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Antidepressants Flashcards

1
Q

Which chemicals are imbalanced in affective disorders such as depression

A

NE, Serotonin, and Dopamine

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2
Q

What percentage of antidepressants are bound to plasma proteins

A

90-95%

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3
Q

Where are antidepressants metabolized and excreted

A

By the liver, and excreted in the urine

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4
Q

Do antidepressants have a large or small therapeutic index

A

small

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5
Q

Do antidepressants have long or short half-lives

A

long

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6
Q

what are the 5 general classes of antidepressants

A

Tricyclics, SSRIs, SNRI, Atypical, and MAOI

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7
Q

What is the general MOA for antidepressants overall

A

increase adrenergic or serotonergic transmission

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8
Q

What is the MOA for Tricyclics, SSRIs, and SNRIs

A

Block the NE or serotonin (5-HT) transporters at the presynaptic terminals

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9
Q

What is the MOA for MAOIs

A

inhibit the breakdown of NE and Serotonin (5-HT) (increase the amount of NE and serotonin in the presynaptic terminal)

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10
Q

How do tricyclics prevent the reuptake of both NE and 5-HT

A

by inactivating the “amine” pump on the presynaptic nerve terminal

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11
Q

What other receptors do tricyclics have an effect on

A

Muscarinic, histamine H1, and Alpha 1 receptors

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12
Q

Amitryptyline

A

Tertiary Amine Tricyclic

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13
Q

Clomipramine

A

Tertiary amine tricyclic

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14
Q

Doxepin

A

Tertiary Amine Tricyclic

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15
Q

Imipramine

A

Tertiary amine tricyclic

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16
Q

Trimipramine

A

tertiary amine tricyclic

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17
Q

TACID

A

tertiary amine tricyclics (NE, 5-HT) (Trimipramine, Amitryptyline, Clomipramine, Imipramine, Doxepin)

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18
Q

Amoxapine

A

Secondary Amine Tricyclic (NE)

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19
Q

Desipramine

A

secondary amine tricyclic

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20
Q

maprotiline

A

Secondary amine tricyclic

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21
Q

Nortryptyline

A

Secondary amine tricyclic

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22
Q

Protryptyline

A

secondary amine tricyclic

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23
Q

DAMNP

A

Secondary Amine Tricyclics (Desipramine, Amoxapine, Maprotiline, Nortryptyline, Protryptyline)

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24
Q

what is the first choice for monopolar depression

A

SSRI

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25
CEFFSP
SSRI
26
Citalopram
SSRI
27
Escitalopram
SSRI (also approved for adolescents)
28
Fluoxetine
SSRI (t1/2=72 hr)
29
Fluvoxamine
SSRI
30
Paroxetine
SSRI (noted for its anticholinergic side effects; good for social phobia)
31
Sertraline
SSRI (t1/2=36 hr)
32
These drugs have less antimuscarinic and antihistaminic effects than tricyclics, but more adrenergic effects compared to SSRIs
SNRI
33
Duloxetine
SNRI
34
Milnacipran
SNRI
35
Levomilnacipran
SNRI
36
Venlafaxine
SNRI
37
Desvenlafaxine
SNRI
38
Does Mom Love Vicki Davis
SNRI (Duloxetine, Milnacipran, Levomilnacipran, Venlafaxine, Desvenlafaxine
39
Bupropion
Atypical antidepressant
40
What is the MOA for Bupropion
blocks reuptake of dopamine and NE, 3 fold increase in seizures
41
Mirtazapine
Atypical antidepressant
42
Trazodone
Atypical antidepressant
43
Can block histamine receptors , Alpha 2 receptors, and 5-HT receptors, and sedation is the most prominent adverse effect
Mirtazapine
44
widely prescribed as a sedative hypnotic for those with difficulty sleeping. Reduced problem with anticholinergic effects
Trazodone
45
Nefazodone
Atypical Antidepressant
46
Back box warning for rare but fatal liver toxicity
Nefazodone
47
Vilazodone
Atypical
48
"dual action" antidepressant: can block serotonin reuptake transporter and act as partial agonist at 5-HT receptor
Vilazodone
49
Vortioxetine
Atypical
50
Inhibits the serotonin reuptake transporter, along with mixed agonist/antagonist effects at serotonin receptors. Partial agonist at 5-HT
Vortioxetine
51
These drugs are used mostly for treatment-resistant depression or "refractory" depression
MAOIs
52
These drugs inactivate the enzyme that metabolizes NE and serotonin
MAOI (monoamine oxidase Inhibitor)
53
Which type of antidepressants require dietary changes to regulate tyramine consumption
MAOIs
54
Isocarboxazid
MAOI
55
Phenelzine
MAOI
56
Tranylcypromine
MAOI
57
Selegiline
MAOI (transdermal patch)
58
PITS
MAOI (Phenelzine, Isocarboxazid, Tranylcypromine, selegiline)
59
What are common adverse effects of antidepressants
CV (orthostatic hypotension), seizures, sexual dysfunction, blood abnormalities, abnormal bleeding, serotonin syndrome, manic episodes
60
Agitation, hallucinations, coma, or other changes in mental status; coordination problems or muscle twitching, vomiting or diarrhea
Serotonin syndrom
61
What are some drug interactions with antidepressants
CNS depressants, antimuscarinic agent, or MAOIs; Symptahomimetic agents also (synergistic effect), and tamoxifen
62
Which antidepressant should you not mix with tamoxifen
SSRIs
63
Why is the drug interaction of tamoxifen and SSRIs bad
Tamoxifen is metabolized by CYP2D6 and SSRIs inhibit CYP2D6
64
Which drug is the best choice for bipolar depression
Lithium
65
Does Lithium bind to plasma proteins
No
66
Where can lithium be excreted
Urine and breast milk (women who are breastfeeding shouldn't be on lithium)
67
Does lithium undergo metabolization
no, because it's an ion
68
What is lithium's MOA
Unknown; but know it alters reuptake of ST, NE, and DA. It also decreases protein kinases in the brain tissue
69
What are the adverse effects of lithium
nausea, diarrhea, drowsiness, dry mouth and thirst, weight gain, insomnia, polyuria, acquired nephrogenic diabetes
70
What symptom does lithium toxicity not have that neuroleptic malignant syndrome or serotonin syndrome have
hyperthermia
71
What drug interaction does lithium have
diuretics, NSAIDs, and ACE inhibitors
72
This is the first drug given FDA approval for long term prophylactic treatment of bipolar disorder without an indication of acute mania
lamotrigine
73
this drug is FDA approved for mania and is extensively used off-label for long-term prophylactic treatment of bipolar patients
Valproate
74
This drug is sometimes used for treatment-resistant bipolar disorder and remains under investigation
carbamazepine
75
Which antipsychotics are used for maintenance therapy
respieridone, aripiprazole and olanzapine, clozapine, and quetiapine
76
This antipsychotic is used for bipolar maintenance
risperidone
77
This antipsychotic is used for mania prophylaxis
aripiprazole and olanzapine
78
This antipsychotic is used for refractory mania
clozapine
79
This antipsychotic is used for bipolar depression
quetiapine and lurasidone

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