Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm > antidepressants > Flashcards

antidepressants Flashcards

(67 cards)

Start Studying
1
Q

Imipramine (Tofranil, Janimine)

A

TCA, prototype
blocks reuptake of NE and 5-HT
treatment of enuresis and urinary incontinence, neuropathic pain
TCAs cheaper than newer drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Amitriptyline (Elavil)

A

TCA

more sedation and anticholinergic activity than imipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fluoxetine (Prozac)

A

SSRI, prototype
OCD, GAD, PMDD, bulimia, anorexia nervosa
-less sedation antiACh and CV effects than TCAs
SEs: ha, anxiety, tremor, agitation, nausea, and sexual dysfunction in males. (suicide?)
-liver metab., req. 4-5 wks of tx to reach steady state/be cleared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fluvoxamine (Luvox)

A

SSRI
Selective inhibitor of 5‐HT reuptake that is similar to fluoxetine
-used for OCD in US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sertraline (Zoloft)

A

SSRI
selective inhibitor of 5‐HT reuptake, effects/SEs like fluoxetine, less drug interactions
-relatively slow elimination (T1⁄2 = ~24 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Paroxetine (Paxil)

A

SSRI
selective inhibitor of 5‐HT reuptake, effects/SEs like fluoxetine, can have drug interations
-more rapidly metabolized (T1⁄2 = ~10 hours) and it does not form active metabolites.
more weight gain than other SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Citalopram (Celexa)

A

SSRI, newer

-similar to other SSRIs (esp. sertraline) -fewer drug interactions than fluoxetine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Escitalopram (Lexapro)

A

SSRI, newer

-similar to other SSRIs (esp. sertraline) -fewer drug interactions than fluoxetine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Venlafaxine (Effexor) and desvenlafaxine (Pristiq)

A

SNRI
Serotonin‐Norepinephrine Reuptake Inhibitors (and dopamine!)
-depression, GAD, social anxiety disorder, panic disorder, PTSD, OCD
-more rapid onset (1-2 wks?)
-less CV SEs than TCAs
-may have stimulant activity (used for ADHD in kids)
-may work when don’t respond to SSRIs
SEs: nausea, nervousness, anxiety, sweating, HTN, tachycardia, palpitations, sexual dysfunction.
-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Duloxetine (Cymbalta)

A

SNRI, newer
neuropathic pain

other SNRIs: desvenlafaxine, levomilnacipran, milnacipran.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Trazodone (Desyrel)

A

Second generation antidepressant
FA:
Primarily blocks 5-HT2, α1-adrenergic, and H1 receptors; also weakly inhibits 5-HT reuptake.
use: mostly insomnia, as high doses are needed for antidepressant effects
-lower incidence antiACh and CV SEs than TCAs
SEs: priapism, sexual dysfunction in males, sedation (used at night)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nefazodone (Serzone)

A

Second generation antidepressant

inhibit the reuptake of 5‐HT but also block 5‐HT‐2 receptors. (similar to trazadone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bupropion (Wellbutrin)

A

Second generation antidepressant
selectively inhibits DA reuptake (FA: inhibits dopamine»NE uptake via unknown mechanism)
-has mild stimulant activity; “psychic energizer”
-more likely than other antidepressants to produce seizures
-tx of nicotine, cocaine and amphetamine dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mirtazepine (Remeron)

A

Second generation antidepressant, chemically different from TCAs and SSRIs

-α2-antagonist (^release of NE and 5-HT), potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist
SEs: like TCAs (mild ACh, hypotension, tachy)
FA: Sedation, ^serum cholesterol, ^appetite
-both antidepressant and anxiolytic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Atomoxetine (Strattera)

A

Selective Norepinephrine Reuptake Inhibitor
-ADHD, different than stimulants
SEs: suppression of appetite, decreased weight gain, increased blood pressure, tachycardia, sexual dysfunction in adult males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Phenelzine (Nardil)

A 
MAO Inhibitors (both A and B)
contains a hydriazide group that can form covalent bonds with MAO-->can irreversibly inactivate MAO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tranylcypromine (Parnate)

A

MAO Inhibitors (both A and B)- binds tightly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Selegiline (Emsam)

A

MAO Inhibitors
selective inhibitor of MAO‐B
-available as a patch preparations (EMSAM) for treatment of depression
-Parkinson’s disease
-does NOT undergo the classic interactions with tyramine and other sympathomimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lithium carbonate (Eskalith and others)

A

mood stabilizer

  • most effective drug for manic-depressive disorder (bipolar)
  • ionic theory ‐ may alter the neuronal distribution or effect of Na+, K+ or Ca2+ in the CNS.
  • biogenic amine theory may later the release, reuptake, or metabolism of NT amine.
  • phospholipid theory ‐ may alter the metabolism of phospholipids that are involved in the phosphoinositide signaling pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Valproic Acid Analogs (Depakene/Depakote)

A

mood stabilizer

manic-depressive disorders/bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Carbamazepine (Tegretol)

A

mood stabilizer

manic-depressive disorders/bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clonazepam (Klonopin)

A

mood stabilizer

manic-depressive disorders/bipolar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

drugs that can induce depression

A

reserpine, B-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pharm manangement for depression

A

(effective in 70-80% of pts)
1st line: SSRIs and 2nd gen
2nd/3rd: TCAs and MAO’s (potential toxicity)
-benzos (alprazolam (Xanax)) for anxiolytic effects
-antipsychotics (2nd gen) for schizo symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Manic-depressive disorder pharm management
(effective in 80%) Lithium: reduce the fluctuation in mood swings. Antipsychotics are used in severe phases of mania. Antidepressants can help in some severely depressed patients, but may also trigger a switch to the manic phase
26
FA TCAs
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.
27
FA TCA mechanism and use
Block reuptake of norepinephrine and less so 5-HT. (3o amines have a greater effect on 5‐HT than the 2o) Major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis.
28
FA TCA SEs
Sedation, α1-blocking effects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth). 3° TCAs (amitriptyline) have more anticholinergic effects than 2° TCAs (nortriptyline). Can prolong QT interval. *Tri-C’s: Convulsions, Coma, Cardiotoxicity* (arrhythmia due to Na+ channel inhibition); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline). Tx: NaHCO3 to prevent arrhythmia. 
29
FA SSRIs
Fluoxetine, paroxetine, sertraline, citalopram. "Flashbacks paralyze senior citizens."
30
FA SSRI Mechanism and SEs
5-HT–specific reuptake inhibitors. Fewer than TCAs. GI distress, SIADH, sexual dysfunction
31
FA SSRI uses
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder.
32
CNS effects of TCAs/2nd gens
- sedation (tolerance develops: tricyclic tertiary amines > tricyclic secondary amines > second generation drugs) - effect takes time (2-4 wks) - may also tx OCD, panic attacks, GAD, social phobias - CNS stim: 10%, may induce manic phase in bipolar pts - decreased seizure threshold
33
Acute effect of TCAs/2nd gens
inhibition of the synaptic reuptake of NT amines (NE, 5‐HT, and DA)
34
Bupropion (Wellbutrin) SEs
stimulant effects (tachycardia, insomnia), headache, seizures in anorexic/bulimic patients. No sexual side effects.
35
Trazodone (Desyrel) SEs
sedation, nausea, priapism, postural hypotension. Called traZZZobone due to sedative and male-specific side effects.
36
Chronic effect of TCAs/2nd gens
alterations in the density and sensitivity of | receptors for NT amines
37
TCAs/2nd gens may directly interact with ??
certain NT receptors -agonists or antagonists at muscarinic, serotonin, alpha adrenergic or dopaminergic receptors may also INdirectly influence receptors
38
TCA/2nd gen Anticholinergic side effects
dry mouth, constipation, urine retention, loss of visual accommodation, etc -Usually more severe than those of antipsychotic drugs. -amitriptyline is the worst, SSRI’s the least
39
TCA/2nd gen CV SEs
- postural hypotension ‐ due to alpha blockade and interference with hemostatic reflexes in the CNS - tachycardia ‐ due to potentiation of the effects of NE and an anticholinergic effect in the heart. - flattening or inversion of the T‐wave - *arrhythmias* - BBW: may increase suicidal ideation in children
40
TCA/2nd gen metabolism
-demethylation and aromatic hydroxylation in liver ‐ caution in patients with liver disease and large potential for drug interactions -conversion of some agents to active metabolites -relatively narrow therapeutic windows (in general)
41
TCA/2nd gen Toxic Reactions and Side Effects
anticholinergic CNS: tremor, agitation, manic phase, parkinsonism (rare), inc. seizure risk in epileptic pts CV: hypotension, tachy, arrhythmias -weight gain w. TCAs -impotence due to alpha blockade; may have retrograde ejaculation -possible teratogenic effects -blood dyscrasias (rare but may be fatal)
42
TCA/2nd gen (atypicals) acute poisoning
fairly common ‐ serious toxicity at doses 5‐10 times normal therapeutic doses, life‐threatening emergency! -CNS agitation-->grand mal seizures-->coma -extreme hypotension, tachycardia, and arrhythmias progressing to total CV collapse. -classic “anticholinergic” symptoms tx: supportive, NaHCO3 reduces cardiotoxic effects of TCAs (or antiarrhythmics, B-blockers, CCBs)
43
TCA/atypical drug interactions
anticholinergics sedatives, alcohol biogenic amines and adrenergic drugs ‐ potentiation guanethidine ‐ antidepressants decrease its effect by blocking its uptake by nerve ending drugs metabolized by microsomal system, many complex interactions MAO inhibitors: “serotonin syndrome” anticoagulants – complex effects through hepatic metabolism and through clotting mechanism (serotonin is involved in platelet aggregation and blood clotting)
44
serotonin syndrome
tremors, hypertension, hyperpyrexia and seizures -At least 2‐4 weeks should elapse before switching from a tricyclic or second generation antidepressant to an MAO inhibitor and vice‐versa.
45
other antidepressant uses
- enuresis and urinary incontinence (imipramine) - pain from neuropathies (tricyclics, duloxetine and others) - adjuncts in the management of chronic pain - cocaine and amphetamine dependence - GAD and panic/phobia disorders - OCD
46
MAO-inhibitors: acute and chronic effects
acute effect ‐ increased synaptic levels of NE, 5‐HT and DA chronic effect ‐ decreased number and sensitivity of adrenergic and serotonergic receptors
47
FA: MAO-inhibitors
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor). (MAO Takes Pride In Shanghai).
48
FA: MAO-i mechanism and use
Nonselective MAO inhibitionlevels of amine NTs (NE, 5-HT, DA). Atypical depression, anxiety, (bulimia, OCD, PTSD, narcolepsy)
49
FA: MAO-i SEs
``` HTN crisis (most notably with ingestion of *tyramine*, which is found in many foods such as aged cheese and wine), can be lethal, seen w. non-selectives-->HTN, fever, convulsions CNS stimulation. Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan (to prevent serotonin syndrome). ```
50
MAO-inhibitor CNS effects
little effect initially antidepressant action usually takes several weeks to develop normalization of sleep patterns CNS stimulation in some patients (tremors, insomnia, hallucinations); switch to manic phase in patients with bipolar phase.
51
MAO-i SEs (proz)
orthostatic hypotension ‐ normal effect at therapeutic doses HTN ‐ in overdose or in interaction with sympathomimetic GI effects (nausea, constipation) headache, dizziness, vertigo CNS stimulation liver damage allergic reactions, skin rashes, etc...
52
other MAO-i potentiations (like tyramine effect)
pheochromocytoma amphets, cocaine, DA TCAs and other antideps (wait 3-4 wks) -may slow metab of other drugs
53
lithium metabolism
excreted by kidneys -caution in patients with impaired renal function -enhanced reabsorption in sodium depleted patients -any drugs (i.e. NSAIDs, diuretics, etc..) that after renal function can influence the renal excretion of lithium -low therapeutic index (2-3): therapeutic range 0.8‐1.4 mEq/l; severe toxicity above 2.0 mEq/l
54
symptoms of acute lithium intoxication
GI: N/V/D NM: fatigue, weakness, fine tremor, ataxia, hyperirritability neurosens: blurred vision, tinnitus CNS: slurred speech, dizziness, confusion, restlessness, grand mal seizures, stupor, coma CV: arrhythmias, hypotension, circulatory collapse *may appear drunk*
55
tx of lithium intoxication
remove drug, symptomatic support: maintain fluids and electrolytes, administer anticonvulsants, antiarrhythmics, and CV drugs as needed. induce diuresis hemodialysis
56
other lithium toxic effects
a. EKG changes; arrhythmias b. hypothyroidism* c. polydipsia, polyuria d. kidney damage* ‐ nephrogenic diabetes insipidus e. weight gain f. dermatological problems g. teratogenic effects* *avoid in these pts
57
lithium has been tried for these conditions
cluster headache, premenstrual syndrome, tardive dyskinesia, hyperthyroidism and post partum affective psychosis.
58
lithium drug reactions
- ^^ levels by NSAIDs and diuretics (interfere with renal excretion of lithium) - Carbamazepine, antidepressants, antipsychotics, and methyldopa can enhance the neurotoxic effects of lithium. - Lithium can enhance the effects of antidepressants and other CNS drugs.
59
FA: lithium SEs
tremor, hypothyroidism, polyuria (causes nephrogenic diabetes insipidus), teratogenesis. Causes Ebstein anomaly in newborn if taken by pregnant mother. Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by kidneys; most is reabsorbed at PCT with Na+. Thiazide use is implicated in lithium toxicity in bipolar patients.
60
LMNOP—Lithium side effects:
Movement (tremor) Nephrogenic diabetes insipidus HypOthyroidism Pregnancy problems
61
moderate‐severe endogenous depression
SSRI's: first choice TCAs and other second generation antideps may be preferred in some pts MAO inhibitors are alternative drugs ‐ remember to clear TCAs before starting
62
mild acute depression with anxiety
antianxiety drugs, especially alprazolam (Xanax)
63
bipolar | manic‐depressive disorders
lithium antipsychotic drugs (for severe acute manic phase) antidepressants (for severe depressed phase) valproic acid analogs (Depakene/Depakote) is also gaining in use carbamazepine (Tegretol) – is becoming more widely used
64
A withdrawal syndrome that includes ?? can occur when antidepressant drugs are abruptly discontinued after long term usage. Accordingly, the dose of the drug should be gradually tapered off over a period of ??Discontinuation problems are more severe with shorter acting drugs like ? and less severe with longer acting drugs like ?.
lethargy, chills, neurologic disturbances and muscle aches 2‐4 weeks. paroxetine fluoxetine
65
only FA: buspirone
Stimulates 5-HT1A receptors. GAD. Does not cause sedation, addiction, or tolerance. Takes 1–2 weeks to take effect. Does not interact with alcohol (vs barbiturates, benzodiazepines). "I’m always anxious if the bus will be on time, so I take buspirone"
66
FA: serotonin syndrome
3 A’s: neuromuscular Activity (clonus, hyperreflexia, hypertonia, tremor, seizure), Autonomic stimulation (hyperthermia, diaphoresis, diarrhea), and Agitation. Treatment: cyproheptadine (5-HT2 receptor antagonist).
67
only FA: varenicline
Nicotinic ACh receptor partial agonist. Used for smoking cessation. Toxicity: sleep disturbance. 

Pharm (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions