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Antidepressants Flashcards

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1
Q

Monoamine hypothesis

A

deficiency in monoamines (serotonin, norepinephrine, dopamine) linked to depressive symptoms

developed bc of reserpine

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2
Q

MOA

A

monoaminase

enzyme that degrades serotonin, norepinephrine, dopamine

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3
Q

serotonin

A

5 HT

throughout the body

stimulates peristalsis (GI tract - 90%)

CNS (mood, sexual behavior, sleep, temp, etc.)

Cardiovascular

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4
Q

dopamine

A

CNS - reward, emotion, cognition, memory

endocrine - prolactin secretion

cardio - norepinephrine/epinephrine release

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5
Q

high dopamine

A

schizophrenia

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6
Q

low dopamine

A

parkinson’s

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7
Q

norepinephrine

A

cardiovascular (a-1= vasoconstriction, b-1 = increased HR)

fight or flight (increased RR, blood sugar, relax intestinal muscles)

CNS (concentration, alertness)

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8
Q

depression medication classes (6)

A

SSRI

SNRI

select antidepressants

TCAs

MAOis

Herbals

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9
Q

which class of medications are NEVER used first line

A

MAOi, Herbals, sometimes TCAs

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10
Q

how long is a “trial” of antidepressants

A

4-8 weeks

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11
Q

what other factors must be considered before starting an antidepressant?

A

Tapering

other things causing depression – beta blockers***

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12
Q

SSRI mechanism

A

selectively inhibits reuptake of serotonin into pre synaptic neuron (SERT receptor)

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13
Q

SSRI names

A
  1. Fluoxetine/Prozac
  2. Sertraline/Zoloft
  3. Paroxetine/Paxil
  4. Citalopram/Celexa
  5. Escitalopram/Lexapro
  6. Fluvoxamine
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14
Q

Fluoxetine

A

Prozac

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15
Q

Sertraline

A

Zoloft

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16
Q

Paroxetine

A

Paxil

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17
Q

Citalopram

A

Celexa

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18
Q

Escitaplopram

A

Lexapro

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19
Q

dosage of Celexa

A

20-40 mg/day MAX

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20
Q

SSRI side effects(systems/specific)

A

***GI (n/v, dry mouth)

CNS (sedation, insomnia, sucidial ideation )
Erectile dysfunction
hyponatremia (ADH elevation)
anticholinergic
perimenopausal women - helps hot flashes
QTc prolongation

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21
Q

anticholinergic symptoms

A

anti-SLUDGE

dry mouth, eyes, urinary retention, constipation

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22
Q

QT prolongation

A

prolonging of QT interval (normal - 400 msec, this - 500+ msec)

risk factors: medication hypokalemia)

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23
Q

drug interactions of SSRI

A

other serotonergic medications

+CYP drug

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24
Q

Fluoxetine drug interactions

A

CYP2C19 inhibitor

clopidogrel (2C19 substrate - unable to work if taken with Flux.)

also tamoxifen

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25
SNRI (drug list)
1. Venlafaxine/Effexor 2. Descenlafaxine 3. Duloxetine/Cymbalta 4. Levonmillnacipran
26
SNRI mechanism
selectively inhibits reuptake of serotonin and norepinephrine NET and SERT
27
SNRI side effects
GI (n/v/dry mouth) CNS (insomnia, libido, suicidal ideation) Erectile dysfunction ** Increased BP (N.e.) (usually not clinically sig. but keep in mind for uncontrolled HTN)
28
specific duloxetine side effects
Anti-cholinergic symptoms and liver toxicity
29
SNRI drug interactions
other seroternergic meds duloxetine specific CYP1A2
30
duloxetine drug interactions
CYP 1A2 substrate with CIPRO (1A2 inhibitor) it competes with the substrate and decreases its ability to work
31
other indications duloxetine
diabetic neuropathy fibromyalgia chronic musculoskeletal pain
32
other indications venlafaxine
off table diabetic neuropathy
33
venlafaxine
effexor
34
duloxetine
cymbalta
35
bupropion (gen., mechanism)
other medication used after SNRI inhibits norepinephrine and dopamine reuptake (no MAO or serotonin activity) NET and DAT receptor blocker
36
bupropion brand name
wellbutrin
37
bupropion side effects
increased seizure risk*** (dose related) CNS function (headache, insomnia, irritability, decreased appetite, improved sexual dysfunction, smoking cessation (Zyban))
38
bupropion drug interactions
MAO inhibitors -- can lead to hypertensive crisis
39
other antidepressant list
1. mirtazapine 2. vortioxetine 3. trazodone 4. nefazodone 5. vilazodone
40
mirtazapine
pre-synaptic a-2 agonist (increased Ne and serotonin) pronounced sedation (can be used in insomnia) weight gain
41
vortioxetine
inhibits serotonin reuptic (5HT1A agonist) improved cognition, SE of SSRI brand name only
42
trazodone
inhibits serotonin reuptake, 5ht2A antagonist causes orthostatic hypotension, sedation, priapism
43
nefazone
inhibits serotonin reuptake , 5HT2A antagonist less risk of trazodone SE can cause liver toxicity, potent CYP3A4 inhibitor
44
vilazodone
inhibits serotonin reuptake, 5HT1 agonist clinical advantage unknown, brand name only
45
TCA drug list
1. amitriptyline 2. imipramine 3. despiramine 4. nortriptyline
46
TCA mechanism
selectively inhibits reuptake of serotonin and norepinephrine antihistamine and anticholinergic effects Na channel blocker***
47
TCA side effects
``` anticholinergic orthostatic hypertension cardiotoxicity narrow therapeutic index -- suicidal ideation GI/CNS ```
48
TCA overdose management
sodium bicarbonate for cardiac toxicity mixed with dextrose
49
TCA drug interactions
antiocholinergic agents other serotonergic medication
50
MAOi drug list
1. isocarboxazid 2. phenelzine 3. selegilline** parkinson's 4. tranylcypromine
51
MAOi mechanisms
increases endogenous concentrations of norepinephrine, dopamine, serotonin they inhibition of monoamine oxidase not first therapy -- reserved for patients refractory to SSRI, SNRI, bupropion
52
MAOi side effects
orthostatic hypotension CNS (decreased libido, anorgasmia) weight gain hypertensive crisis
53
MAOis hypertensive crisis****
avoid tyramine containing foods (breaks down into n.e. and dopa) metabolism is inhibited by MAOis so there is an excess -- causes HTN treat with alpha blocker
54
drug interactions MAOi
other srotonergic meds (2 week washout) antihypertensive meds
55
serotonin syndrome
excess of serotonin can be idiosyncratic, accidental interaction or intentional over dose
56
symptoms of serotonin syndrome
tremor, hyperreflexia muscle rigidity hyperthermia agitaiton/diaphoresis increased bowel sounds (diarrhea)
57
serotonin syndrome management
discontinue meds monitor the vitals serotonin antagonist - cyproheptadine
58
cyproheptadine
non-sepcfic antagonist of 5HT-1 and 5HT-2 receptors ONLY oral (may be given via NG tube) can be used in allergies and anorgasmia
59
resistant depression treatment
second generation antipsychotics ariprprazole, brexipiprazole, quetiapine olanzapine/fluoxetine are FDA approved
60
herbals for depression
SAMe- S-adenosyl methionine st. john's wart
61
SAMe
Metabolite found that there was a remission and adverse events decreased
62
BEERs list
anticholinergic (urinary retention, constipation) chronic seizures SIADH SSRIs
63
pregnancy and depression meds
maternal depression adversely affects child development both meds and untreated cause problems os must weigh risk v. benefits

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