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Flashcards in Antidepressant medications Deck (110)
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1

How do antidepressants work?

Block reuptake pump (serotonin transporter OR NE transporter)
This leads to increased levels of neurotransmitters in snyapse

2

What causes receptors to down-regulate?

Increased level of SERT or NT in synapse

3

What do antidepressants impact?

Gene expression

4

When are MAOIs CI'd?

SSRIs
SNRIs
TCAs
Sympathomimetics
Levadopa (d/t risk of HTN crisis)
Foods containing tyramine

5

When are MAOIs used?

MDD
Treatment resistant depression

6

Why are MAOIs not used anymore?

Newer safer options

7

How do we counsel patients on MAOIs?

Signs of HTN crisis, foods to avoid

8

What pumps do TCAs work on?

Serotonin
NE
Dopamine

9

What receptors do TCAs work on?

Muscarinic cholinergic
Histamine-1
Alpha-1

10

Where do TCAs block sodium channels?

Heart and brain (OD potential)

11

What are TCA OD sx?

Cardiac arrhymthias
Hypotension
Seizures
Coma Death

12

When do we avoid TCAs?

Patients with current suicidal ideations or h/o suicidal ideations or attempts

13

What is the MOA of MAOIs?

Nonselective and irreversible inhibitor of:
MAO A: serotonin and NE
MAO B: dopamine

14

Are TCAs considered "me too" drugs?

No

15

What levels should be checked with TCAs?

Blood levels for toxicity (not TDM)

16

What happens if there is abrupt withdrawal of TCAs?

Cholinergic rebound

17

What is the MOA for SSRIs?

Selective and potent inhibition of serotonin reuptake
Minor actions on other receptors, which accounts for differences in agents

18

What are TCAs?

Amitriptyline
Nortriptyline
Imipramine
Desipramine
Doxepin

19

What are MAOIs?

Phenelzine
Tranylcypromine
Selegiline

20

Which TCA is the most anticholinergic?

Amitriptyline

21

What is the management of acute phase agitation, anxiety, panic attacks, akathisia, "jitteriness syndrome"?

New onset: Decrease SSRI/SNRI to lower dose, titrate more slowly

22

What SEs do serotonin cause in the limbic cortex?

Agitation
Anxiety
Panic attacks
Akathisia
Jitteriness syndrome
Insomnia

23

What is the management of acute phase insomnia?

Take dose in morning

24

What SEs does serotonin cause in the brainstem?

Nocturnal awakenings/sleep disturbances

25

What is the management of nocturnal awakenings/sleep disturbances?

Decrease dose, take dose in AM

26

What are the SEs of serotonin in the spinal cord?

Sexual dysfunction

27

What is the management of acute phase sexual dysfunction?

Waiting 2-8 weeks for spontaneous remission
Decrease dose
Switching to a different SSRI/non-SSRI antidepressant

28

What are the SEs of serotonin on the hypothalamus or brainstem?

HA
Nausea/vomiting
Reduced appetite
Wt loss

29

What is the management of acute phase HA?

Watch and monitor, consider APAP PRN
May consider switching to a different agent

30

What are the SEs of serotonin on the GI tract?

GI distress - increased bowel motility, cramps, and diarrhea