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Psychiatry > Antidepressants > Flashcards

Antidepressants Flashcards

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
Q

Differences and similarities between antidepressants:

A

They all have the same efficacy, but different safety profiles and side effects.

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26
Q

% of Depressed patients who will respond to antidepressants:

A

70%

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27
Q

Onset of effect with antidepressants =

A

Somewhere between 2-8 weeks

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28
Q

Withdrawal with antidepressants?

A
  • There is a withdrawal response
  • Symptoms include: dizziness, headaches, nausea, and insomnia
  • Therefore some antidepressants will need to be tapered
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29
Q

Fluoxetine:

  • Class =
  • Half life =
  • Pregnancy?
  • Safe in kids?
  • Common side effects =
  • Common drug interactions =
A
  • 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
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30
Q

Fluvoxamine

  • Class =
  • FDA approved for…
  • Most common side effects =
  • Drug Interactions?
A
  • SSRI
  • Approved only for OCD
  • Nausea and vomiting are very common
  • MANY drug interactions
31
Q

Citalopram

  • Class =
  • Drug interactions =
  • Pros in terms of side effects?
A
  • SSRI
  • Fewest drug interactions
  • Fewer sexual side effects
32
Q

Escitalopram

  • Class
  • Differences from Citalopram?
A
  • SSRI
  • Levo-enantiomer of citalopram –> similar efficacy but fewer side effects
  • More expensive than citalopram
33
Q

Side effects of SSRI compared to MAOi and TCA and why?

A
  • Much fewer

- Due to 5HT selectivity you don’t need to deal with the histamine and adrenergic side effects

34
Q

Most common side effects of SSRIs:

A
  • GI symptoms
  • Sexual dysfunction
  • Insomnia
  • Vivid dreams
  • Headache
  • Anorexia and weight loss
  • Restlessness
  • Seizures
  • Serotonin syndrome
35
Q

Common causes of serotonin syndrome:

How to avoid serotonin syndrome caused by SSRI + MAOi =

A
  • SSRI + MAOi
  • SSRI + Triptans

• SSRI should not be used for at least 2 weeks before or after the use of MAOi

36
Q

Venlafaxine

  • Class =
  • Indications =
  • Drug interactions =
  • Contraindicated in patients with…
A
  • SNRI
  • Depression, anxiety, ADHD
  • Few drug interactions
  • Contraindicated in patients with labile or high BP
37
Q

Desvenlafaxine

  • Class
A
  • SNRI

- This is the active metabolite of venlafaxine and it is the same but is more expensive.

38
Q

Trazodone

  • Class =
  • Indications =
  • Side Effects =
  • Perks over SSRIs =
A

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
Q

Nefazodone

  • Class =
  • Indications =
  • Side Effects =
  • Perks over SSRIs =
A

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
Q

Mirtazepine

  • Class =
  • Indications =
  • Side Effects =
  • Perks over SSRIs =
A

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
Q

Tricyclic Antidepressants

  • MOA =
  • General indications =
  • General half-lives =
  • Side Effects =
A

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
Q

Amitriptyline

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

Class =
- TCA (tertiary amine)

Indications =

  • Chronic Pain
  • Migraines
  • Insomnia

Specific Side Effects =
- HIGHLY anticholinergic

43
Q

Tertiary Amines:

  • Most common examples:
  • Degree of anticholinergic effects:
  • Degree of sedation:
A

Most common examples:

  • Amitriptyline
  • Imipramine
  • Clomipramine
  • Doxepin

Degree of anticholinergic effects:
- HIGHLY Anticholinergic

Degree of sedation:
- HIGHLY Sedative

44
Q

Secondary Amines:

  • Difference from tertiary amines:
  • Most common examples:
  • Degree of anticholinergic effects:
  • Degree of sedation:
A

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
Q

Clomipramine

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

Class =
- TCA (Tertiary Amine)

Indications =
- OCD

Specific Side Effects =
- HIGHLY anticholinergic

46
Q

Doxepin

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

Class =
- TCA (Tertiary Amine)

Indications =

  • Chronic Pain
  • Sleep aid

Specific Side Effects =
- HIGHLY anticholinergic

47
Q

Nortriptyline

  • Class =
  • Indications =
  • Perks over other TCAs =
A

Class =
- TCA (2º Amine)

Indications =
- Chronic Pain

Perks over other TCAs =
- The LEAST anticholinergic

48
Q

Treatment of TCA overdose =

A

IV NaHCO3

49
Q

Desipramine

  • Class =
  • Indications =
  • Perks over other TCAs =
A

Class =
- TCA (2º Amine)

Indications =
- Neuropathic Pain

Perks over other TCAs =
- The LEAST sedating

50
Q

Most common tetracycltic antidepressants =

A

Amoxapine

Maprotiline

51
Q

Amoxapine

  • Class =
  • Indications =
  • Specific Side Effects =
  • Specific perks over other antidepressants =
A

Class =
- tetracyclic antidepressant

Indications =

  • MDD
  • Mild cases of psychosis

Specific Side Effects =

  • EPS
  • Similar to TCAs

Specific perks over other antidepressants =
- Faster onset

52
Q

Maprotiline

  • Class =
  • Indications =
  • Specific Side Effects =
  • Specific perks over other antidepressants =
A

Class =
- tetracyclic antidepressant

Indications =

  • MDD
  • Neuropathic Pain

Specific Side Effects =

  • Seizure
  • Arrhythmia
  • High mortality on OD

Specific perks over other antidepressants =
- Faster onset

53
Q

MAOi’s Side Effects =

A
  • Serotonin Syndrome (if used with triptans or SSRI)
  • HTNsive Crisis
  • Orthrostatic Hypotension
  • Drowsiness
  • Weight Gain
  • Sex dysfunction
  • Paresthesias if person has pyridoxine deficiency
54
Q

MAOi MOA =

A
  • Inhibition of MAO-A and MAO-B enzymes
55
Q

MAOi General indications =

A
  • Refractory Depression
56
Q

Drugs used for OCD:

A
  • SSRI in high doses

- Clomipramine (TCA)

57
Q

Drugs used for Panic Disorder:

A
  • SSRI
  • Imipramine (TCA)
  • MAOi
58
Q

Drugs used for eating disorders:

A
  • SSRI (high doses)
  • TCA
  • MAOi
59
Q

Disorders requiring high doses of SSRI:

A
  • OCD

- Eating Disorders

60
Q

Drugs for Social Phobia:

A
  • SSRI
  • TCA
  • MAOi
61
Q

Drugs for GAD:

A
  • SSRI
  • Venlafaxine (SNRI)
  • TCAs
62
Q

Drugs for PTSD:

A
  • SSRI
63
Q

Drugs for IBS:

A
  • SSRI

- TCAs

64
Q

Drugs for enuresis:

A
  • Imipramine (TCA)
65
Q

Drugs for Neuropathic Pain =

A
  • Amiltriptyline
  • Nortriptyline
  • Duloxetine
66
Q

Drugs for Chronic Pain =

A
  • SSRI

- TCA

67
Q

Drugs for fibromylagia =

A
  • Duloxetine

- Pregabalin

68
Q

Drugs for migraines =

A
  • Amiltripyline
  • SSRI
  • Triptans
69
Q

Drugs for smoking cessation =

A

Bupropion

70
Q

Drugs for Premenstrual Dysphoric Disorder =

A

SSRI

71
Q

Drugs for Insomnia =

A
  • Mirtazapine
  • Trazodone
  • Amiltriptyline (TCA)
72
Q

TCA with the highest incidence of sexual dysfunction =

A

Clomipramine

73
Q

Antidepressants which DO NOT cause sexual dysfunction =

A
  • Bupropion
  • Mirtazapine
  • Nefazodone

Psychiatry (14 decks)

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