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Anti-depressants Flashcards

(134 cards)

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1
Q

depression is defined as having ____ or more of the symptoms in the same ____ week period

A

5 or more symptoms, 2 week period

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2
Q

Gold standard for MDD diagnosis

A

Structured Clinical Interview for DSM-V

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3
Q

interview assessment for depression

A

Hamilton Depression Rating Scale

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4
Q

2 self-administered screening tools

A

Beck Depression Inventory, Edinburgh Postnatal Depression Score

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5
Q

Having a first degree relative with MDD increases risk ____x with _______ onset and recurrence

A

2-4x, earlier onset

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6
Q

5 causes/risk factors for MDD

A

temperament, environment, genetic, gender, cultural

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7
Q

Depression prevalence is higher in which gender

A

females

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8
Q

2 environmental risk factors for MDD

A

adverse childhood experiences, stressful life events

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9
Q

3 health statuses that could cause depression

A

hypothyroidism, cancer, pain disorders

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10
Q

depression can lead to death by

A

suicide

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11
Q

which hypothesis suggests that depression is related to a deficiency in serotonin, NE, and dopamine

A

monoamine hypothesis

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12
Q

the monoamine hypothesis suggests that depression is related to a deficiency in _________, _________, and __________

A

serotonin, norepinephrine, and dopamine

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13
Q

evidence for Monoamine hypothesis: depletion of monoamines by __________ can _________ depression

A

reserpine, induce depression

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14
Q

Reserpine is a _______ inhibitor and can ______ monoamines which _______ depression

A

VMAT2 inhibitor, deplete monoamines, induce depression

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15
Q

dietary ______ (a precursor of _______) is required for effect of SSRIs

A

tryptophan, serotonin precursor

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16
Q

the neurotropic hypothesis suggests that changes in _______ factors (especially _______) appear to play a major role in depression

A

trophic factors, BDNF

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17
Q

BDNF stands for

A

brain derived neurotropic factor

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18
Q

which hypothesis suggests that a decrease in trophic factors leads to depression

A

neurotropic hypothesis

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19
Q

stress and pain are associated with a ______ in BDNF and cause _______ changes in the brain

A

decrease, structure

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20
Q

major depression is associated with _____% loss in hippocampal volume

A

5-10%

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21
Q

chronic administration of antidepressants _______ BDNF —> _______ neurogenesis

A

increase BDNF, increased neurogensis

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22
Q

depressed patients often have _______ glutamate in CSF and cortex

A

elevated

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23
Q

chronic antidepressant use ________ glutamate transmission

A

decreases

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24
Q

stress ________ the release of glutamate in the brain; antidepressants ________ this

A

increases, decrease

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25
Ketamine is a _____ receptor antagonist and has antidepressant effects
NMDA (glutamate receptor)
26
what is the glutamate receptor
NMDA
27
which drug is an NMDA Receptor antagonist
Ketamine
28
MDD is associated with ______ cortisol and altered functioning of _____
elevated coristol, HPA axis
29
5 drug classes
MAOi, Tricyclics, SSRI, SNRI, Atypical
30
3 MAOIs
Phenelzine, Tranylcypromine, Selegiline
31
class of Phenelzine
MAOi
32
class of Tranylcypromine
MAOi
33
class of Selegiline
MAOi
34
which MAOi is also used in Parkinsons and why
Selegiline, has higher affinity for MAO-B
35
2 types of Tricyclics
tertiary amines and secondary amines
36
5 Tricyclic tertiary amines
Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine
37
5 tricyclic secondary amines
Amoxapine, Desipramine, Maprotiline, Nortriptyline, Protriptyline
38
class of Amitriptyline
Tricyclic (tertiary)
39
class of Clomipramine
Tricyclic (tertiary)
40
class of Doxepin
Tricyclic (tertiary)
41
class of Imipramine
Tricyclic (tertiary)
42
class of Trimipramine
Tricyclic (tertiary)
43
class of Amoxapine
Tricyclic (secondary)
44
class of Desipramine
Tricyclic (secondary)
45
class of Maprotiline
Tricyclic (secondary)
46
class of Nortriptyline
Tricyclic (secondary)
47
class of Protriptyline
Tricyclic (secondary)
48
are tertiary or secondary Tricyclics more selective for inhibiting NE reuptake
secondary
49
class of Citalopram
SSRI
50
class of Escitalopram
SSRI
51
class of Fluoxetine
SSRI
52
class of Fluvoxamine
SSRI
53
class of Paroxetine
SSRI
54
class of Sertraline
SSRI
55
3 SNRIs
Venlafaxine, Atomoxetine, Duloxetine
56
class of Venlafaxine
SNRI
57
class of Atomoxetine
SNRI
58
class of Duloxetine
SNRI
59
active metabolite of Venlafaxine
Desvenlafaxine
60
4 atypical antidepressants
Bupropion, Mirtazapine, Nefazodone, Trazodone
61
class of Bupropion
atypical
62
class of Mirtazapine
atypical
63
class of Nefazodone
atypical
64
class of Trazodone
atypical
65
indication of Bupropion
smoking cessation
66
4 non-pharmacological treatments
psychotherapy, electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation
67
4 off label indications of antidepressants
pain disorders, PMDD, vasomotor symptoms, stress urinary incontinence
68
7 FDA approved indications of antidepressants
MDD, panic disorder, GAD, PTSD, OCD, bulimia, smoking cessation
69
enzyme that breaksdown serotonin, 5HT
monoamine oxidase
70
MOA of monoamine oxidase inhibitors
inhibit MAO ---> increase presynaptic NE and 5HT available for relase
71
MOA of SSRIs
inhibit presynaptic SERT ---> decrease 5HT reuptake ----> increase 5HT in synapse
72
SSRIs: inhibit presynaptic _______, _______ 5HT reuptake, _______ 5HT in synapse
SERT, decrease reuptake, increase 5HT
73
MOA of tricyclics and SNRIs
inhibit presynaptic NET ---> decrease reuptake ----> increase amount in synapse
74
tricyclics and SNRIs inhibit presynaptic ______
NET
75
Tricyclics also block _____ which decreases _____ signaling and increases _____ signaling
alpha1 receptors, decreases IP3, increases NE
76
serotonin syndrome can be caused by an overdose of
antidepressants | Using more than 1 at the same time, Not properly weaning from one before starting another
77
most antidepressants should be D/C at least _____ weeks before starting a new one
2 weeks
78
long half life serotonergic reuptake inhibiting agents (ex: ________) should be D/C at least ____ weeks before MAOI is initiated
Fluoxetine, 4-5 weeks
79
do secondary or tertiary amines have more side effects
tertiary
80
which class has the best side effect profile
SSRIs
81
route of administration is almost always ______
oral
82
SSRIs are generally ______ and _______ absorbed and survive first pass effect
rapidly and well absorbed
83
SSRIs have a ______ bioavailability (____% for sertraline to ____% for Fluvoxamine)
high, 45% - 90%
84
peak plasma conc ____ hours after administration
4-6 hours
85
most antidepressants are _______ protein bound, which _______ distribution
highly, decreases
86
SSRIs are ________ which _______ distribution. (______ volume of distribution)
lipophilic, increases, large VOD
87
______ is the primary metabolic enzyme for most antidepressants
CYP2D6
88
Exceptions to metabolism: _________ and __________ which are metabolized by CYP____ and _____
Citalopram and Escitalopram, CYP3A4 and 2C19
89
_________ and _________ have active metabolites
Fluoxetine and Sertraline
90
antidepressants are excreted _______
renally (adjust dose in renal failure)
91
antidepressants have a ______ half life. makes _______ dosing appropriate
long half life, once daily dosing
92
food-drug interactions: MAOIs + _______ containing foods
tyramine
93
what types of food contain tyramine
fermented, cured, aged, spoiled
94
Tyramine is metabolized by _____
MAO
95
MAOIs ________ tyramine metabolism ---> _______ systemic tyramine absorption ---> tyramine taken up into adrenergic nerve endings ---> release of ________ into blood vessels ---> vessel _______ ---> ______ blood pressure ---> __________ crisis
decreases metabolism, increase absorption, catecholamines, vessel constriction, increase BP, hypertensive
96
3 CYP2D6 inhibitors
Fluoxetine, Paroxetine, Duloxetine
97
4 CYP3A4 inhibitors
Fluvoxamine, Nefazodone, Sertraline, Fluoxetine
98
what 3 things are CYP3A4 substrates
Citalopram, Escitalopram, TCAs
99
Substrates of CYP2D6
TCAs, Trazodone, Paroxetine, Duloxetine, Venlafaxine, Bupropion, Mirtazapine
100
4 patient factors
sex, age, race/culture, sexual orientation
101
antidepressants are wrongfully thought of as _________ in many cultures
Addictive
102
BBW for antidepressants
increased risk of suicidal thinking in children, adolescents, and young adults
103
__________ is contraindicated in pregnancy due to __________ malformation in fetus
Paroxetine, cardiac malformation
104
best course of treatment for antidepressants during pregnancy
continue antidepressant therapy
105
_________ circulating glucocorticoids can cause _____ birth weight
increased, low birth weight
106
indication of atomoxetine
ADHD
107
which tertiary tricyclic is LEAST LIKELY to cause seizures
Doxepin
108
main risk with MAOIs
Serotonin Syndrome
109
a person will develop ________ to MOST side effects of antidepressants
tolerant (GI, sedation)
110
2 main side effects of SSRIs
GI effects and Sexual effects
111
side effects of tertiary tricyclics
seizures, sedation, hypotension, Anti-ACh effects, weight gain, sexual effects, cardiac effects
112
what are ACh side effects
dry mouth, pupil dilation, sensitive to light, hot/flushed/dry skin, increased intraocular pressure
113
what side effect is very common amgonst antidepressants
sexual (ED, decreased libido)
114
symptoms of Serotonin Syndrome
Hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, agitation can process to coma/death
115
antidepressant monotherapy should NOT be prescribed for patients with ________
bipolar disorder
116
why should antidepressant monotherapy not be prescribed for bipolar pt
can induce manic state
117
antidepressants have a delayed effect; can take ______ weeks to take effect
4-6 weeks
118
antidepressant can cause physical _______, which leads to withdrawal
dependence NOT ADDICTION!!!
119
be very careful when switching between antidepressant classes to avoid ________
serotonin syndrome
120
therapeutic range of citalopram
20-40
121
therapeutic range of escitalopram
10-20
122
therapeutic range of fluoxetine
20-80
123
therapeutic range of fluvoxamine
100-200
124
therapeutic range of paroxetine
20-40
125
therapeutic range of sertraline
100-150
126
therapeutic range of TERTIARY tricyclics
100-200
127
therapeutic range of protriptyline
15-40
128
therapeutic range of amoxapine
200-300
129
therapeutic range of desipramine
100-200
130
therapeutic range of maprotiline
100-150
131
therapeutic range of nortriptyline
75-140
132
therapeutic range of phenelzine
30-60
133
therapeutic range of tranylcypromine
20-30
134
therapeutic range of selegiline
10

Pharmacology (5 decks)

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