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Therapeutics III > Anti-Depressants > Flashcards

Anti-Depressants Flashcards

1
Q

Citalopram drug class

A

SSRI

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2
Q

Citalopram clinical pearl

A

QTc prolongation for doses greater than 40mg/day

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3
Q

Citalopram cyp interactions

A

CYP 2C19 substrate

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4
Q

Escitalopram drug class

A

SSRI

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5
Q

Fluoxetine drug class

A

SSRI

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6
Q

Fluoxetine clinical pearl

A

long half life
No need to taper down
Weight loss, insomnia, fatigue

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7
Q

Fluoxetine CYP

A

2C19 and 3A4 inhibitor

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8
Q

Fluvoxamine drug class

A

SSRI

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9
Q

Fluvoxamine clinical pearl

A

approved for OCD

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10
Q

Fluvoxamine CYP

A

1A2

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11
Q

Paroxetine drug class

A

SSRI

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12
Q

Paroxetine clinical pearl

A

must taper due to anticholinergic effects
weight gain, sedation
Pregnancy category D

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13
Q

Paroxetine CYP

A

2D6

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14
Q

Sertraline drug class

A

SSRI

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15
Q

SSRI general adverse effects

A

increased bleeding risk, anxiety/agitation, GI UPSET, sexual dysfunction, hyponatremia/SIADH, decreased bone mineral density, akathisia

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16
Q

Desvenlafaxine drug class

A

SNRI

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17
Q

Desvenlafaxine clinical pearls

A

Dose limited side effect: nausea

renal dosing

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18
Q

Desvenlafaxine CYP

A

no cyp interactions

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19
Q

Duloxetine drug class

A

SNRI

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20
Q

Duloxetine clinical pearl

A

slowly titrate dose to avoid nausea

HEPATOTOXICITY- MUST GET LFT’S AT INITIATION

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21
Q

Duloxetine CYP

A

1A2 substrate

2D6 inhibitor and substrate

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22
Q

Levomilnacipran drug class

A

SNRI

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23
Q

Levomilnacipran clinical pearl

A

Must adjust dose in renal impairment or strong CYP

24
Q

Levomilnacipran CYP

A

3A4 substrate

25
Q

Milnacipran drug class

A

SNRI

26
Q

Milnacipran clinical pearl

A

indicated for fibromyalgia

renal dosing

27
Q

Venlafaxine drug class

A

SNRI

28
Q

Venlafaxine clinical pearl

A

Dose must be >150mg/day to have NE effects

29
Q

Venlafaxine CYP

A

substrate of 2D6 and 3A4 (major)

30
Q

SNRI general adverse effects

A

Variable amounts of sedation, increased bleeding risk, anxiety/agitation (when starting), GI upset, sexual dysfunction, blood pressure elevation, hyponatremia, decreased bone mineral density, nausea, akathisia

31
Q

Amitriptyline drug class

A

TCA

32
Q

Desipramine drug class

A

TCA

33
Q

Doxepin drug class

A

TCA

34
Q

Imipramine drug class

A

TCA

35
Q

Nortriptyline drug class

A

TCA

36
Q

Amitriptyline clinical pearl

A

used at lower doses for neuropathic pain

37
Q

Doxepin clinical pearl

A

commonly used for insomnia

38
Q

Nortriptyline clinical pearl

A

Used in smoking cessation

39
Q

TCA adverse effects

A

CNS: sedation, increased seizures, confusion
Anticholinergic: blurred vision, urinary retention, constipation
CV: orthostatic hypotension, tachycardia
Others: weight gain, sexual dysfunction
OVERDOSE CAN CAUSE ARRHYTHMIAS

40
Q

Isocarboxazid drug class

A

MAOI

41
Q

Phenelzine drug class

A

MAOI

42
Q

Selegiline drug class

A

MAOI

43
Q

Tranylcypromine drug class

A

MAOI

44
Q

MAOI clinical pearls

A

Must have 2 week washout period between antidepressants (5 weeks if fluoxetine)
Tyramine diet
Can cause serotonin syndrome and hypertensive crisis

45
Q

MAOI contraindications

A

pheochromocytoma, hepatic/renal dysfunction, cerebrovascular disease, excessive caffeine use, elective surgery, concomitant sympathomimetics (cocaine, amphetamines, etc.), CV disease, use with SSRI

46
Q

Bupropion MOA

A

Dopamine/NE reuptake inhibitor (does not affect serotonin)

47
Q

Bupropion contrainidications

A

active seizure disorder or eating disorder (stimulating effects suppress appetite)

48
Q

Bupropion CYP

A

2D6 inhibitor

49
Q

Mirtazepine MOA

A

Presynaptic alpha-2 blocker as well as 5HT2, 5HT3, and H2 receptor blockage

50
Q

Mirtazepine adverse effects

A

increased sedation and appetite in doses smaller than 15mg/day
warning for agranulocytosis and increased cholesterol
NO CLINICALLY SIGNIFICANT INTERACTIONS

51
Q

Trazodone MOA

A

Selectively inhibits neuronal reuptake of serotonin and acts as an antagonist at 5HT1, 5HT2, H1, and alpha-1

52
Q

Trazodone clinical pearls

A

sedation (pts may not be able to tolerate high effective doses), can see lower doses of trazodone being used in combination with other antidepressants despite SSRI component
PRIAPISM

53
Q

Vilazodone MOA

A

SSRI and possibly contributes to 5HT1a agonism (possibly making it work faster?)

54
Q

Vilazodone clinical pearls

A

take with food, titrate up to 40mg

Major CYP 3A4 interactions

55
Q

Vortioxetine MOA

A

SSRI and 5HT1A agonist, 5HT3 antagonist

56
Q

Vortioxetine clinical pearls

A

take with meals

Strong CYP 2D6 substrate

57
Q

Imipramine use

A

children with ADHD or nocturnal enuresis

Therapeutics III (11 decks)

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