Antidepressants and Mood Stabilizers - Craviso Flashcards
(92 cards)
1
Q
currently available drugs to treat depression are based on what theory of depression?
A
monoamine theory
2
Q
T/F: all antidepressants cause immediate effects on synaptic monoamine levels
A
true
3
Q
Despite an immediate increase in synaptic monoamine levels, why is there a delay of several weeks for antidepressants to have the desired effect?
A
slow increase in the expression of BDNF that promotes synaptogenesis
4
Q
What percent of patients are refractory to multiple different antidepressants?
A
20%
5
Q
What are the four major classes of antidpressants?
A
- SSRIs
- SNRIs
- Other new antidpressants
- MAOIs
6
Q
SNRI block the uptake of what two amines?
A
5HT and NE
7
Q
older tricyclic antidepressants are antagonists against (one/several) receptors
A
several
8
Q
Newer antidepressants inhibit reuptake of what amine?
A
dopamine
9
Q
MAOIs inhibit the metabolism of what two amines?
A
5-ht and NE
10
Q
What are the firstline SSRIs?
A
FLUOXETINE (Prozac; Prozac Weekly) SERTRALINE (Zoloft) PAROXETINE (Paxil) CITALOPRAM (Celexa) ESCITALOPRAM (Lexapro)
11
Q
how are SSRIs metabolized?
A
CYP450 in the liver
12
Q
which SSRIs are the potent inhibitors of CYP2D6?
A
fluoxetine and paroxetine
13
Q
which SSRIs are the low level inhibitors of CYP2D6?
A
citalopram and escitalopram
14
Q
What are the major SE of taking SSRIs?
A
significant sexual dysfunction GI disturbances insomnia, restlessness anorexia or wt. loss early on or wt. gain with long term use QT prolongation with citalopram
15
Q
T/F; SSRIs have a withdrawal syndrome
A
true; nausea, dizziness, anxiety, tremor, and palpiations
16
Q
Use of which SSRI during pregnancy is linked to an increased risk of cardiovascular malformations in the fetus?
A
paroxetine
17
Q
5-HT syndrome is seen with (SSRIs/MAOIs) that enhane 5-HT transmission
A
MAOIs
18
Q
What is the only antidepressant approved for use in children?
A
fluoxetine
19
Q
which SSRI is approved for use in adolescents?
A
escitalopram
20
Q
why is the use of antidepressants limited in children?
A
risk of increasing SI
21
Q
Which SSRI is sued for SAD?
A
paroxetine
22
Q
Which SSRI is used as a migraine prophylactic?
A
fluoxetine
23
Q
Which SSRI is used for PMS and PMDD and hot flashes?
A
paroxetine
24
Q
Which SSRI is used for bulimia nervosa?
A
fluoxextine
25
Which newer, selective SNRI is the firstline druge that blocks NE and 5ht reuptake as well as weakly blocking DM reuptake?
Effexor
26
What are the side effects of SNRIs?
same as SSRIs;
| dose related increase in BP
27
What are the additional uses of SNRIs?
Tx of neuropathic pain
| anxiety disorders
28
Pristiq is a metabolite of which SNRI?
Effexor
29
Cymbalta is contraindicated in pts with what dz?
chronic liver disease or hepatic insufficiency
30
What are the additional uses of cymbalta?
fibromyalgia
Diabetic peripheral neuropathy
long term Tx of GAD
31
What are the common TCA's?
Nortriptyline
Imipramine
Amitriptyline
32
Why are TCAs no longer used?
1. can be fatal in overdose
2. are cardiotoxic
3. have a propensity to lower seizure threshold
4. have significant antagonist activity at several types of neurotransmitter receptors
33
WHich TCA is a migraine prophylactic?
amitriptyline
34
When do you use TCAs?
pt is refractory to common antidepressants
35
What are the three receptor types that TCAs block?
1. mACh
2. a 1
3. H1
36
what are the SE associated with blocking mACh receptors?
sedation, cognitive impairment, confusion, delirium, blurred
vision, dry mouth, tachycardia, urinary retention
37
what are the SE associated with blocking a1 receptors?
orthostatic hypotension, sedation
38
what are the side effects associated with blocking H1 receptors?
sedation
39
At therapeutic doses all TCAs can cause what SE?
lowering of seizure threshold
sexual dysfunction
weight gain
40
T/F: at toxic doses, ALL TCAs are cardiotoxic and OD is fatal
true
41
T/F: some pts develop cardiotoxicity to TCAs at therapeutic doses
true
42
what are the mechanisms of TCAs being cardiotoxic?
QT prolongation
ventricular block
arrhythmias
ventricular tachycardia
43
What is the MOA of TCA causing death via OD?
hyperpyrexia, hypertension and tachycardia, arrhythmias, severe anticholinergic effects and convulsions
44
What types of drugs have interactions with TCAs?
MAOIs
Anticholinergics and antihistamines
CNS depressants
45
what happens when you take MAOIs with tCAs?
severe HTN, serotonin syndrome
46
what happens when you take anticholinergics or antihistamines with TCAs?
additive effects due to blockade of mACh and H1 receptors
47
What happens when you take CNS depressants with TCAs?
more sedation
48
what is the only antidepressant that works by blocking dopamine reuptake?
Buproprion (wellbutrin)
49
What are some of the SE of wellbutrin?
insomnia
dose related seizure
contraindicated in seizure and eating disorders (electrolyte imbalance)
precipitate psychotic episodes`
50
T/F: wellbutrin has fewer sexual SE
true
51
What is the sustained release formula of wellbutrin used in smoking cessation>
Zyban
52
Remeron is an antagonist of (a1/a2) receptors that mediate negative feedback for NE and 5ht release
a2
53
T/F: remeron has sexual SE equal to SSRIs
false, like wellbutrin
54
Trazodone blocks 5ht reuptake by blcoking 5ht2 receptors and 5ht1(a/b) partially
5ht1a
55
What are the strange side effects of trazodone?
sig. drowsiness
GI upset
orthostatic htn
PRIAPISM
56
Vibryd is a hydbrid SSRI and partial agonist of (blank) receptor
5ht1a
no wt. gain
no sexual side effects
57
MAO-a metabolizes (NE and 5-ht / Dopamine)
MAO-a = 5-ht and NE
58
MAO-b metabolizes (NE and 5-ht / Dopamine)
dopamine
59
Why are MAOIs a last choice?
risk of hypertensive crisis
60
What degenerative disease do you use MAOIs to treat?
parkinsons
61
Selegeline is a (reversible/irreversible) MAOI
reversible
62
Phenelzine is a (reversible/irreversible) MAOI
irreversible
63
why is selegiline given as a transdermal patch?
bypasses the gut and lowers the risk of HTN crisis via tyramine
64
MAOI's have side effects with what drugs?
1. indirect acting sympathomimetics and tyramine coantianing foods
2. SSRIs and 5 ht- receptor agonists causing serotonin sydrome
65
What are the characteristics of a manic episode?
1.exaggerated optimism and self-confidence
2. decreased sleep without experiencing fatigue
3. grandiose delusions, inflated sense of self-importance
4. excessive irritability; aggressive behavior
5. racing speech, flight of ideas
impulsiveness, poor judgment
6. easily distracted
7. reckless behavior
66
How many full cycles is considered rapid cycling in bipolar?
4 full cycles
67
Eskalith is lithium (carbonate/citrate)
carbonate
68
Cibalith is lithium (carbonate/citrate)
citrate
69
What is the firstline drug for mania?
lithium
70
Pts with bipolar disorder can experience what when taking SSRIs?
mood swings
71
T/F: pts with bipolar disorder may initially need an SSRI along with their lithium
true
72
T/F: lithium is not effective for rapid cyclers
true
73
Lithium effects are (immediate/build over time)
build over time
74
This drug causes the inhibition of recycling of inositol substrates
lithium
75
This drug alters the function of GPCRs assc'd with B-adrenergic and M1ACh receptors
lithium
76
Lithium distributes into (blood volume/total body water volume)
total body water
77
How soon does normal lithium reach peak plasma? Slow release?
Normal; 1-2 hours
| slow release: 4 hours
78
How is lithium eliminated?
via the kidney; half life of 20-24 hours
79
Renal clearance of lithium is proportional to (blank)
plasma concentration
80
Dehydration, CHF, renal dz, old age can all (inc/dec) lithium levels
increase
81
Na depletion may cause sig. lithium (excretion/retention)
retention
82
Lithium clearance is (inc/dec) by loop and thiazide diuretics, NSAIDS, and ACE inhibitors
decreased
83
lithium clearance is (inc/dec) by osmotic diuretics, acetazolamide, caffeine, and theophylline
increased
84
What are the SE of lithium?
```
drowsiness, slowed mentation, forgetfulness
GI distrubances
Polyuria and thirst
wt. gain
mild tremor in fingers
```
85
What are the major complications of long term lithium use?
interstitial nephritis
| depression of thyroid function (via iodine interference)
86
Can lithium be used during pregnancy?
not during first trimester or during breastfeeding
87
lithium has a (high/low) therapeutic index
low
88
Above 2.5 mEq/L lithium SE inlcude....
ataxia
gross tremor
cardiac arrhythmias
coma and convulsion
89
T/F: lithium tox can be seen at any blood levels
true
90
What is an anti-epileptic drug that is first line for mania and mixed states?
```
valproic acid (depakote)
or
carbamazepine (tegretol)
or
lamotrigine
```
91
What are the atypical antipsychotics?
```
QUETIAPINE (Seroquel)
OLANZAPINE (Zyprexa)
RISPERIDONE (Risperdal)
ARIPIPRAZOLE (Abilify)
LURASIDONE (Latuda) – bipolar depression only
ASENAPINE (Saphris)
```
92
T/F: lorazepam and clonazepam can be used for treating acute mania
true
