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Pharm > Pharm-Depression > Flashcards

Pharm-Depression Flashcards

1
Q

What three neurotransmitters are decreased in major depression?

A

NE, 5-HT, and DA

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2
Q

How long does it take to see evident clinical response with depression pts?

A

2-12 weeks

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3
Q

When should you consider changing therapy with depressive pts?

A

If no response within 2-8 weeks

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4
Q

Classes of Antidepressants?

A

SSRIs, SNRIs, atypical antidepressants, TCAs, MAOIs, St. John’s wort (dietary supplement)

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5
Q

SSRIs? (7)

A
  1. Citalopram (Celexa)
  2. Excitalopram (Lexapro)
  3. Fluoxetine (Prozac)
  4. Fluvoxamine (Luvox)
  5. Paroxetine (Paxil)
  6. Sertraline (Zoloft)
  7. Vilazodone (Viibryd)
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6
Q

What is the first line (usually) for late-onset depression?

A

SSRIs

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7
Q

What is the downside to SSRIs?

A

GI symptoms

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8
Q

Besides GI symptoms, what do people complain about with SSRIs?

A

Sexual dysfunction

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9
Q

Why are SSRIs the preferred drug for late-onset depression?

A

has better side effect profile and tolerability compared to other antidepressants, also less drug interactions

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10
Q

What class of antidepressants are usually safe if a pt is on a lot of other meds?

A

SSRIs

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11
Q

SE of citalopram (celexa)?

A

Dose related QT prolongation,
max dose = 40 mg/day
if >60, max = 20 mg/day

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12
Q

When do you d/c citalopram (celexa)?

A

If pt has persistent QTc >500 ms

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13
Q

What is second-line if pt fails SSRI?

A

SNRI

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14
Q

When are SNRIs first line?

A

in pts with fatigue or pain syndromes

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15
Q

Venlafaxine (Effexor) is a _______? MOA?

A

SNRI, inhibits 5-HT reuptake at low doses and NE reuptake at higher doses

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16
Q

Desvenlafaxine (Pristiq) is a primary metabolite of ?

A

Venlafaxine (Effexor)

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17
Q

What is Duloxetine (Cymbalta)?

A

A SNRI with both 5-HT and NE reuptake inhibition across all doses

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18
Q

What can Duloxetine (Cymbalta) help with?

A

neuropathic pain assoc. with depression, also can be used for urinary incontinence.

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19
Q

SE of Effexor?

A

similar to SSRIs, nausea, sexual dysfunction, priaprism (rare)

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20
Q

Which antidepressant may cause a dose-related increase in diastolic blood pressure?

A

Effexor

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21
Q

SE of Cymbalta?

A

nausea, dry mouth, constipation, decreased appetite, insomnia, and increased sweating

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22
Q

Can TCAs cause sedation?

A

YES

23
Q

Which antidepressants can also be used to treat hot flashes?

A

TCAs

24
Q

List of TCAs? (8)

A
  1. Elavil 2. Anafranil 3. Norpramin 4. Sinequan 5. Tofranil 6. Pamelor 7. Vivactil 8. Surmontil
25
Q

How do TCAs work?

A

They potentiate the activity of NE and 5-HT by blocking their reuptake

26
Q

What varies among the different TCAs?

A

potency and selectivity of TCAs for the inhibition of reuptake of NE and 5-HT

27
Q

Most common SE of TCAs = ________ effects

A

anticholinergic effects

28
Q

What can TCA overdose cause?

A

severe arrythmias

29
Q

What can TCAs cause in pts with pre-existing heart problems?

A

Cardiac conduction delays and possibly even a heart block

30
Q

Which antidepressant is contraindicated in pts with a family history of sudden cardiac death?

A

Desipramine (Nopramin), a TCA

31
Q

Trazadone and Nefazodone are ___________ antidepressants.

A

Atypical, Triazolopyridines

32
Q

What type of pts should trazadone be used for? Why?

A

Depressed patients who have trouble sleeping, because it has SE of sedation and dizziness

33
Q

There is limited use of Nefazodone because of what?

A

Hepatotoxicity

34
Q

What is a rare but potentially serious SE of trazadone?

A

priaprism

35
Q

Trazadone and Nefazodone are both assoc. with what?

A

Orthostatic hypotension

36
Q

An example of an aminoketone (a form of atypical antidepressant) is what?

A

Wellbutrin

37
Q

How does wellbutrin work?

A

It inhibits the reuptake of both NE and dopamine by blocking the pumps

38
Q

When should you tell pts to take Wellbutrin?

A

In the morning, it will wake them up

39
Q

Wellbutrin can also be used for ?

A

Smoking cessation

40
Q

Less _________ and ________ with wellbutrin when compared to SSRIs

A

GI distress and sexual dysfunction

41
Q

Wellbutrin is contraindicated in what pts?

A

Pts with eating disorders such as bulimia and anorexia, bc they are more likely to have electrolyte imbalances leading to seizures

42
Q

Example of a tetracyclic antidepressant?

A

Mirtazapine

43
Q

How do tetracyclic (Mirtazapine) antidepressants work?

A

Enhance central nonadrenergic and serotonergic activity through the antagonism of central presynaptic alpha2-adrenergic autoreceptors and heteroreceptors

44
Q

Mirtazapine may benefit pts with what?

A

A loss of appetite, may potentiate weight gain

45
Q

SE of Mirtazapine?

A

Somnolence, weight gain, dry mouth, and constipation

46
Q

Weight gain will be less with larger/smaller doses of mirtazapine?

A

Will be less with LARGER doses

47
Q

Examples of MAO-Is used for depression? (4)

A
  1. Marplan 2. Nardil 3. Emsam 4. Parnate
48
Q

MOA of MAO-Is?

A

They increase the concentrations of NE, 5-HT, and DA within the neuronal synapse through inhibition of the MAO enzyme

49
Q

Which MAOIs are nonselective inhibitors of MAO-A and MAO-B?

A

Nardil and Parnate

50
Q

What was recently approved by the FDA to treat major depressive disorder that involves MAOIs?

A

A selegiline (Emsam) transdermal patch that allows inhibition of MAO-A and MAO-B in the brain yet has reduced effects of MAO-A in the gut.

51
Q

_______________, the most frequently prescribed MAOI has mild to moderate sedating effects.

A

Phenelzine (Nardil)

52
Q

What is a potentially serious SE of MAOIs if they are taken with foods high in tyramine?

A

Hypertensive crisis

53
Q

What foods are high in tyramine?

A

cheese, processed meat, sauerkraut

54
Q

Don’t combine ____________ (ABx) with an SSRI due to potential of serotonin syndrome.

A

Linezolid

Pharm (6 decks)

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