Antidepressants Flashcards

(73 cards)

1
Q

Donepezil

A

Cholinesterase inhibitor

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2
Q

Methylphenidate:

A

Class = Stimulant

Indications = ADHD // Demoralization

Side Effects = Tics in children //

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3
Q

Duloxetine:

  • Class
  • Indications
  • Side Effects
A

Class:
- SNRI

Indications:

  • Depression
  • GAD
  • Diabetic Neuropathic Pain
  • Fibromylagia

Side Effects

  • Increased suicidality
  • Liver-related side effects
  • Dry Mouth
  • Constipation
  • Other SSRI symptoms
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4
Q

Bupropion

  • Class
  • Indications
  • Side Effects
  • Pros
  • Contraindications:
A

Class =
- NE-DA Reuptake Inhibitors

Indications =

  • Depression
  • Smoking cessation aid
  • Adult ADHD
  • Adjunt antidepressant to SSRI

Side Effects =

  • Insomnia
  • Headache
  • Increased risk of seizures at high doses
  • Increases risk of psychosis at high doses
  • Increased risk of anxiety at high doses

Pros =

  • Does not cause sexual dysfunction
  • Does not cause weight gain

Contraindications =

  • Hx of seizures
  • Active eating disorder (can cause weight loss)
  • Currently using an MAOi
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5
Q

Clonidine
- Class

  • Indications
  • Side Effects
A

Class = Alpha-2 Agonist

Indications =

  • Tourette’s
  • ADHD
  • Panic Disorder
  • GAD
  • Hypertension
  • Treatment of HTN and other sx during opiate withdrawal

Side Effects =

  • Sedation
  • Dry mouth
  • Hypotension
  • Dizziness
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6
Q

Sertraline:
- Class

  • Indications
  • Side Effects
  • Drug interactions?
A

Class = SSRI

Indications =

  • Depression
  • GAD
  • Panic Disorder

Side Effects =

  • Highest risk of GI of all SSRI
  • Sleep changes are common
  • Sex dysfunction
  • Nausea

Drug interactions =
- very few

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7
Q

Benzodiazepines:
- Indications

  • Side Effects
A

Indications:

  • acute relief of anxiety
  • EtOH withdrawal
  • Catatonia

Side Effects:

  • sedation
  • dependence
  • psychomotor retardation
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8
Q

Paroxetine
- Class

  • Indications
  • Side Effects
  • Half life
  • Drug interactions?
A

Class:
- SSRI

Indications:

  • Depression
  • obsessive-compulsive disorder
  • panic disorder
  • social anxiety
  • posttraumatic stress disorder
  • generalized anxiety disorder

Side Effects:

  • High degree of anticholinergic side effects
  • Withdrawal symptoms more likely

Half-life:
- very short, which causes the high incidence of withdrawal symptoms

Drug interactions
- common due to the fact that it is highly protein bound

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9
Q

Oxazepam
- Class

  • Indications
  • Side Effects
  • Perks
A

Class:
- Benzo

Indications:
- EtOH withdrawal

Side Effects:
- Sedation

Perks:
- not metabolized by liver, which means it can be used in chronically EtOHic patients with liver failure.

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10
Q

Alprazolam

  • Class
  • Indications
  • Side Effects
  • Pros:
  • Cons:
A

Class:
- Benzo

Indications:
- Acute anxiety relief

Side Effects:

  • Sedation
  • Dependency (high)

Perks:

  • Extremely fast onset and duration.
  • Therefore makes a great anxiolytic

Cons:
- the quick onset and short duration make it a prime candidate for developing dependence

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11
Q

Chlordiazepoxide

  • Class
  • Indications
  • Side Effects
  • Pros:
  • Cons:
A

Class:
- Benzo

Indications:

  • Acute anxiety relief (for longer term)
  • EtOH withdrawal relief

Side Effects:

  • Confusion
  • Constipation
  • Drowsiness
  • Fainting
  • Altered sex drive
  • Liver problems
  • Lack of muscle coordination
  • Minor menstrual irregularities
  • Nausea

Perks:

  • Slow onset
  • Long Duration
  • This makes it less likely to cause dependence

Cons:
- Slow onset, etc makes it not as good of an anxiolytic

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12
Q

Buprenorphine

  • Class
  • Indications
  • Side Effects
  • Pros
  • Cons
A

Class =
- Partial opiate agonist

Indications =
- Maintenance therapy for opiate withdrawal / recovery

Side Effects =

  • nausea and vomiting
  • drowsiness
  • dizziness
  • headache
  • perspiration
  • miosis
  • orthostatic hypotension
  • male ejaculatory difficulty
  • decreased libido
  • urinary retention.

Perks:
- Since it is a partial opiate agonist, there is less abuse potential than for methadone, and it will not cause respiratory depression.

Cons:
- It does not work as well as methadone

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13
Q

Imipramine

  • Class =
  • Indications =
  • Specific Side Effects =
A

Class =
- TCA (3º Amine)

Indications =

  • Panic Disorders
  • Enuresis

Specific Side Effects =
- Highly Anticholinergic

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14
Q

HAM Side Effects:

  • Define:
  • Which drugs have them?
A
  • anti-Histamine = sedation and weight gain
  • anti-Adrenergic = hypotension
  • anti-Muscarinic = Dry mouth, blurred vision, urinary
    retention
  • Seen in anti-psychotics
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15
Q

Serotonin Syndrome

  • Presentation =
  • Etiology =
  • Drugs which can cause it =
  • Treatment =
A
  • Confusion, flushing, diaphoresis, tremor, myoclonic jerks,
    hyperthermia, hypertonicity, rhabdomyolysis, renal failure,
    death.
  • Occurs when there is too much serotonin.
  • Caused by SSRI and MAOi–classically when they are
    given simultaneously.
  • Treatment is to stop the drugs.
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16
Q

Hypertensive Crisis

  • Pathophysiology =
  • Occurs when…
A
  • Caused by a build-up of stored catecholamines
  • Mixing MAOi’s with food with tyramine or with
    sympathomimetics.
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17
Q

Extrapyramidal Side Effects

  • Define =
  • Drugs causing them?
  • Reversible?
  • Onset?
  • Life Threatening?
A

Define:

  • Parkinsonism –> Masklike face; cogwheel rigidity; pill- rolling tremor
  • Akathisia –> restlessness and agitation
  • Dystonia –> Sustained contraction of muscles of neck, tongue, eyes, and diaphragm

Drugs:
- High potency typical antipsychotics

Reversibility:
- Reversible

Onset:
- within days of starting medication

Severity:
- can be life threatening due to dystonia of the diaphragm

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18
Q

Hyperprolactinemia:

- Drugs causing it =

A
  • High potency traditional antipsychotics

- Risperidone

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19
Q

Tardive Dyskinesia:

  • Define =
  • Drugs causing it =
  • Onset =
  • Reversibility =
A
  • Choreiform movements, typically of the mouth and tongue
  • Caused by high potency typical antipsychotics
  • Onset is usually years after long term antipsychotic use
  • Can be irreversible
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20
Q

Neuroleptic Malignant Syndrome:

  • Signs and Symptoms =
  • Lab findings =
  • Drugs causing it =
  • Onset =
  • Mortality rate =
A
  • Fever, tachycardia, HTN, tremor, lead pipe rigidity
  • Elevated CPK
  • Can be caused by any antipsychotic, but more commonly high potency typical antipsychotics
  • Can occur at any time during treatment course
  • 20% mortality rate
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21
Q

Important cytP450 inducers:

A
  • Smoking
  • Carbamazepine
  • Barbituates
  • St. John’s Wort
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22
Q

Important cytP450 inhibitors:

A
  • Fluvoxamine
  • Fluoxetine
  • Paroxetine
  • Duloxetine
  • Sertraline
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23
Q

Drugs which are known to exacerbate alzheimers:

A

Anticholinergic drugs

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24
Q

Major categories of antidepressants =

A
  • SSRI
  • SNRI
  • TCA
  • MAOi
  • Bupropion
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25
Differences and similarities between antidepressants:
They all have the same efficacy, but different safety profiles and side effects.
26
% of Depressed patients who will respond to antidepressants:
70%
27
Onset of effect with antidepressants =
Somewhere between 2-8 weeks
28
Withdrawal with antidepressants?
- There is a withdrawal response - Symptoms include: dizziness, headaches, nausea, and insomnia - Therefore some antidepressants will need to be tapered
29
Fluoxetine: - Class = - Half life = - Pregnancy? - Safe in kids? - Common side effects = - Common drug interactions =
- SSRI - Longest half-life (some formulations last 1 week) - Safe in pregnancy - Safe in kids - Common side effects include sleep disturbances and anxiety (as well as the other SSRI s/e) - Elevates plasma level of neuroleptics
30
Fluvoxamine - Class = - FDA approved for... - Most common side effects = - Drug Interactions?
- SSRI - Approved only for OCD - Nausea and vomiting are very common - MANY drug interactions
31
Citalopram - Class = - Drug interactions = - Pros in terms of side effects?
- SSRI - Fewest drug interactions - Fewer sexual side effects
32
Escitalopram - Class - Differences from Citalopram?
- SSRI - Levo-enantiomer of citalopram --> similar efficacy but fewer side effects - More expensive than citalopram
33
Side effects of SSRI compared to MAOi and TCA and why?
- Much fewer | - Due to 5HT selectivity you don't need to deal with the histamine and adrenergic side effects
34
Most common side effects of SSRIs:
- GI symptoms - Sexual dysfunction - Insomnia - Vivid dreams - Headache - Anorexia and weight loss - Restlessness - Seizures - Serotonin syndrome
35
Common causes of serotonin syndrome: How to avoid serotonin syndrome caused by SSRI + MAOi =
- SSRI + MAOi - SSRI + Triptans • SSRI should not be used for at least 2 weeks before or after the use of MAOi
36
Venlafaxine - Class = - Indications = - Drug interactions = - Contraindicated in patients with...
- SNRI - Depression, anxiety, ADHD - Few drug interactions - Contraindicated in patients with labile or high BP
37
Desvenlafaxine - Class
- SNRI | - This is the active metabolite of venlafaxine and it is the same but is more expensive.
38
Trazodone - Class = - Indications = - Side Effects = - Perks over SSRIs =
Class: - Serotonin receptor antagonists and agonist Indications: - Insomnia - Major depression - major depression with anxiety Side Effects: - Sedation - ***Priapism*** - Nausea - Dizziness - Orthostatic HTN - Cardiac Arrhythmias Perks over SSRI: - No Sex Dysfunction - No REM alterations
39
Nefazodone - Class = - Indications = - Side Effects = - Perks over SSRIs =
Class: - Serotonin receptor antagonists and agonist Indications: - Insomnia - Major depression - major depression with anxiety Side Effects: - ***Rarely serious liver failure*** - Sedation - Priapism - Nausea - Dizziness - Orthostatic HTN - Cardiac Arrhythmias Perks over SSRI: - No Sex Dysfunction - No REM alterations
40
Mirtazepine - Class = - Indications = - Side Effects = - Perks over SSRIs =
Class: - alpha-2 adrenergic antagonists Indications: - Refractory major depression Side Effects: - Weight gain - Agranulocytosis - Dry mouth - Constipation - Dizziness - Sedation Perks over SSRI: - No Sex Dysfunction
41
Tricyclic Antidepressants - MOA = - General indications = - General half-lives = - Side Effects =
MOA: - Inhibit reuptake of NE and 5HT--increasing monoamine availability in the synapse General indications: - Depression - Anxiety - Panic disorder - Pain disorders Half-lives: - generally long ``` Side Effects: - HAM side effects • H - weight gain, sedation • A - Orthostatic Hypotension • M - Anticholinergics - QT, QRS, PR interval prolongation - Seizures - Priapism - Falling in elderly patients ```
42
Amitriptyline - Class = - Indications = - Specific Side Effects =
Class = - TCA (tertiary amine) Indications = - Chronic Pain - Migraines - Insomnia Specific Side Effects = - HIGHLY anticholinergic
43
Tertiary Amines: - Most common examples: - Degree of anticholinergic effects: - Degree of sedation:
Most common examples: - Amitriptyline - Imipramine - Clomipramine - Doxepin Degree of anticholinergic effects: - HIGHLY Anticholinergic Degree of sedation: - HIGHLY Sedative
44
Secondary Amines: - Difference from tertiary amines: - Most common examples: - Degree of anticholinergic effects: - Degree of sedation:
Difference from tertiary amines: - Metabolites of tertiary amines Most common examples: - Nortriptyline - Desipramine Degree of anticholinergic effects: - Less anticholinergic Degree of sedation: - Less Sedative
45
Clomipramine - Class = - Indications = - Specific Side Effects =
Class = - TCA (Tertiary Amine) Indications = - OCD Specific Side Effects = - HIGHLY anticholinergic
46
Doxepin - Class = - Indications = - Specific Side Effects =
Class = - TCA (Tertiary Amine) Indications = - Chronic Pain - Sleep aid Specific Side Effects = - HIGHLY anticholinergic
47
Nortriptyline - Class = - Indications = - Perks over other TCAs =
Class = - TCA (2º Amine) Indications = - Chronic Pain Perks over other TCAs = - The LEAST anticholinergic
48
Treatment of TCA overdose =
IV NaHCO3
49
Desipramine - Class = - Indications = - Perks over other TCAs =
Class = - TCA (2º Amine) Indications = - Neuropathic Pain Perks over other TCAs = - The LEAST sedating
50
Most common tetracycltic antidepressants =
Amoxapine Maprotiline
51
Amoxapine - Class = - Indications = - Specific Side Effects = - Specific perks over other antidepressants =
Class = - tetracyclic antidepressant Indications = - MDD - Mild cases of psychosis Specific Side Effects = - EPS - Similar to TCAs Specific perks over other antidepressants = - Faster onset
52
Maprotiline - Class = - Indications = - Specific Side Effects = - Specific perks over other antidepressants =
Class = - tetracyclic antidepressant Indications = - MDD - Neuropathic Pain Specific Side Effects = - Seizure - Arrhythmia - High mortality on OD Specific perks over other antidepressants = - Faster onset
53
MAOi's Side Effects =
- Serotonin Syndrome (if used with triptans or SSRI) - HTNsive Crisis - ***Orthrostatic Hypotension*** - Drowsiness - Weight Gain - Sex dysfunction - Paresthesias if person has pyridoxine deficiency
54
MAOi MOA =
- Inhibition of MAO-A and MAO-B enzymes
55
MAOi General indications =
- Refractory Depression
56
Drugs used for OCD:
- SSRI in high doses | - Clomipramine (TCA)
57
Drugs used for Panic Disorder:
- SSRI - Imipramine (TCA) - MAOi
58
Drugs used for eating disorders:
- SSRI (high doses) - TCA - MAOi
59
Disorders requiring high doses of SSRI:
- OCD | - Eating Disorders
60
Drugs for Social Phobia:
- SSRI - TCA - MAOi
61
Drugs for GAD:
- SSRI - Venlafaxine (SNRI) - TCAs
62
Drugs for PTSD:
- SSRI
63
Drugs for IBS:
- SSRI | - TCAs
64
Drugs for enuresis:
- Imipramine (TCA)
65
Drugs for Neuropathic Pain =
- Amiltriptyline - Nortriptyline - Duloxetine
66
Drugs for Chronic Pain =
- SSRI | - TCA
67
Drugs for fibromylagia =
- Duloxetine | - Pregabalin
68
Drugs for migraines =
- Amiltripyline - SSRI - Triptans
69
Drugs for smoking cessation =
Bupropion
70
Drugs for Premenstrual Dysphoric Disorder =
SSRI
71
Drugs for Insomnia =
- Mirtazapine - Trazodone - Amiltriptyline (TCA)
72
TCA with the highest incidence of sexual dysfunction =
Clomipramine
73
Antidepressants which DO NOT cause sexual dysfunction =
- Bupropion - Mirtazapine - Nefazodone