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Anti-Depressants Wolters Flashcards

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1
Q

What is the monoamine hypothesis, what are monoamines, and what drug helped make this conclusion?

A

The monoamine hypothesis is that psychological disorders such as depression are due to a deficit of monoamines such as serotonin, norepinephrine, and dopamine. The drug that helps determine this is RESERPINE which depleted monoamine storage in WWII.

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2
Q

What receptors do serotonin, norepinephrine and dopamine go to?

A

Serotonin: sert –> 5-HT
Norepinephrine –> A1 & B1
Dopamine: DAT –> DA

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3
Q

Where are serotonin receptors found in the body what are the effects of said monoamine??

A

90% - GI Tract
CNS - mood and sexual behavior

Cardiovascular- released by platelets for hemostasis

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4
Q

Where are dopamine receptors found in the body what are the effects of said monoamine?

A

CNS: emotion, cognition, memory, reward

Endocrine: regulate prolactin

Cardiovascular: vasoconstriction & dilation

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5
Q

What patterns are found in Parkinson’s and schizophrenia regarding dopamine?

A

decreased levels in Parkinson’s and increased levels in schizophrenia

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6
Q

Where are norepinephrine receptors found in the body and what are the effects of said monoamine?

A

Cardio: a1- vasoconstriction b1- increases heart rate

Fight or flight - less diarrhea

CNS: concentration and alertness

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7
Q

What monoamine is best in treating septic shock?

A

norepinephrine

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8
Q

What 2 general classes should be used as initial therapy in treating depression and what 6 specific antidpresseion should also first be useD?

A

SSRIs
SNRIs

bupropion
mirtazapine
vortioxetine
trazodone
vilazodone
nefazodone
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9
Q

in what time frame should a patient expect for their anti-depressant to start working?

What other important details might you want to discuss with a patient regarding using anti-depressants?

A

4-8 wks
only 60-70% of patients achieve remission

Med-changes such as beta-blockers will make you feel crappy and depressed

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10
Q

What are the 6 SSRI’s you need to know?

A 
Fluoxetine - Prozac 
Sertraline - Zoloft 
Paroxetine - Paxil 
Citalopram - Celexa 
Excitalopram - Lexapro
Fluvoxamine - Luvox
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11
Q

What 3 major side effects are noted with the SSRI paroxetine, commonly known as Paxil?

A

Sedation, anticholinergic, hyponatremia

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12
Q

What SSRI is an S-Isomer of citalopram and has less side effects and better efficacy?

A

Escitalopram - Lexapro

SSRI

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13
Q

What drug class can help perimenopausal women?

A

SSRIs

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14
Q

What SLUDGE-M characteristics make up cholinergic drugs?

A 
Salivation
Lacrimation
Urination
Diarrhea
GI cramping
Emesis
Miosis
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15
Q

What SLUDGE-M characteristics make up anti-cholinergic drugs?

A 
Dry Mouth 
Dry Eyes
Retention
Constipation
Mydriasis
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16
Q

What 2 drugs are significant is causing QT prolongation and what are the red flags and things to note about QT prolongation?

A

citalipram/escitalipram

hypokalemia and magnesia can cause this

and QTc >500msec is cause for concern

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17
Q

What antibiotic has potential to cause serotonin syndrome in patients taking SSRIs

A

Linezolid which covers MRSA

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18
Q

What is the drug interaction between fluoxetine and clopidogrel?

A

Fluoxetine inhibits clopidorel ??

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19
Q

What are the 2 main SNRIs we need to know?

A

Venlafaxine - Effexor

Duloxetine - Cymbalta

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20
Q

What class of anti-depressants has a significant side effects of increasing blood pressure?

A

SNRIs

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21
Q

What is a CYP1A2 inhibitor that interacts with Ciprofloxacin?

A

Duloxetine

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22
Q

What SNRI is mostly used for chronic muscle pain?

A

duloxetine

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23
Q

Buproprion

MOA
use when….
Side effects

Do Not Use With!!!

A

Wellbutrin

Has action at Dopamine and norepinephrine REUPTAKE

used after SSRIs fail

increased risk of seizures
Weight Loss
Improves sexual dysfunction

Use in smoking cessation

Do not use with MAOIs - hypertensive crisis

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24
Q

What are the 5 other SNRI antidepressants we need to know?

A 
Mirtazapine
Vortioxetine 
Trazadone 
Nefazodone
Vilazodone
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25
Mirtazapine MOA S/e
Increase NE and 5HT in synapse Acts like SNRI S/e: Pronounced sedation, weight gain Great for depressed grandmas who cannot sleep and are too skinny
26
Vortioxetine
Inhibits serotonin reuptake "Improves cognition"
27
Trazadone
Inhibits serotonin reuptake Can cause orthostatic hypertension, sedation, used for insomnia and risk for prolonged erection
28
Usual dose for Citalopram and it's brand name
20-40 (40 max because BBW QTc prolongation risk) | Celexa
29
Side effects of SSRI
GI N/V dry mouth Perimebipausal women help with hot flashes CNS, urogential, anticholingetic, etc
30
QT prolongation risk factors
Major: medications (don't give citalobam or escitalopram if QTc>500), hypokalemia magnesmia Others: genetic LVH heart disease age> 65 female bradycardia
31
Inhibitors of Tamoxifen
Fluoxetine, paroxetine
32
Unique Side effect SNRI
Increased blood pressure avoid with uncontrolled HTN Also Duloxetine has anticholingeric symptoms (anti SLUDGEM)
33
Drug interaction of Duloxetine
CYP1A2 inhibitors - Ciprofloxacin/fluvoxamine CYP2D6 inhibitors (like paroxetine)
34
Bupropion brand name , facts, side effects
Wellbutrin (2nd choice - after failure of SSRI), stops norepinephrine and dopamine SE: increased risk Sz, use in smoking cessation
35
Mirtazapine función
Pre-synaptic alpha 2 antagonist (increase NE and 5HT) | Sedation used for insomnia, weight gain
36
Trazodone function
Insomnia (use for)
37
Nefazodone BBW MOA
Liver toxicity BBW, potent CYP3A4 inhibitor
38
Trycyclic antidepressants side effects
Anticholenrgic (esp Amitriptyline) Narrow therapeutic index (Amitriptyline 4x critical value: 125-250 Crit=500) GI
39
TCA overdose management
Sodium bicarbonate
40
MAOi side effect
``` Hypertensive crisis (Also orthostatic hypotension, CNS, weight gain) ```
41
Serotonin Syndrome symptoms that differentiate it
Agitation, diaphoresis, increased bowel sounds (diarrhea, N/V)
42
Serotonin syndrome management the serotonin antagonist
Cyproheptadine: not IV, emergent NG tube
43
Trend of remission rates based on treatment
Gradual downward trend as you switch agents
44
Geriatric Beer's list problems and drugs that cause them
Anti-cholinergic: TCA, paroxetine Chronic seizures: bupropion SIADH: SSRI (fluoxetine, paroxetine) Constipation and urinary retention are common side effect
45
Fluoxetine
Prozac
46
Special side effect of fluoxetine
Hyponatremia
47
What specific drug interaction was indicated with fluoxetine/Prozac?
With clopidogrel Fluoxetine is a cyp2c19 inhibitor and clopidogrel is a prodrug that needs activated so clopidogrel won't work w lol
48
What to drugs can increase the potential risk of breast cancer relapse?
Peroxetine aka Paxil and fluoxetine aka Prozac
49
What second-generation antipsychotics are FDA approved as adjuncts for resistant depression?
Aripiprazole brevipiprazol and quetiapine
50
What to second-generation antipsychotics or after he proved for treatment of resistant depression
Olanzapine and fluoxetine
51
What antidepressant medications are on the beers list?
All anti-cholinergics such as TCAs and paroxetine Bupropion SSRIs such as fluoxetine and paroxetine
52
Sertraline
Zoloft
53
Paroxetine
Paxil
54
What are specific side effects for PAROXETINE?
It is an SSRI so they will have complaints possibly of nausea vomiting dry mouth, suicidal ideation Specifically: sedation , anti-cholinergic side effects, hyponatremia
55
Citalopram
Celexa
56
Dosing of citalopram/Celexa?
The max dose is 40 mg per day due to the blackbox warning risk of QTC prolongation
57
Escitalopram
Lexapro
58
What SSRI is only indicated for OCD?
Fluvoxamine/Luvox
59
Luvox them in
Luvox
60
What SSRIs need to be monitored for QTC prolongation? 2
Citalopram/ceLexa EsCitalopram/Lexapro
61
Venlafaxine
SNR I Effexor
62
Duloxetine
Snri Cymbalta
63
Which SNR I needs to be monitored for intake ant cholenergic symptoms and liver toxicity?
Duloxetine/cymbalta
64
What SNR I is mostly used for chronic musculoskeletal pain?
Duloxetine/Cymbalta
65
What SNR I is used of the label for diabetic neuropathy?
Venlafaxine

Behavioral Medicine (9 decks)

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