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Pharm Final UNIT!!!! > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What is description of depression?

A
  • Depressed/ sad mood

- Anhedonia (diminished interest in normal activities

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2
Q

What is typical management/ monitoring of a patient on a new anti-depressant?

A
  • Close monitoring/ management

- F/u 1-2 weeks for S/I (can be daily)

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3
Q

What is treatment for first depressive episode?

A

AFTER 1st successful titration continue treatment for 6-12 months

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4
Q

What is treatment for recurring/ chronic depression

A

Pharm and therapy for life

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5
Q

What main BBW is important regarding the class of antidepressants?

A

S/I, increase in children, adolescents, and young adults 18-24 most prominently

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6
Q

What effects does serotonin have on the CNS?

A

Modulates attention, behavior, and thermoregulation

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7
Q

Counseling points for antidepressant use?

A

A patient must be counseled on suicide risk increase until medication is stabilized

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8
Q

What occurs in serotonin syndrome?

A

Increase in serotonergic activity in CNS

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9
Q

What causes exist for serotonin syndrome?

A
  • Therapeutic dosing
  • Inadvertent drug reactions b/w drugs
  • Intentional self poisoning
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10
Q

What categories are consistent with serotonin syndrome?

A
  1. Mental status change 2. Autonomic manifestations 3. Neuromuscular hyperactivity
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11
Q

What are the main features of mental status change in serotonin syndrome?

A
  • Anxiety
  • Agitation
  • Delirium
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12
Q

What are the main features of autonomic manifestations in serotonin syndrome?

A
  • Diaphoresis
  • Hyperthermia
  • Tachycardia
  • HTN
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13
Q

What are the main features of neuromuscular hyperactivity in serotonin syndrome?

A
  • Clonus
  • Hyperreflexia
  • Tremor
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14
Q

What is the typical onset for serotonin syndrome?

A

Presents within 24 hours and most within 6 hours of change in dose or drug change

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15
Q

What are physical exam findings found in serotonin syndrome?

A

Deep tendon reflex hyperreflexia, inducible spontaneous muscle clonus, agitation, diaphoresis, flushed, tremor, B/L Babinski sign

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16
Q

What labs are diagnostic of Serotonin syndrome?

A

No labs are DX

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17
Q

How is serotonin syndrome diagnosed?

A

Having taken a serotonergic medication and: -Spontaneous muscle clonus (alone)
-Inducible clonus PLUS agitation or diaphoresis
Ocular clonus PLUS agitation or diaphoresis
Tremor PLUS hyperreflexia
Hypertonia PLUS temperature above 38C PLUS ocular clonus or inducible clonus

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18
Q

What treatment is expected in serotonin syndrome?

A
  • Stop the offending agent
  • Supportive agents based on vitals
  • Sedate with benzos
  • And treat with serotonin antagonist
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19
Q

What is the serotonin antagonist to be used in serotonin syndrome?

A

Cyproheptadine

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20
Q

How does Neuroleptic malignant syndrome differ from Serotonin syndrome?

A
  • Caused by dopamine antagonists
  • Onset is days to weeks
  • Causes bradyreflexia and severe muscle rigidity
  • Resolution days to weeks
  • Bromocriptine is antagonist
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21
Q

How do serotonin selective reuptake inhibitors work?

A

Inhibit serotonin transporter increasing the serotonin concentration in synapse

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22
Q

What disorders are SSRI’s indicated for treatment?

A
  • Major depressive D/O
  • Bipolar (not when manic)
  • PTSD
  • eating disorder
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23
Q

What are the most common SSRI’s?

A
  • Citalopram
  • Escitalopram
  • Sertraline
  • Fluoxetine
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24
Q

What drug class has the most serious DDIs with SSRI’s?

A

MAOIs

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25
Q

What DDI is most common with mix of of SSRIs and MAOIs?

A

High risk of serotonin syndrome

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26
Q

What ADRS exist with use of SSRIs?

A
  • Increased suicidal ideation
  • Sexual dysfunction (women decreased libido and in men erectile dysfunction”
  • Weight gain
  • Drowsiness
  • Manifest mania in Bipolar D/O
  • Insomnia, HA, anxiety, dizzyness
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27
Q

Use of SSRIs increase risk of …?

A
  1. DM
  2. Abnormal bleeding
  3. Bone loss
28
Q

What SSRIs are best to use if a patient is taking medications that act on common enzymes (3A4, 2C9, 2C19)?

A

Escitalopram or Citalopram (no DDI w/ enzymes)

29
Q

What are individual ADRs with Citalopram ?

A

FDA warning QT prolongation at higher doses above 40 mg/d (Escitalopram deemed clinically insignificant so no warning)

30
Q

What is a required before issue of a higher dose of Citalopram?

A

Baseline ECG (also should be performed if concomittant use of other QT prolongation meds)

31
Q

What SSRI’s should not be used in a pregnant pt due to cause of birth defects?

A

-Fluoxetine and Paroxetine (worst)

32
Q

How do SNRI’s work?

A

Inhibit reuptake of NE and 5-HT

33
Q

What are the SNRI drugs?

A
  • Duloxetine
  • Venlafaxine
  • Desveniafaxine
  • Levomilnacipran
34
Q

What are common ADRs of the SNRI class?

A
  • N/V
  • Diaphoresis
  • Sexual dysfunction
  • Insomnia
  • Withdrawal syndrome
35
Q

What Drugs should not be prescribed with SNRIs?

A

-Like SSRIs, do not prescribe MAOIs or other serotonergic drugs

36
Q

What main ADR does Levomilnacipran have that is not shared by the other SNRIs?

A

Orthostatic hypotension

37
Q

What main ADR does Venlafaxine have that other SNRIs do not?

A

Increased BP and constipation

38
Q

What drugs makes up the serotonin modulators?

A
  • Vortioxetine
  • Vilazodone
  • Trazadone
39
Q

Vortioxetine and Vilazodone treat what disorders other than depression?

A

Only indicated for depression

40
Q

What indications for trazodone use?

A

Depression and insomnia

41
Q

What ADRs associated with use of trazodone?

A

Somnolenece, anticholinergic, and orthostatic hypotension

Rare- but serious = QT prolongation arrythmias and priapism

42
Q

What is significant about the atypical antidepressants?

A

They do not work on serotonin

43
Q

What is the most common atypical antidepressant?

A

Bupropion

44
Q

How does Bupropion work?

A

It blocks reuptake on DA and NE; DOES NOT WORK ON 5-HT

45
Q

What does Bupropion treat other than depression?

A
  • Tobacco dependence
  • Obesity
  • Hypoactive sexual disorder
46
Q

What ADRs are associated with Bupropion use?

A
  • Lowers seizure threshold
  • Insomnia
  • Weight loss
47
Q

What are CIs of Bupropion use?

A
  • Eating disorder
  • Seizure D/O
  • Use w/ other meds that lower seizure threshold
  • Use w/in 2 weeks of MAOI
48
Q

What benefit does bupropion offer?

A

Adjunct with SSRI/SNRI to counter act the sx from other drugs (weight loss and sexual dysfunction)

49
Q

What other atypical anti-depressant exists?

A

Mirtazapine

50
Q

What clientele is Mirtazapine good for use?

A

Old ladies (frail that don’t eat)

51
Q

What are Mirtazapines ADRs?

A
  • Weight gain
  • Appetite increase
  • Drowsiness/sedation
52
Q

What are the “dirtiest” anti depressant drugs?

A

MAOIs (monoamine oxidase inhibitors)

53
Q

How do MAOIs work?

A

Inhibit MAO-A and/or MAO-B enzymes which in turn decreases consumption of monoamines (5-HT, NE, DA)

54
Q

When are MAOIs indicated?

A

Refractory depression

55
Q

When should MAOIs be used first line?

A

Never

56
Q

What drugs make up the MAOI group?

A
  • Tranylcypromine
  • Isocarboxazid
  • Phenelzine
  • Selegiline transdermal
57
Q

Why are MAOIs rarely used?

A

Potentially lethal food and drug interactions

  • Tyramine containing diet required
  • Causes serotonin syndrome if combined with other anti depressant drugs
  • DDis with triptans, tramadol, stimulants, etc.
58
Q

What drug class is has reserved use if SSRIs/ SNRIs or other anti-depression drugs fail?

A

Tricyclic antidepressants

59
Q

What drugs make up the tricyclic antidepressants?

A
  • Amitryptiline
  • Nortryptiline
  • Imipramine (Clomipramine, Doxepin)
60
Q

Other than reserved treatent in depression where would you see the use of Amitryptiline or Nortryptiline?

A
  • Insomnia
  • Chronic pain
  • Anxiety disorders
61
Q

Other than 5-HT and NE, what other effects do tricyclic antidepressants have on the body?

A

Affect histamine, ACH, and alpha-adrenergic receptors

62
Q

What ADRs are associated with tricyclic antidepressants?

A
  • Anticholinergic (fatal cardiac arrhythmia)
  • Weight gain
  • QT prolongation
  • Hypotension
  • Sedation
  • Seizures
63
Q

What is recommended to use when switching antidepressants with different MOA?

A

Cross taper to prevent withdrawal symptoms and reduce ADRs

64
Q

When can an immediate change occur in antidepressant medications?

A

Same neurotransmitter/ mechanism involved

65
Q

What is the range for a taper schedule when switching antidepressants?

A

2-4 weeks

66
Q

When initiating anti-depressant medications what information must a provider counsel the patient on (not SI related)?

A

No to abruptly stop taking the drug due to ADRs

Pharm Final UNIT!!!! (6 decks)

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