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Anti-depressants Flashcards

(48 cards)

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1
Q

What are the 5 R’s of antidepressant efficacy?

A
  1. Response– 50% or better reduction in symptoms from baseline
  2. Remission– symptom free
  3. Recovery– 2-6 months of remission (no symptoms)
  4. Relapse–return of symptoms after remission but before recovery
  5. Recurrence–return of symptoms after recovery
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2
Q

What are the symptoms of withdrawal from antidepressants?

A 
F- flu like symptoms
I- insomnia
N- nausea
I- imbalance
S- sensory disturbances
H- hyperarousal
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3
Q

Which antidepressant can also be used for nicotine withdrawal?

A

bupropion

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4
Q

Which antidepressant can be used for enuresis

A

imipramine

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5
Q

Which antidepressant can be used for diabetic peripheral neuropathy, fibromyalgia, and chronic msk pain?

A

duloxetine

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6
Q

Which antidepressant can be used for stress incontinence?

A

duloxetine

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7
Q

Which SSRI is only used for OCD?

A

fluvoxamine

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8
Q

MOA SSRI

A

selectively inhibit the pre-synaptic reuptake of serotonin, via the SERT channel

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9
Q

SSRIs

A

Citalopram
escitalopram
fluoxetine
paroxetine
vortioxetine–also partial agonist at 5-HT1b & full agonist at 5-HT1a, full antagonist at 5-HT1d3,7
sertaline
vilazodone–also partial agonist at 5-HT1a

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10
Q

SE of SSRIs

A

sedation or insomnia/agitation/nervousness
sexual dysfunction
weight gain
acute withdrawal reactions

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11
Q

Rare SE of SSRIs, dose dependent

A

QT prolongation
hyponatremia
serotonin syndrome
suicidality

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12
Q

Symptoms of serotonin syndrome

A

sweating, hyperreflexia, akathisia/myoclonus, shivering/termors

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13
Q

What are the distinguishing features of serotonin syndrome vs neuroleptic malignant syndrome?

A

neuroleptic malignant syndrome is caused by dopaminergic agents (antipsychotics)

will have hyporeflexia vs hyper & clonus
will have normal pupils vs dilated
will have normal or decreased bowel sounds vs increased activity

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14
Q

Which SSRI has the most risk of drug-drug interaction

A

fluoxetine

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15
Q

Which SSRIs has the least risk of drug-drug interaction

A

vortioxetine & escitalopram

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16
Q

MOA of SNRIs

A

selectively inhibit the pre-synaptic reuptake of serotonin (SERT) & norepinephrine (NET)

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17
Q

what do tertiary amines TCAs inhibit

A

TCAs are part of SNRIs

inhibit both NE/5HT relatively equally

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18
Q

What do secondary amines TCAs inhibit

A

NE>5-HT

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19
Q

list the tertiary amine TCAs

A

amitriptyline
clomipramine
doxepin
imipramine

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20
Q

list the secondary amine TCAs

Study These Flashcards
A

amoxapine
desipramine
nortriptyline

21
Q

list the other SNRIs

Study These Flashcards
A

desvenlafaxine
duloxetine
venlafaxine
levomilnacipran

22
Q

What 3 other receptors do TCAs have an effect on

Study These Flashcards
A

histamine (H1)
muscarinic
a1 adrenergic

23
Q

What are the 3 key TCA side effects

Study These Flashcards
A
  1. cardiovascular (alpha)–tachy, ortho hypotension, dysrhythmias
  2. anticholinergic (muscarinic)–dry mouth, urinary retention/constipation, blurred vision
  3. CNS (histamine)–sedation/fatigue, dizziness/seizures
24
Q

3 Cs of toxic ingestion of TCAs

Study These Flashcards
A

Coma
Cardiotoxicity (conduction abnormalities)
Convulsions

25
SE of non-TCA SNRIs
like SSRIs but with less risk of sexual dysfunction
26
MOA of action of SARAs
2 agents block SERT but also block post-synaptic a1 receptors on noradrenergic neurons & post-synaptic 5-HT2 receptors --trazadone & nefazodone 1 agent blocks pre-synaptic a2 receptors on noradrenergic & serotonergic neurons & blocks post-synaptic 5-HT2/3 receptors --miratazapine
27
SE of SARAs
``` sedation (most with trazadone/mirtazapine) ortho hypotension (most with trazadone) weight gain (most with mirtazapine) ```
28
MOA of NDRIs
selectively inhibits pre-synaptic reuptake of norepinephrine (NET) and dopamine (DAT)
29
Which SNRI also blocks dopamine
amoxapine
30
what is the only NDRI called
bupropion
31
which 2 drugs mess with dopamine
bupropion (NDRI) and amoxapine (SNRI)
32
SE of NDRIs
agitation/insomnia seizures (dose dependent, or those at risk)!!
33
MOA of MAOIs
inhibition of MAO (a and b subtypes) increase levels of monoamines in neuronal vesicles & increase amounts of NE, 5-HT, and DA released --all are nonselective except selegiline (B selective)
34
List the MAOIs
isocarboxazidp phenelzine selegiline tranylcypromine
35
SE of MAOIs
orthostatic hypotension sexual dysfunction weight gain insomnia/agitation/nervousness
36
Drug interactions of MAOIs
any 5-HT/NE affecting drugs--SSRIs/TCAs/SNRIs, amphetamines, anti-hypertensives ---2 wk washout period (whatever that means) risk of serotonin syndrome risk of hypertensive crisis
37
Risk of hypertensive crisis in MAOIs increased with
increased tyramine in GI tract may induce significant catecholamine release --least risk with selegiline ``` tyramine containing foods: aged cheeses soy beans fermented & pickled meats, fish processed, pickled or cured meats tap beer, red wine over-ripe fruits soy/fish/shrimp sauces ```
38
s/s of hypertensive crisis
``` severe headache nausea/vomiting sweating/severe anxiety nosebleeds tachycardia CP changes in vision SOB confusion ```
39
MOA & administration of esketamine
NMDA-receptor (glutamate) antagonist - -indicated for treatment resistant depression in conjunction with ongoing antidepressant therapy - -nasal admin - -pt observed for 2 hours post dose
40
MOA & administration of brexanolone
GABAa receptor positive allosteric modulator - -indicated for post-partum depression - -60 hr IV administration
41
List the anti-seizure agents used as mood stabilizers
carbamazepine lamotrigine divalproex/valproic acid
42
MOA of lithium
neurotransmitter modulation-- inhibits dopamine neurotransmission interferes with both stimulatory & inhibitory G-proteins by keeping them in inactive state --downregulates NMDA receptor --increases GABA levels in CSF --inhibits PKC, MARCKS, GSK-3
43
SE of lithium
polyuria--looks like nephrogenic diabetes insipidus --lithium handled by kidneys similar to Na/K, competes with Na for kidney reabsorption also, tremor, mental confusion/dizziness/sedations. thyroid goiter, leukocytosis, seizures, serotonin syn
44
Drug interactions of Lithium
diuretics (esp. thiazides) ACEIs NSAIDs
45
Indications for lithium
- -acute & maintenance tx of mania/bipolar I disorder - -augmentation in unipolar depression - -Off label: reduced risk of suicide in mood disorders
46
What is valproic acid/divalproex used for
acute bipolar I (with & w/o psychotic features)
47
What is lamotrigine used for
maintenance of bipolar I & II
48
What is Carbamazepine used for
acute & mainenance tx of acute mania & mixed episodes of bipolar I --CYP450 inducer!

Psych (8 decks)

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