Antidepressants & ECT II Flashcards

1
Q

Fluoxetine (Prozac)

A

SSRI; half life 2-3 days

No serotonin discontinuation symptoms

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2
Q

Sertraline (Zoloft)

A

SSRI; half life of 24 hrs, risk of discontinuation symptoms

Weak dopaminergic activity, useful after brain injury

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3
Q

Paroxetine (Paxil)

A

SSRI; half life of 24 hrs, somewhat sedating, useful in anxiety disorders

  • Significant 2D6 inhibition
  • Anticholinergic side effects
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4
Q

Citalopram (Celexa)

A

SSRI; half life of 24 hrs

Fewer drug interactions, useful if someone is on numerous meds

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5
Q

What is the enantiomer of Citalopram (Celexa)?

A

Escitalopram (Lexapro)

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6
Q

Fluvoxamine (Luvox)

A

SSRI

Approved for treatment of OCD, but used by some to treat depression

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7
Q

fever, delirium, hypertension, hypotension, neuromuscular excitability occurring after taking a certain class of drugs

A

Serotonin Syndrome

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8
Q

Buproprion (Wellbutrin)

A
  • Dopamine and NE reuptake inhibition (most likely)
  • Few side FX
  • Electrolyte imbalance –> increased seizure risk
  • Used in smoking cessation
  • May be useful for ADHD
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9
Q

What is Buproprion (Wellbutrin) contraindicated in?

A

Patients with history of seizures, patients with eating disorders or other metabolic disturbances

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10
Q

What drug can be effective in decreases sexual side FX when given with an SSRI?

A

Buproprion (Wellbutrin)

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11
Q

Venlaxafine (Effexor)

A

SNRI (serotonin-NE reuptake inhibition)

  • Side FX similar to SSRIs
  • Dose related increase in BP
  • Useful in patients on numerous meds (very few drug interactions)
  • Treatment of generalized anxiety disorder
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12
Q

Desvenlafaxine (Pristiq)

A
  • SNRI
  • Relatively greater NE reuptake inhibition than venlaxafine, but more serotonergic than noradrenergic
  • Plasma levels more consistent than venlaxafine
  • More potent effect on NE may be helpful in pain conditions like fibromyalgia
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13
Q

Duloxetine (Cymbalta)

A
  • SNRI
  • Less likely than Effexor to cause dose-related HTN
  • Also indicated for depression and diabetic neuropathic pain
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14
Q

Mirtazapine (Remeron)

A
  • alpha-2 Antagonist at central presynaptic adrenergic autoreceptors
  • very sedating
  • Antihistaminic properties dramatically increase appetite and weight gain
  • Useful for people w/ loss of appetite and poor sleep
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15
Q

Trazodone

A
  • Most common use is for insomnia in low doses

- Major concern is priapism, and failure to treat in time can lead to permanent erectile dysfunction

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16
Q

TCA Side Fx

A
  • Anticholinergic - dry mouth, urinary retention, constipation, blurred vision
  • Alpha adrenergic blockade - orthostatic hypotension
  • Antihistamine - sedation, increased appetite, weight gain
17
Q

TCAs cause prolongaiton of what cardiac EKG interval?

A

QT

18
Q

T or F. TCAs are not lethal in overdose.

A

F - very lethal

19
Q

MAOI’s (monoamine oxidase inhibitors)

A
  • Inhibits enzyme that metabolizes NE, serotonin, dopamine, tyramine, resulting in increase in neurotransmitters in synapse
  • Used for major depression, anxiety disorders, social phobia, treatment resistant depression
  • Hypertensive crisis can occur as side effect when combined with certain drugs/foods
20
Q

Selegiline (EMSAM)

A

MAOI-B previously used for Parkinson’s, but was used off label for depression

21
Q

How long do you have to be off of an MAOI before a regular diet can be resumed or contraindicated meds started?

A

at least 2 weeks

22
Q

What drug can cause congenital cardiac abnormalities in first trimester?

A

Paroxetine (Paxil)

23
Q

When does postpartum depression occur?

A

Within four weeks of delivery

24
Q

What is normal postpartum sadness timeframe?

A

7-10 days

25
Q

What is drug of choice for postpartum depression? Why?

A

Sertraline b/c exposure through breast milk is lower than in utero

26
Q

What does ECT induce?

A

Bilateral, generalized tonic-clonic seizure for 30-90 seconds, often involving deeper brain structures like thalamus and also affecting every major neurotransmitter system

27
Q

What conditions is ECT used for?

A
  • Major depressive disorder
  • Manic episodes
  • Schizophrenia
28
Q

What type of schizophrenia can be helped by ECT? Which is not helped by ECT?

A

Schizophrenia characterized by catatonic or mood symptoms most likely show a response.

Chronic schizo does not.

29
Q

T or F. ECT can help with somatization disorders, personality disorder, OCD

A

False

30
Q

What medications are given to a patient prior to ECT?

A

Muscarinic anticholinergic agent for control of oral and respiratory secretions

General anesthetic, usually short acting barbiturate

Muscle relaxants to decrease bone fractures, succinylcholine

31
Q

What receptors are down regulated in ECT?

A

Post synaptic beta adrenergic receptors

32
Q

Common side FX of ECT

A
  • headache, confusion, delirium, muscle soreness, some memory impairment
33
Q

What can be used as therapy for SAD (seasonal affective disorder) which occurs in winter months or in cloudy climates?

A

Light therapy

34
Q

What newly approved treatment for depression generates a magnetic field that induces an electrical current in undrlying areas of brain?

A

Transcranial magnetic stimulation

35
Q

What highly experimental treatment is a battery powered pulse generator implanted in chest with leads tunneled under scalp and guided into brain near the cingulate cortex?

A

Deep brain stimulation