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!!!!! Pharm Spring 16 Exam 2 !!!!! > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

SSRIs can act on

A
  1. serotonin
  2. norepi
  3. dopamine
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2
Q

regardless of acting on serotonin, norepi or dopamine ALL SSRIs __________

A

block the repuptake of serotonin

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3
Q

some of the side effects caused by SSRIs is due to the ________.

A

Alpha 2 receptor blockade

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4
Q

oldest SSRI that works on serotonin only and also has a very active metabolite

A

Fluoxetine (Prozac)

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5
Q

has an active metabolite and a shorter elimination half time that fluoxetine

A

Sertraline (Zoloft)

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6
Q

SSRI with the longest elimination half time. How long is it?

A

Fluoxetine (Prozac) 3-6 Days

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7
Q

three other SSRIs that only act on serotonin

A
  1. Paroxitine (Paxil)
  2. Fluvoxamine (Luvox)
  3. Escitalopram (Lexapro)
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8
Q

SSRIs that act on NE and serotonin

A
  1. Buproprion (wellbutrin)
  2. Trazadone (desyrel)
  3. Nefazadone (serzone)
  4. Venlafaxine (effexor)
  5. Duloxetine (cymbalta)
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9
Q

What makes SSRIs have a higher index of safety than other antidepressants

A
  1. Minimal effects on blood pressure
  2. Minimal changes in conduction
  3. Minimal changes in the seizure threshold
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10
Q

if one antidepressant isn’t working the patient should….

A

try another one, because they have a high index of safety

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11
Q

Biggest complaint with SSRI see effects

A

Sexual dysfunction and weight gain

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12
Q

insomnia/fatigue agitation headache N/V rarely orthostatic hypotension

A

side effects of SSRIs

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13
Q

SSRI constellations with anesthesia

A
  1. Inhibits CYP 450 system
  2. Potential anti platelet activity - increased bleeding risk
  3. Serotonin Syndrome
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14
Q

Due to excess availability of serotonin in the CNS

A

Serotonin syndrome

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15
Q

Presents as muscle rigidity, hyperreflexia, diaphoresis, ataxia, shivering, fever and confusion

A

Serotonin syndrome

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16
Q

drugs that could potentiate a serotonin syndrome

A

phenylpipridine opioids:

  1. Methadone
  2. demerol
  3. tramadol
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17
Q

Methadone, demeorl and tramadol

A

weak serotonin repuptake inhibitors that could possibly potentiate a serotonin syndrome

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18
Q

SSRIs at lower doses can be used to treat_________ by inhibiting the overactive inflammatory response systems

A

chronic pain syndromes

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19
Q

Tricyclics are _________________.

A

Tertiary of Secondary amines

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20
Q

Tertiary amines inhibit ____________ reuptake while Secondary amines inhibit ____________ reuptake

A

Serotonin AND Norepi only Norepi

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21
Q

elimination half time of tricyclics

A

10-80 hours

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22
Q

how are tricyclics metabolized

A

by the liver

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23
Q

Tricyclics are highly ____________ and strongly _________.

A

lipid soluble - easily absorbed GI protein bound - to tissue and plasma proteins

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24
Q

_________ should not be given with tricyclics because they can cause CNS toxicity with _________, _________, ___________

A

MAOI

  1. hypothermia
  2. seizure
  3. coma
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25
Because ___________ cause anticholinerdic side effects caution should be executed with \_\_\_\_\_\_\_\_\_\_. they are highly unpredictable and can cause an increase in \_\_\_\_\_\_\_\_\_\_\_. An indirect agent should be aboided because an increase in _________ may be exaggerated due to larger amounts of _________ available at the synapse. Insead a ___________ acting agent should be used and with \_\_\_\_\_\_\_\_.
Tricyclic Antidepressants Sympathetomimetics Blood Pressure Blood Pressure Norepi Direct lower doses
26
Tricyclics and the cardiovascular system
1. **depresses conduction of the atria and ventricals**- prolonged PR, Wide QRS and flat or inverted T-waves 2. **Orthostatic Hypotension** - r/t activation of presynaptic Alpha-2 causing vasodilation 3. **Decreaed seizure threshold**
27
Tricyclic overdose
Cardiotoxic effects, Seizure potential and CNS depression can be **fatal**
28
Tricyclics and Volitile anestheisa gasses
May need a higher MAC because more NE is present
29
Tricyclics and Opioids
Decrese opioid dose
30
Tricyclics and Induction agents
Most agents are **cardiac depressants-** 1. with conduction changes from tricyclics 2. induction agents can cause **dangerous arrhythmias**
31
Tricyclics and Barbituates
Decrease barbituate dose
32
Tricyclics and Anticholonergic
Because of the Anticholinergic side effectspt more likely to have **post op delerium** try to use something that does not cross the BBB like **glycopyrolate** instead of atropine
33
Flushing, dry mouth and skin, mydriasis, progressively red hot and dry treated with physostigmine
Anticholonergic toxicity or Central anticholinergic syndrome wth Tricyclics
34
life threatening, intractable myocardial debression or ventricular dysrhythmias usually cause of death
Tricyclic Overdose
35
Tertiary amines
Tricyclics- inhibit serotonin and NE reuptake at presynaptic terminals ## Footnote 1. Amytriptyline (elavil) 2. Imipramine (tofranil) 3. Clomiparime (anafanil)
36
Secondary amines
Tricyclic antidepressants that inibit NE reuptake at the presynaptic terminals 1. Desipramine (norpramin) 2. nortruptyline (pamelor)
37
Presenting features of tricyclic overdose
agitation, excitement, delerium which progresses to seizures, respiratory depression, cardiac dysrhythmias and sudden death. there are hypotensive anticholinergic effects
38
how long will someone need to be monitored for a tricyclic overdose?
10 days, they can still have dysrhythmias for 10 days
39
what is given for anticolonergic psychosis
physostigmine
40
Levophed
direct acting agent for blood pressure support that can be used with tricyclics
41
Acidosis and tricyclic overdose
Acidosis may INCREASE unbound drug causing dysrhythmias Give HCO3- to keep PH normal
42
Why should tricyclics be weaned
to prevent withdrawl symptoms
43
MAO is found in the __________________ and functions to _________________ inculding 1.\_\_\_\_\_\_\_, 2.\_\_\_\_\_\_\_\_\_\_, 3.\_\_\_\_\_\_\_\_\_, 4.\_\_\_\_\_\_\_\_\_\_
outer mitochondrial membrane inactivate monoamines dpoamine serotonin epinepherine norepinepherine
44
MAOIs mechanism of action
**block** the enzyme that **metabolizes biogenic amines**, thereby **increasing** neurotransmitters in the CNS and peripheal autonomic nervous system
45
Deaminate: Serotonin, NE, Epi
MAO A
46
platelts contain exclusively _________ also 60% of MAO in the brain is \_\_\_\_\_\_\_\_
MAO A Type A
47
Deaminate: Phenylethylamine
MAO B
48
Selecive MAO-B inhibitor at lower doses and non-selective at higher doses
Selegiline (eldepryl) dont need to follow tyrosine free diet at lower doses
49
List to Memorize of MAOIs
1. Brofaramine 2. selegiline (eldepril) 3. Iproniazid 4. isocarboxazid (marplan) 5. Phenelzine (nardil) 6. Meclobemide 7. befloxatone 8. Tranycupromine (parnate)
50
Why do MAOIs have such a long duration of action
they bind **irreversibly** to MAO- the body actually has to form NEW enzymes to continue break down bioamines
51
MAOIs have NO effect on the ___________ and do NOT produce \_\_\_\_\_\_\_\_\_\_.
Seisure Threshold Cardiac dysrythmias
52
Where is the MAO enzyme present?
liver, GI tract, kidneys, lungs
53
most common side effect with MAOIs
orthostatic hypotension especially with the elderly
54
Side effects of MAOIs
1. Anticholonergic like effects 2. impotancy/anorgasmy 3. weight gain 4. sedation ir mild stimulate effects 5. Orthostatic hypotension
55
What metabolizes tyramine
MAO A in GI tract and liver
56
Tyromine is a precursor for ______ and ______ and can act as a \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
1. Dopamine 2. NE 3. catchecholamine releasing agent
57
What happens when a person on an MAOI eats tyramine
Massive release of endogenous catechacholamines leading to a hypertensive crisis that can be lethal hyperpyrexia CVA
58
MAOI dietary restricions
1. Cheese 2. Fava beans 3. red wine 4. avacado 5. cured meats, sourcrout
59
Drug ABSOLUTELY CONTRAINDICATED with MAOI - what do we use it for?
Meperidine (demerol)- used for post op shivering
60
MAOI drug cautions: Can cause CNS excitation, delerium, seizure, DEATH
1. Tricyclic antidepressants 2. opioids 3. cold-allergy drugs 4. sympathomimetics 5. nasal decongestants 6. SSRIs
61
1. Serious headache 2. vomiting 3. chest pain
Symtoms to report with MAOI - could be the start of a Catechacholamine surge
62
Excitatory response may look like serotonin syndrome
MAOI and Meperidine (Demerol)
63
can inhibit the neuronal serotonin uptake
Meperedine (Demerol)
64
Agitation, skeletal musle rigidity, hyperpyrexia (high fever)
Excitatory response of MAOI with Meperedine (Demerol) Type I
65
Hypotension, Respiratory depression, Coma
Depressive response of MAOI with Meperedine (Demerol) Type II
66
Why does Meperedine (Demerol) react with MAOIs
MAOIs inhibits one of the enzymes that breaks down Meperedine (demerol).
67
Morphine and Opioids with MAOIs
respiratory depressive effects cand be enhanced with MAOIs
68
Four RULES for MAOIs and Anesthetics
1. minimize the possibility of s**ympathetic nervous system stimulation** or **drug induced hypotension** 2. Caution with sympathetomimetics **-** Use **DIRECT** acting agents, **NO EPHEDRINE** 3. Caution with opoids**- NO Meperidine (Demerol)** 4. May need a **higher MAC**- r/t extra biogenic amines circulating
69
MAOI and Sympathomimetics
1. May get an exagerated response from indirect acting drugs- **NO EPHEDRINE** 2. **Use direct acting agesnt like Phenylephrine** 3. Decrease dose by 1/3 an titrate to effect - can always give more, but cant take back what you have given
70
Hyperthemia, Mydriasis, Tachycardia, Seizure and death
MAOI overdose- only treatable with supportive care.
71
1. Dizziness 2. Myalgias - muscle pain 3. Paresthesia 4. irritability 5. insomnia 6. visual disturbances 7. tremors 8. letahrgy 9. N/V/D
Discontinuation of antidepressants

!!!!! Pharm Spring 16 Exam 2 !!!!! (11 decks)

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