Antidepressant Pharm Flashcards
(26 cards)
8 conditions to remember that indicate antidepressants?
MDD, several types of anxiety, PTSD, Panic Disorder, OCD, Seasonal Affective Disorder, Premenstrual Dysphoric Disorder, Disruptive Mood Disorder.
What is the primary MOA of antidepressants?
They are trying to increase the level of serotonin or NE
Usually, do this by blocking the re uptake of these NTs
What are the 5 families/classifications of antidepressants?
SSRIs, SNRIs, TCAs, MAOIs, Atypical antidepressants
MOA of SNRIs?
What are SNRIs also effective in treating besides depression that SSRIs are not and give 4 examples?
Block serotonin re uptake via SERT and NE re uptake via NET
Chronic pain symptoms in conditions like diabetic neuropathy, postherpetic neuralgia, fibromyalgia and low back pain.
What is the MOA of SSRIs?
what are they the drug of choice for?
What 3 receptors do SSRIs have very little effect on?
Selectively inhibit re uptake of serotonin via SERT and a little bit of NE re uptake blocking, but mostly serotonin.
Depression
Histamine, muscarinic and adrenergic
4 more common side effects of SSRIs?
3 rare but serious adverse effects of SSRIs?
What serious side effects is seen in kids/teens/YA?
CNS problems, sexual dysfunction, weight gain in adults and weight loss in teens, acute withdrawal reaction, GI effects
QT prolongation, hyponatremia, and serotonin syndrome
Suicide
3 distinct features of neuroleptic malignant syndrome and what drug precipitates it?
4 distinct features of serotonin syndrome?
Hypo reflexia, normal pupils, and normal or decreased bowel sounds…dopamine agents
Hyperreflexia, clonus dilated pupils and hyper active bowels
What two other drug families, if combined with antidepressants, can cause serotonin syndrome?
Opioids and migraine meds
Fluoxetine and paroxetine are strong inhibitors of what?
Citalopram and setraline are weak inhibitors of what?
CYP 450
Paroxetine and fluvoxamine are used in patients with what and why?
Fluoxetine or sertraline are used in patients with what and why?
Insomnia because they are more sedating than activating when treating depression
Patients who are fatigued because they are more activating than sedating
Bupropion or mirtazapine are good to use in patients with depression with what?
If patients are experiencing sexual dysfunction, these two are good to switch to.
Fluoxetine, Sertraline and fluvoxamine is approved to treat what in kids?
Fluoxetine and Escitalopram is approved to treat what in kids?
OCD
Depression
What is the MOA of TCAS?
What 3 other receptors do TCAS block?
Amoxapine blocks which additional receptor?
Block re uptake or serotonin and NE
Histamine, muscarinic and adrenergic
Dopamine
Indication for amitrityline?
What other antidepressant family should not be given with amitriptyline?
Back box warning?
Drug interaction?
Depression, it is sedative
MOAI
Suicide
Cyp 450 2d6
4 actions/effects of TCAs?
Elevate mood
Improve mental alertness
Increase physical activity
Reduce morbid preoccupation
3 C’s of toxic ingestion of TCAs?
Coma, cardiotoxicity (conduction abnormalities), and convulsions
3 CV side effects of TCAs because of adrenergic interaction?
3 anticholinergic side effects of TCAs?
2 CNS effects because of blocking histamine?
Tachycardia, orthostatic hypotension, dysrhythmias
Dry mouth, urinary retention/constipation, blurred vision
Sedation and dizziness
What is the black box warning for Amoxapine?
Suicide and worsening of depression in patients with MDD
MOA of bupropion?
2 clinical uses?
Weak dopamine and NE re uptake blocker
Depression and withdrawal symptoms of nicotine
MOA of mirtazapine?
Clinical use?
One common effect?
Enhances serotonin and NE transmission by blocking alpha 2 and
Also blocks 5ht2 receptors
Depression
Sedation because of antihistamine activity, but no anti muscarinic activity or sexual dysfunction
MOA of vilazodone and Vortioxetine?
Serotonin re uptake inhibitor
What do the following three atypical antidepressants have in common?
Mirtazapine, nefazodone, and trazodone?
Sedative
Effect of using a MOAI, basically the MOA and then effect?
Clinical use of MAOIs?
Irreversible blocks MOA increasing NE, dopamine, and serotonin
Depression when there other ones don’t work or allergy issues and anxiety.
What are the 5 R’s of general antidepressant efficacy? Response? Remission? Recovery? Relapse? Recurrence?
Greater than 50% reduction in symptoms, partial response is between 25% and 50% reduction
Symptom free
2-6 months of ongoing remission
Return of symptoms after remission but before recovery
Return of symptoms after recovery
