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Flashcards in Antidepressant Drugs Deck (87):
1

NT involved in MDD

serotonin
NE
DA

2

brain structures involved in MDD and their roles

amygdala- higher activity
hippocampus- smaller = issues with long term memory and recollection

3

effects of antidepressants

increase in libido, concentration, energy, mood
decrease in anhedonia, hopelessness

4

risk of using antidepressants in bipolar disorder

cause switch to mania

5

antidepressants best for bipolar disorder

SSRI
bupropion

6

4 theories of how antidepressants work

monoamine hypothesis
permissive hypothesis
dysregulation
post synaptic receptor sensitivity hypothesis

7

monoamine hypothesis

decrease 5HT and DA synaptic concentrations
*doesn't explain lag in effect

8

permissive hypothesis

5HT- mood expression
NE- mood type
depresssed- low 5HT and NE
mania- low 5HT and high NE

9

dysregulation

NT are out of whack leading to pre/post changes

10

post synaptic receptor sensitivity hypothesis

up regulation of receptors when monoamines are low
down regulation of receptors when monoamines are high/normal

11

3 ways of achieving balance of NT

enzyme inhibition
reuptake inhibition
receptor blockage

12

class using enzyme inhibition

MAOI

13

class using reuptake inhibition

TCA
SSRI
SNRI
vilazodone
bupropion

14

class using receptor blockage

mirtazapine
trazodone
nefazodone

15

first line treatment for depression

SSRI

16

Drugs that inhibit SERT

SSRI
SNRI
TCA

17

SSRI advantages

few side effects
few interactions
safe
once daily dosing

18

SSRI in order of decreasing half life

fluoxetine
sertraline
citalopram
escitolpram
paroxetine
fluvoxamine

19

fluoxetine

SSRI
active metabolite- norfluoxetine
VERY long half life (1-3 days)
2D6 inhibitor

20

sertraline

SSRI
active metabolite
2D6 substrate

21

citalopram

SSRI
2D6 substrate

22

paroxetine

SSRI
2D6 inhibitor

23

escitolpram

2D6 inhibitor

24

fluvosamine

SSRI
shortest half life (1d)
cyp inhibitor
used mainly for OCD

25

SSRI with 2D6 interactions

fluvoxamine
fluoxetine
sertraline
citalopram

26

SSRI drug interactions

clozapine
fentanyl
hydrocodone
methadone
tamoxifen
tramadol

27

SSRI ADR

NVD
anorexia
delayed ejaculation
anorgasmia
insomina/sedation
temp increase in anxiety
headache

28

SSRI major drug interactions

MAOI

29

serotonin syndrome

too high serotonin from combo of drugs that increase serotonin
autonomic instability
rigidity
fever
stupor
death

30

treatment of serotonin syndrome

stop SSRI
benzodiazepines
short acting drugs for BP control
non depolarizing neuromuscular blocker
intubation

31

SNRI MAO

SERT and NET inhibition

32

SNRI drugs

venlafaxine
desvenlafaxine
duloxetine
milnacipran

33

venlafaxine dose info

SNRI
prodrug- active form desvenlafaxine
dose dependent effects
low dose- SERT inhibition
mid dose- NET inhibition
high dose- DA reuptake inhibition

34

ADR venlafaxine

HTN
sweating

35

duloxetine dose

SNRI
low dose- SERT and NET inhibition

36

duloxetine use

SNRI
diabetic peripheral neuropathy
fibromyalgia
pain

37

milnacipran use

SNRI
prodrug for fibromyalgia

38

venlafaxine

SNRI prodrug

39

duloxetine

SNRI

40

milnacipram

SNRI prodrug

41

milnacipran use

fibromyalgia

42

levomilnacipran

SNRI
active form of milnacipran

43

levomilnacipran use

antidepressant

44

MAOI drugs

phenelzine
tranylcypramine
selegiline

45

phenelzine selectivity

MAO nonselective

46

tranylcypramine selectivity

MAO nonselective

47

selegiline selectivity

MAO B

48

selegiline use

low dose transdermal for parkinson's

49

MAOI ADR

tyramine effect
serotonin syndrome
orthostatic hypotension

50

tyramine effect

increased circulating tyramine increases NE levels which leads to HTN crisis

51

symptoms of tyramine effect

bad headache
neck pain
sweating
HTN
intracerebral hemorrhage

52

MAOI drug interactions

linezolid- antibiotic
anything that increases serotonin/NE

53

TCA

tricyclic antidepressants

54

TCA MOA

SERT and NET inhibition

55

other receptors affected by TCA

histamine H1
alpha
muscarinic

56

effects of TCA via histamine receptor

sedation
weight gain
hypotension

57

effects of TCA alpha receptor

orthostatic hypotension
dizziness
reflex tachycardia

58

effects of TCA muscarinic

dry mouth
blurry vision
constipation
urinary retention
dizziness
delirum

59

effects of TCA overdose

respiratory depression
arrhythmia

60

TCA secondary amines

desipramine
nortriptyline

61

desipramine

TCA secondary amines

62

nortriptyline

TCA secondary amine

63

TCA tertiary amines

amitriptyline
imipramine
clomipramine

64

amitryptyline

TCA tertiary amine

65

imipraminne

TCA tertiary amine

66

clomipramine

TCA tertiary amine

67

SARI

serotonin antagonist and reuptake inhibitor

68

SARI drugs

trazodone
nefazodone

69

trazodone receptors

5HT2a*
5HT2c
alpha1

70

high dose trazodone

5HT2a + SERT for depression

71

low dose trazodone

5HT2a for insomnia, PTDS

72

benefits of trazodone

avoids:
sexual dysfunction
sedation
anxiety

73

ADR of trazodone

sedation
dizziness
rare priapism

74

nefazodone receptors

5HT2a, 5HT1a, alpha1, NET inhibition

75

ADR nefazodone

hepatotoxic
cyp inhibitor

76

vilazodone MOA

SERT inhibition
5HT1a partial agoinst

77

bupropion MOA

DA and NE reuptake inhibitor
AChN antagoinst

78

bupropion use

with SSRI for sexual dysfunction
smoking cessation

79

hydroxybupropion

active metabolite of bupropion similar to amphetamine

80

effects of bupropion

agitation
anxiety
restlessnes

81

use of bupropion

psychomotive retarded depression
hypersomina
if concerned about weight gain

82

bupropion ADR

insomnia
constipation
dry mouth
seizures

83

contraindications bupropion

eating disorders
epilepsy

84

NaSSA

noradrenergic and specific serotonergic antidepressant

85

mirtazapine

NaSSA

86

mirtazapine MOa

alpha2 antagoinst- increase 5HT and NE release
5HT2/3 antagoinst- blocks DA and NE release in reward area
H1 antagonist=- sedation, weight gain

87

drugs with minimal interactions

sertraline
escitalopram
venlafaxine
mirtazapine