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Antidepressant Meds Flashcards

(54 cards)

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1
Q

Name the different classes of Antidepressants

A
  • Tricyclic Antidepressants (TCAs)
  • Monoamine-oxydase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
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2
Q

The Biogenic Amine Hypothesis states that depression is caused by a deficiency of _________, particularly ___________ and ________

A

monoamines, noradrenaline and serotonin

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3
Q

Parts of the brain affected by depression

A

Amygdala
Cerebral Cortex
Hippocampus
Thalamus

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4
Q

People who suffer from recurrent depression have a significantly smaller __________, the brain region associated with forming new memories

A

hippocamps

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5
Q

___________ is when drug elimination is proportional to its concentration or a percentage of the drug is eliminated each hour. (ex: antibiotics)

A

First order biotransformation

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6
Q

___________ drug metabolized at a specific rate regardless of the concentration or elimination. (ex: alcohol)

A

Zero order biotransformation

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7
Q

After 1st half life, ___ of drug remains in system. After 2nd half life, ____ drug remains in system. After 3rd half life, ____ drug remains in system.

A

50%, 25%, 12%

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8
Q

___ half lives must pass before a single dose of a chemical is eliminated

A

5

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9
Q

Facts about TCAs

A
  • Inhibit or block active reuptake of norepinephrine
  • Sedative effects are attributed to antihistaminic action (H1) receptors
  • TCAs absorbed from the GI tract
  • Largely metabolized by first pass metabolism
  • Highly lipophilic (concentrated in heart and brain)
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10
Q

TCAs effects

A
  • Appetite returns after 5-7 days
  • Insomnia improves after 3-4 days
  • Takes 10-14 days to act
  • Full effect may take 6 weeks
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11
Q

Two major mistakes in prescribing TCAs

A
  • Inadequate dose

- Inadequate time allowed for functioning

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12
Q

Name the meds that are safe to prescribe for depression in elderly

A

SSRIs & buproprion, mirtazapine, moclobemide, &venlafaxine. Advantage is lower anticholinergic effects & are thus well tolerated by patients with cardiovascular disease

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13
Q

Side effects of TCAs

A
  • Anticholinergic effects
  • Cardiac arrhythmia
  • Orthostatic hypertension
  • Hypertension
  • Sedation
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14
Q

Name the Tricyclic Antidepressants (TCAs)

A 
Amitriptyline - Elavil
Desipramine - Norpramin
Doxepin - Sinequan
Imipramine - Tofranil
Nortripyline - Aventyl, Pamelor
Protriptyline - Vivactil
Trimipramine - Surmontil
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15
Q

Facts about MAOIs

A

Interferes with MAO-A & MAO-B

Superior to TCAs in atypical depression

MAOIs successfully treat 55-70% of depression

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16
Q

Which MAOI does not appear to have a high risk for inducing mania?

A

Tranylcypromine (Parnate)

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17
Q

Name the MAOIs

A

Phenelzine - Nardil
Tranylcypromine - Parnate
Isocarboxazid - Marplan
Selegiline - Emsam

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18
Q

A serotonergic crisis occurs when you combine a _____ with a _____

A

MAOI and SSRI

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19
Q

How does the body respond to a serotonergic crisis?

A

Elevated temp, fever

Abnormal muscle movements, twitches, myclonic jerking muscles

Autonomic dysreflexia - overreaction of the involuntary (autonomic) nervous system to stimulation

Rarely - generalized seizure

Possible effects
- hypotension
- anxiety & agitation
- shivering
- enhanced startle response
- insomnia
confusion & delirium
- Shock
- Death
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20
Q

A noradrenergic crisis emerges from combining _____ with ______, tyramine containing foods, stimulants such as ephedrine, pseudoephedrine, phenylephrine, phenylpropanolamine

A

MAOIs with TCAs

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21
Q

Side effects of noradrenergic crisis

A

Hypertension

Occipital headache

Stiff or sore neck

Flushing or sweating

Cold clammy skin

tachycardia

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22
Q

If noradrenergic crisis is severe, you may see

Study These Flashcards
A

Sudden unexplained nosebleeds

Dilated pupils, visual disturbance

Photophobia

Chest pain

Stroke/coma/death

23
Q

_______ (SSRI) appears to cause the most sedation

24
Q

______ (SSRI) causes the most GI upset

25
_________ (SSRI) causes the most short-term weight loss and activation (e.g., anxiety and agitation)
fluoxetine
26
Name SSRIs and dosage range
Floxetine - Prozac 20-60 mg children - 5-10mg Paroxetine - Paxil 10-60 mg Sertraline - Zoloft 50-150 mg Citalopram - Celexa 40-60 mg Escitalopram oxalate - Lexapro 10-20 mg Vilazodone hydrochloride -Viibryd 10-40 mg Vortioexitine - Brintellix 10-40 mg Fluvoxamine - Luvox 100-300mg
27
______ (SSRI) helps overweight client, has a long half life, may causes immediate worsening of depression
Fluoxetine (Prozac)
28
What does Prozac treat?
- MDD - OCD - Moderate to severe bulimia nervosa - panic disorder - In Jan 2003, prozac was approved by the FDA for the tx of depression and OCD in children and adolescents who are 7 to 17 years of age
29
Which SSRI is lowest in anorexia, has half life of 26 hrs (so unlikely to build up), low mania induction in bipolar, causes dryer mouth than other SSRIs, can cause somnolence
Sertraline (Zoloft)
30
FDA approves zoloft for:
- MDD - OCD - Panic disorder PTSD - Premenstrual dysphoric disorder in adulta (PMDD) (newest indicatin) - social anxiety disorder
31
FDA approves Paroxetine (paxil) for:
``` OCD Depression Panic disorder Generalized anxiety disorder PTSD Social phobia ```
32
_______ (SSRI) is not well tolerated by clients with severe anxiety symptoms
Citalopram (Celexa)
33
Citalopram (Celexa) is approved for:
MDD | Depression
34
Which SSRI may take 4 or more weeks to act, has the active isomer of the antidepressant citalopram, and has a recommended dose of 10mg daily?
Escitaloram oxalate (Lexapro)
35
FDA approves Escitalopram (Lexapro) for:
MDD | GAD
36
Which SSRI is used to treat MDD, has a recommended INITIAL dose of 40 mg/day, and then treatment should be titrated, starting with an initial dose of 10mg/day for 7 days, followed by 20 mg/day for an additional 7 days, and then an increase to 40 mg/day
Vilazodone hydrochloride (Viibryd)
37
_______ (SSR) is a serotonin modulator and simulator, is specificially indicated for MDD, recommended dose is 10 mg, and then should be increased to 20 mg/day.
Vortioxetine - Brintellix
38
Name the SNRIs (5):
``` Venlafaxine - (Effexor) 75 to 225 mg Venlafaxine (Effexor XR) Duloxetine (Cymbalta) 20 to 60 mg Mirtazapine - (Remeron) 15 to 45 mg Desvenlafaxine - (Pristiq) 50 to 400 mg ```
39
What was the first SNRI to be marketed in the US and was approved by the FDA in 1993?
Venlafaxine (Effexor)
40
Venlafaxine (Effexor) is effective in treating what?
Geriatric and melancholic depression
41
_________ is used to treat MDD and GAD and is also used to treat a chronic pain disorder called fibromyalgia and to treat pain caused by nerve damage in persons with diabetes (neuropathy) and other diseased characterized by neuropathy
Duloxetine (Cymbalta)
42
______ should NOT be taken with thioridazine (Mellaril) or a MAOI
Duloxetine - Cymbalta
43
____ was the 3rd SNRI approved by the FDA in Feb 2008
Pristiq
44
The recommended dose for Pristiq is _____ once daily.
50 mg
45
__________ was approved by the FDA in 2013 for MDD
Fetzima
46
______ is NOT approved for use in children under 18
Pristiq
47
Name the atypical antidepressants:
``` Bupropion (Wellbutrin) Nefazadone (Serzone) Clomipramine (Anafranil) Trazadon (Desyrel) Mirtazapine (Remeron) Brexipiprazole - Rexulti ```
48
______ is specifically for OCD and is used with panic & phobias
Clomipramine - Anafranil
49
_______ is used commonly for persons with insomnia and may be prescribed for withdrawal from cocaine
Trazadon-Desyrel
50
_______ major drawback is that it is associated with increased hunger and weigh gain, but less likely to cause nausea, vomiting or sexual dysfunction
Mirtazapine - Remeron
51
_______ has side effects like abnormal dreams, abnormal thinking
Remeron
52
________ is a parenterally administered, general anesthetic used largely for short term diagnostic & surgical procedures. Limited in use because of psychological side effects includeing vivid hallucinations, agitation & confusion.
Ketamine. Sometimes called Special K, Kit Kat, Super Acid, Purple
53
________ is a fast-acting antidepressant that relieves depressive symptoms in hours instead of weeks. FDA granted approval for nasal spray in 2019.
Esketamine
54
__________ can be used in conjunction with an oral antidepressant, was approved for depression tx in adults who have tried other antidepressant meds but have not benefitted from them
Esketamine

Psychosocial Rehabilitation (3 decks)

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