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Antidepressants Flashcards

1
Q

What are the two major downfalls of antidepressants?

A

long dosing before takes effect

Elderly are more susceptible to adberse effects

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2
Q

What is the monoamine/biogenic amine hypothesis?

A

Deficiency in the level of 5HT, NE and DA lead to depression

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3
Q

All currently available antidepressants do what?

A

Enhance the synaptic availability of monoamines

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4
Q

What is the neurotrophic hypothesis of depression?

A

Loss of brain derived neurotrophic factor (BDNF)

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5
Q

What is the MOA of brain derived neurotrophic growth factor?

A

Activate TRK- B receptors, causing an increased neuronal survival and growth

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6
Q

What are the four major categories of antidepressants?

A
  1. MAOIs
  2. tricyclics
  3. SSRIs
  4. Atypical antidepressants
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7
Q

What is the MOA of TCAs?

A

Block the reuptake of NE by NET

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8
Q

What is the MOA of SNRIs?

A

Block the reuptake of NE and 5HT via inhibiting SERT and NET

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9
Q

What is the role of presynaptic autoreceptors like 5HT-1A?

A

Inhibit the release of neurotransmitters

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10
Q

Which type of antidepressants are used to treat chronic pain?

A

TCAs and SNRIs

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11
Q

What are the drugs that cause psychomotor activation, antiparkinsonian effects, psychosis?

A

DA uptake blockade

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12
Q

What are the antidepressants that cause sedation, drowsiness, weight gain, hypotension?

A

H1 receptor blockade

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13
Q

What is the first generation of antidepressants?

A

MAOIs

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14
Q

What are the indications for MAOIs?

A

Resistant depression

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15
Q

What is the MOA of MAOIs?

A

Increase synaptic availability of NE and 5HT by blocking their catabolism via MAO

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16
Q

What is the MOA of MAO-A?

A

Degrades tyramine, NE, 5HT

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17
Q

What is the MOA of MAO-B?

A

targets mainly DA

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18
Q

What are the three major MAOIs?

A

Phenelzine
tranycypromine
Selegiline

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19
Q

What is the MOA of Phenelzine?

A

Irreversible, non-selective MAO-A and MAO-B inhibitors

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20
Q

What is the MOA of tranylcypromine?

A

Irreversible, non-selective MAO-A and MAO-B inhibitors

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21
Q

What is the MOA of moclobemide?

A

Reversible MAO-A inhibitor

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22
Q

What is the MOA of selegiline?

A

Irreversible MAO-B inhibitor

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23
Q

What is low dose selesgiline used for? High dose?

A 
Low= Parkinson's
High = Antidepressant
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24
Q

What is the most common side effect of MAOIs?

A

Orthostatic hypotension

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25
What is the major food interaction that MAOIs have?
Tyramine from cheeses will cause a hypertensive crisis
26
What are the drug interactions that MAOIs have?
SSRIs | TCAs
27
What are the symptoms of MAOI overdose?
Hyperthermia Seizures Shock Delirium
28
Which class of antidepressants has the highest rate of sexual dysfunction?
MAOIs
29
What is the MOA of tyramine?
Triggers the release of catecholamines in the synapse
30
What was the first TCA discovered?
Imipramine
31
What is the major clinical use of TCAs other than depression?
Chronic pain conditions | OCD
32
What is the MOA of TCAs?
Inhibit the reuptake of both 5HT and NE by inhibiting SERT and NET
33
What are the three main TCAs?
Imipramine Desipramine Amitriptyline
34
What is the MOA of imipramine? What is this used to treat besides depression?
TCA | Enuresis
35
What is the MOA of desipramine? What is this used to treat besides depression?
TCA | neuropathic pain
36
What is the MOA of amitriptyline? What is this used to treat besides depression?
TCA | Sedative
37
What is the major issue of prescribing TCAs in the elderly?
falls d/t orthostatic hypotension
38
What are the toxic CNS effects of TCAs?
Szs
39
What is the most serious side effect of TCAs?
Cardiac toxicity
40
What are the three Cs of TCA overdose?
Convulsions Coma Cardiac arrhythmias
41
What is the MOA of fluxetine?
SSRI
42
What is the MOA of sertraline?
SSRI
43
What is the MOA of paroxetine?
SSRI
44
What is the MOA of citalopram?
SSRI
45
What is the MOA of Escitalopram?
SSRI
46
What is the MOA of fluvoxamine?
SSRI
47
What are the six SSRIs?
``` Fluoxetine Sertraline Paroxetine Citalopram Escitalopram Fluvoxamine ```
48
What are the short term side effects of SSRIs?
Nausea GI upset Diarrhea
49
What are the long term side effects of SSRIs?
Sexual dysfunction
50
What is the major drug interaction of SSRIs?
Serotonin syndrome
51
What is the common cause of serotonin syndrome?
Switching medications prior to letting effect wear off
52
Which SSRI has the longest half life? How long before out of system?
Fluoxetine | 4- weeks
53
What are the early symptoms of serotonin syndrome?
``` Lethargy Restlessness Mental confusion Flushing Diaphoresis tremor ```
54
How do you treat serotonin syndrome?
Supportive
55
Most of the SSRI do what to p450 enzymes?
Inhibit them
56
What are the side effects of suddenly stopping SSRIs?
Dizziness Paresthesias Anxiety
57
What is the MOA of SNRIs?
Inhibit reuptake of 5HT and NE
58
What is the MOA of venlafaxine?
SNRI
59
What is the MOA of duloxetine?
SNRI
60
What is the major difference between SNRIs and TCAs, since both work to inhibit serotonin and NE reuptake?
Better side effect profile
61
Which of the SNRIs is used to treat chronic pain?
Duloxetine
62
What is the MOA of trazodone?
Blocks H1 and 5HT2 receptor
63
What is the major side effect of trazodone?
Priapism
64
What is the MOA of buproprion?
Blocks NE and DA reuptake, and increases the release of catecholamines Wellbutrin
65
What is the MOA of mirtazapine?
Blocks alpha 2 receptors, and increases synaptic release of 5HT and NE
66
What is the cause of the antiemetic properties of mirtazapine?
Blocks 5HT2 and 5HT3 receptors
67
What are the side effects of SNRIs
Noradrenergic effects (increase BP)
68
What are the side effects of 5HT2 antagonists like trazodone?
Sedation and priapism
69
What are the two p450 enzymes that are particularly inhibited by antidepressants?
2D6 | 3A4
70
What are the three potent inhibitors of CYP2D6?
Paroxetine Fluoxetine Fluvoxamine
71
Why should you never combine SSRIs and TCAs?
Will cause serotonin syndrome
72
What is the main treatment for bipolar disorder? Does this act fast?
Li No
73
What are the two anticonvulsants used in the treatment of the manic phase of bipolar disorder?
valproic acid | Carbamazepine
74
What is the MOA of lithium?
Stabilizes the post synaptic terminal
75
What are the major side effects of lithium?
Tremor | Hypothyroidism
76
What is the renal issue caused by lithium? MOA?
Nephrogenic DI | Blocks vasopressin/ADH response in the renal tubule
77
What are the skin reactions with Li?
Acne vulgaris | Psoriasis
78
What are the two major drug-drug interactions with Li? What happens here?
Thiazide and loop diuretics Diminished the Li clearance since Na depletion promotes the reabsorption of both Na and Li. This causes an increase in Li in the serum

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