selectively inhibit the reuptake of 5-HT. Specifically, they block the serotonin transporter increase synaptic 5-HT changes in regulation of 5-HT receptors delayed onset of action neuronal platicity (synaptic changes & neurogenesis) may cause changes in neuronal circuitry

SSRI AE Contraindications

AE sexual dysfunction weight gain nausea suicidal ideation controversial in juvenile depression energy comes back before mood withdrawl fluoxetine is least likely neonatal withdrawl Contraindication w/ MAOI - serotonin syndrome any drug that inhibits SSRI metabolism fluoxetine w/ ritonavir paroxetine during pregnancy

MOA block serotonin transported or NE transporter or both (ratios vary) delayed onset of action neuronal plasticity AE Block: Histamine receptors drowsiness Muscarinic receptors dry mouth, blurry vision, constipation, urine retention, recumbent tchycardia & memory impairment alpha1 adrenergic recetors on BV orthostatic hypotension Diaphoresis Cardiac toxicity (decrease vagal influence & act at bundle of His) Seizures (lower t hreshold) Hypomania CI w/ MAOI hypertensive crisis (TCA block NE reuptake & MAOI cause accumulation NE -\> excessive adrenergic stimulation)

MOA inhibit monoamine oxidase A & B AE hypertensive crisis from dietary tyramine "cheese reaction" combo w/ other drugs TCA, ephedrine, methylphenidate, amphetamine, cocaine, cold remedies CNS stimulation (anxiety, hypomania) Orthostatic hypotension

Antidepressant Treatment Flashcards by Katherine E Nordstrom

Which is the only class of drugs approved to treat juvenile depression?

SSRI

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SSRI

MOA

selectively inhibit the reuptake of 5-HT. Specifically, they block the serotonin transporter
- increase synaptic 5-HT
- changes in regulation of 5-HT receptors
delayed onset of action
- neuronal platicity (synaptic changes & neurogenesis)
- may cause changes in neuronal circuitry

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What is the only antidepressant that does not have a delayed onset of action?

ketamine

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SSRI

Contraindications

AE
- sexual dysfunction
- weight gain
- nausea
- suicidal ideation
  - controversial in juvenile depression
  - energy comes back before mood
- withdrawl
  - fluoxetine is least likely
  - neonatal withdrawl
Contraindication
- w/ MAOI - serotonin syndrome
- any drug that inhibits SSRI metabolism
  - fluoxetine w/ ritonavir
- paroxetine during pregnancy

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What are the symptoms in serotnin syndrome?

Treatment?

Symptoms
- agitation, confusion, disorientation, anxiety, hallucinations & poor concentration, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor & fever
- death
Treatment
- resolves on discontinuation of the drugs

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What SSRI is contraindicated during pregnancy?

paroxetine

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What SSRI carries the least risk of causing withdrawl up on stopping treatment?

fluoxetine

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SNRI - name & indication

MOA?

AE?

CI?

Venlafaxine, Duloxetine, desvenlafaxine, levomilnacipran
- depression, generalized anxiety disorder, social anxiety disorder
MOA
- inhibit reuptake of 5-HT & NE
- does NOT block ACh, H, or a1 receptors
AE
- nausea, headache, sexual dysfunction
CI
- w/ MAOI

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List the SSRIs & provide the indications

Drugs
- Fluoxetine
- sertraline
- paroxetine
- fluvoxamine
- citalopram
- escitalopram
Indications
- Depression
- Juvenile depression
- Anxiety

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List the TCAs & provide the indications

Drugs
- Imipramine & Desipramine
Indications
- depression
- depressive phase of bipolar disorder
- neuropathic pain
- ADHD
- panic disorder
- obsessive complusive disorder
- chronic insomnia

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TCA

MOA?

AE?

CI?

MOA
- block serotonin transported or NE transporter or both (ratios vary)
- delayed onset of action
  - neuronal plasticity
AE
- Block:
  - Histamine receptors
    - drowsiness
  - Muscarinic receptors
    - dry mouth, blurry vision, constipation, urine retention, recumbent tchycardia & memory impairment
  - alpha1 adrenergic recetors on BV
    - orthostatic hypotension
- Diaphoresis
- Cardiac toxicity (decrease vagal influence & act at bundle of His)
- Seizures (lower t hreshold)
- Hypomania
CI
- w/ MAOI
  - hypertensive crisis (TCA block NE reuptake & MAOI cause accumulation NE -> excessive adrenergic stimulation)

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What are the symptoms in hypertensive crisis?

Treatment?

Symptoms
- Tachycardia, palpitations, nausea, vomiting
Treatment
- hypertension treated with IV phentolamine (alpha antagonist)
- or sublingualnifedipine (Ca²⁺ channel blocker)

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What are the MAOIs & what are the indication for thier use?

Drugs
- Tranylcypromine
- phenelzine
- isocarboxazid
Indication
- depression, second line
- patients with atypical depression

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MAOI

MOA?

AE?

CI?

MOA
- inhibit monoamine oxidase A & B
AE
- hypertensive crisis from dietary tyramine
  - “cheese reaction”
- combo w/ other drugs
  - TCA, ephedrine, methylphenidate, amphetamine, cocaine, cold remedies
- CNS stimulation (anxiety, hypomania)
- Orthostatic hypotension

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Buproprion belongs to what class?

Indication?

MOA?

AE?

CI?

Atypical antidepressant
Indication
- depression
- counters sexual dysfunction when used wiht SSRI
- hypoactive sexual disorder in women
MOA
- block DA uptake
AE
- reduces seizure threshold
Drug interactions
- w/ MAOI

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Mirtazapine belongs to what class?

Indication?

MOA?

AE?

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Indication
- depression
  - well tolerated alternative to SSRI
  - may counter sexual dysfunction when used with SSRI
- hyopacive sexual disorder in women
MOA
- alpha-2 adrenergic antagonist (may act more rapidly)
AE
- blocks Histamine receptors
- drowsiness & weight gain

Vilazodone belongs to what class?

Indication?

MOA?

AE?

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Atypical Antidepressant
Indication
- second line drug - patients that cannot tolerate TCAs
- combined with another drug for antidepressant induced insomnia
- sedative, may be used for sleep
MOA
- blocks 5-HT reuptake (transporters)
- serotonergic antagonist for most 5-HT receptors
- 5-HT_1A partial agonist
AE
- sedation
- orthostatic hypotension
- nausea
- dry mouth
- priapism

Vilazodone belongs to what class?

Indication?

MOA?

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Atypical antidepressant
Indication
- depression
MOA
- blocking serotonin reuptake through serotonin transporter
- partial agonism of 5-HT_1A presynaptic receptors

Vortioxetine belongs to what class?

Indication?

MOA?

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atypical antidepresant
indication
- depression - may be helpful for cognitive deficits
MOA
- SSRI
- 5-HT_1A full agonist and 5-HT₃ receptor antagonist

What are the atypical antipsychotics?

Indication (with relation to depression)

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Drugs
- Aripiprazole
- quetiapine
- olanzapine & fluoxetine
Indication
- adjunct for patients not adequately responding to SSRI

Symbyax - combo Olanzapine & Fluoxetine

Indication?

AE?

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Indications
- antipsychotic adjuncts for treatment resistand depression
AE
- anticholinergic effects
  - olanzapines antagonism M1-5 receptors
- somnolence
  - olazapines antagonism of H1 receptors
- orthostatic hyoptension
  - olazapines antagonism of alpha1-adrenergic receptors

What is the rapid acting antidepressant?

Indication?

MOA?

AE?

Risks?

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Esketamine nasal spray
Indication
- treatment resistant depression
MOA
- unknown - ketamine is an NMDA receptor antagonist
AE
- sedation, dissociation, BP increase (most within 2 hrs)
Risks
- Risk evaluation & mitigation strategy (REMS)
- only in setting when can be monitored for 2 hrs

What are the indications for Electroconvulsive therapy?

MOA?

AE?

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Indication
- failed to respond to 2 pharmacotherapies
- severely depressed suicidal patients who need rapid relief from symptoms
MOA
- unknown - changes neuronal circuitry
AE
- short term memory loss
- transient impairment of cognitive funcion
- long term memory seems intact

What is the first line treatment for PTSD?

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SSRI
adjunct for nightmares - prazosin
MOA
- centrally & peripherally acting a1-adrenergic antagonist
AE
- orthostatic hypotension

What are the first line drugs for bipolar disorder?

* Lithium * indication - euphoric mania & long term prophylaxis * Valproate * indication * - dysphoric mania or true mixed mania * rapid cycling * MOA * sodium channel modulator / blocker * AE * thrombocytopenia * pancreatitis * liver failure

Second & Third line treatment for Bipolar Disorder?

* Atypical Antipsychotics for manic phase (adjunct or monotherapy) * ; olanzapine * Antidepressants for depressive phase * SSRI, risperidone, atypical antipsychoitics (but buproprion, clozapine, venlafaxine)

Which atypical antipsychotics are **not** indicated in bi-polar disorder?

buproprion, clozapine, venlafaxine

Which SSRI is the most selective

Escitalopram | (will cause the least AE)

Antidepressant Treatment Flashcards

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