSRI

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A

CYP450 1A2 - smoking induces, requires higher doses

CYP450 2D6 - SSRI inhibit this pathway which is used by TCAs (monitor carefully)

23
Q

MAOI drug interactions

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A

wash out period of 2 weeks before starting a MAOI and switching to another drug

24
Q

Specific SNRIs

Study These Flashcards
A

Venlafaxine

Desvenlafaxine

Duloxetine

25
SNRIs mecahnism
acute increases in 5HT at low doses Increases in NE at high doses
26
venlafaxine
SNRI
27
Duloxetine
SNRI
28
Desvenlafaxine
SNRI
29
SNRI side effects
HTN Nausea Agitation Sexual Dysfunction Insomnia Constipation Dizziness (DANISHC)
30
Atypical antidepressants
Mitrazapine - increase NE and 5HT; no sexual dysfunction or GI side effects but weight gain, sedation, and others Bupropion - NE dopamine Reuptake Inbihitor (NDRI); side affects include agitation, insomnia, weight loss, others Trazodone - 5HT reuptake inhibitor; SA - priapism; good for insomnia but poor antidepressant Vilzazone - 5HT reuptake inhibitor
31
Mirtazapine
Atypical antidepressants increase NE and serotonin no sexual dysfunction or GI effects, but has other side affects
32
Bupropion
Atypical antidepressant NE Dopamine Reuptake Inhibitor (NDRI) Side affects without sexual dysdunction Also for smoking cessation, ADD, SSRI induced side effects
33
Trazodone
Atypical antidepressant 5HT reuptake Inhib SA- priapism, headache, sedation Good for insomnia but poor antidepressant
34
Vilazodone
atypical antidepressant 5HT reuptake inhibitor
35
TCA category overview
Tertiary amines - block 5HT and NE reuptake Seconday amines - more selective for NE reuptake blocking
36
TCA teriary amine - specific drugs
Amitryptyline Clomipramine Imipramine
37
TCA secodary amines - specific drugs
Desipramine Nortiptyline
38
TCA side effects
1) block ACh - dry mouth, constipation, urinary retention 2) anti-adreergic - sedation, orthostasis, sexual dysfunction 3) Antihistaminic - sedation, weight gain 4) decreased cardiac conduction Overdose can be deadly - monitor
39
TCA drug - drug interactions
Allow 1 week wash out when switching from TCA to MAOI Cardiac effects with other meds
40
Monoamine Oxidase Inhibitors - subtypes
2 subtypes 1) MAO A - metabolizes NE and 5HT 2) MAO B - converts protoxins to toxins; role in neurodegenrative diseases like parkinson's
41
MAOI mechanism, SA, effectiveness
inhibits the enzyme that metabolizes intracellular amines (DA, NE, 5HT, tyramine) SA - orthostasis, insomnia, sedation, sexual dysfunction, etc Very effective
42
MAOI interactions
Numerous drug-drug HTN crisis with tyramine foods (wine and cheese) HTN No general anesthesia within 10 days
43
MAOI specific drugs
Selegeline Phenelzine Trancyclopromine Isocarboxazid
44
Selegeline
MAOI Transdermal antidepressant minimal side effects
45
Phenelzine
MAOI
46
Trancyclopromine
MAOI
47
Isocarboxazid
MAOI
48
Treating with antidepressants - guidelines
start with lowest dose 2-6 weeks for response (increase dosing every 4-6 weeks, as needed) Treat 6-9 months, if multiple recurrences then might need chronic meds (50%) SA - sleep and appetite improve 1st then mood

Psych (18 decks)

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