Antidepressants Flashcards Preview

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Flashcards in Antidepressants Deck (34)
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1
Q

What is the mechanism of an SSRI?

A

Inhibits 5-HT (serotonin) re-uptake selectively.

2
Q

What is the mechanism of an SNRI?

A

Inhibits re-uptake of both 5-HT and NE selectively.

3
Q

What is the mechanism of a tricyclic antidepressant?

A

Inhibits re-uptake of both 5-HT and NE but acts on other receptors as well (ACh M / alpha 1 adrenergics / H1 receptors).

4
Q

What is the mechanism of buproprion?

A

Inhibits re-uptake of NE and DA.

5
Q

What is buproprion often used for?

A

Smoking cessation

6
Q

What is the mechanims of MAOIs?

A

Inhibition of monoamine oxidase that breaks down neurotransmitters.

7
Q

Are there selective advantages of choosing one antidepressant over another with respect to efficacy?

A

No. They are all about equal in efficacy.

8
Q

What amino acid is serotonin and norepinephrine synthesized from respectively?

A

Tryptophan and Tyrosine

9
Q

What is the mechanism of amphetamines effect on monoamines?

A

Amphetamine is a substrate for NE re-uptake transporter. Inside the cell amphetamine inhibits the vesicular monamine transporter and NE builds up in the cytoplasm. This build up causes reversal / leak of NE into the synaptic cleft.

10
Q

MAO-A degrades which neurotransmitters?

A

5-HT, NE, tyramine

11
Q

MAO-B degrades which neurotransmitter?

A

dopamine

12
Q

Your patient is undergoing chemotherapy and they complain of extreme nausea. What medication could you prescribe and what receptor would it act on?

A

Odansetron antagonizes the 5-HT3 (serotonin) receptor in the nausea / vomitting centers of the brain.

13
Q

How is trazadone a unique drug in the class of antidepressants?

A

Trazadone is a prodrug that is converted to a serotonin receptor antagonist (5-HT2A)

14
Q

What is the mechanism of action for Vilazodone?

A

Acts as both an SSRI + serotonin antagonist at the 5-HT1A receptor in hippocampus.

15
Q

What is the mechanism of imipramine? What category of anti-depressant is imipramine?

A

Imipramine is selective for the serotonin re-uptake transporter while its metabolite is selective for the NE re-uptake transporter. Tricyclic

16
Q

How does mirtazapine work?

A

Antagonist at serotonin receptor. Also is an antagonist for NE receptor on the pre-synaptic cell. Because its an antagonist at the cell it enhances release of NE and 5-HT.

17
Q

How does phenalzine work and what class of drug is it?

A

Hydrazide that binds irreversibly with the enzyme MAO.MAOI

18
Q

How does Tranylcypromine work and what class of drug is it?

A

Does not bind MAO irreversibly but does have a long effect. MAOI

19
Q

What are the side effects of Trazadone?

A

sedation, GI disturbance, orthostatic hypotension (5-HT antagonist)

20
Q

What are the side effects of Mirtazapine?

A

significant sedation, increased appetite and weight gain

21
Q

What are the side effects of buproprion?

A

agitation, insomnia, anorexia

22
Q

What are the MAO-I side effects?

A

orthostatic hypotension, weight gain, sexual disturbances

23
Q

Your patient is taking an MAO-I and you want to counsel her on dietary restrictions she’ll have to adhere to. What do you want to warn her about?

A

Tyramine containing foods (red wine, smoked meats, smoked cheese) can lead to a hypertensive crisis because of uncontrolled catecholamine release.

24
Q

Your patient is taking an MAO-I and a lowly intern prescribes the patient an SSRI or SNRI. What adverse effect might be seen if and MAO-I is taken with an SSRI or SNRI?

A

Serotonin syndrome!

25
Q

Your patient is placed on an SSRI and asks you if its okay to take St. Johns Wort for the depression, sumatriptan for her migranes, and tramadol for her chronic pain. Why would you tell your patient this is dangerous?

A

This can cause SEROTONIN SYNDROME which can lead to an altered mental status, myoclonus, tremors, tachycardia, fever, agitation, HTN, ataxia, sweating, and GI symptoms.

26
Q

Your patient is a 15 year old with new onset major depressive disorder. Which SSRI is the only FDA approved SSRI for children and adolescents?

A

Fluoxetine

27
Q

Your patient has major depressive disorder and you want to treat her with an SSRI. You find out that she is also pregnant. Which SSRI is known to have a risk for adverse effects in pregnancy?

A

Paroxetine

28
Q

Which antidepressant is the most dangerous when it comes to overdosing?

A

TCA; prescribed on a no-refill basis

29
Q

Overdosing on buproprion can lead to …

A

Seizures

30
Q

Overdosing on mertazapine can lead to …

A

sedation, disorientation, tachycardia

31
Q

What is the main mechanism by which antidepressants are cleared from the body?

A

Metabolism by liver enzymes

32
Q

What are the 4 first-line drugs of choice for antidepressants?

A

SSRI, SNRI, buproprion, mirtazapine

33
Q

What is the clinical use of lithium?

A

Mood stabilizer for bipolar disorder.

34
Q

What are the side effects of lithium?

A

Tremor, sedation, edema, heart block (inhibits K+ entry to myocytes), hypothyroidism, polyuria, teratogenesis.