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Pharmacology III > Antidepressants (Exam #1) > Flashcards

Antidepressants (Exam #1) Flashcards

1
Q

What is the general NT abnormality in depression, and how do antidepressants work to fix this?

A

Decreased levels of monoamines (DA, NE or 5-HT)

- ALL antidepressants increase amine neurotransmission

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2
Q

What is the MOA of TCAs?

A

Inhibit NE and 5-HT reuptake

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3
Q

What is the MOA of SSRIs?

A

Selectively inhibit 5-HT reuptake

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4
Q

What is the MOA of SNRIs?

A

Inhibit NE and 5-HT reuptake

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5
Q

What is the MOA of MAOIs?

A

Inhibit reuptake of all 3 (DA, NE, 5-HT)

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6
Q

With reuptake inhibitors, what is an important characteristic that should be considered (and possibly relayed to the patient)?

A

Inhibition occurs immediately, but effects are DELAYED

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7
Q

Besides depression, what are three other uses of TCAs?

A
  • Chronic pain (TMJ)
  • Fibromyalgia
  • Enuresis = DOC
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8
Q

What type of TCAs are Amitriptyline and Imipramine, and how does this affect their MOA?

A

Tertiary amines

- Inhibit 5-HT reuptake

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9
Q

What type of TCAs are Nortriptyline and Desipramine, and how does this affect their MOA?

A

Secondary amines

- Inhibit 5-HT reuptake

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10
Q

Are secondary or tertiary amine TCAs preferred, and why (2)?

A

Secondary = preferred

- Tertiary produce more seizures and are more sedating

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11
Q

How are TCAs metabolized?

A

CYP2D6 = drug interactions common

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12
Q

What seven AEs are commonly seen with TCAs?

A
  • Drowsiness (histamines blocked)
  • Constipation, dry mouth (cholinergic blocked)
  • CV effects, arrhythmias (adrenergic blocked)
  • Analgesia
  • SIADH
  • Sexual dysfunction
  • Decreased seizure threshold
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13
Q

What is an important toxicity/overdose associated with TCAs? Ho do you treat it (3)? What there meds can be used to manage the arrhythmias?

A

Torsades de Pointe

  • Treat with Mg, Isoproterenol, cardiac pacing
  • For arrhythmias, use Lidocaine, Propranolol, Phenytoin
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14
Q

What is the most likely antidepressant to inhibit CYP2D6? What class is it a part of?

A

Fluoxetine (Prozac)

- SSRI

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15
Q

Which SSRI is preferred in the elderly?

A

Sertraline (Zoloft)

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16
Q

What is the current DOC for depression, and which two drugs specifically?

What is the LAST option for depression?

A

SSRIs

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

LAST option = MAOIs

17
Q

If sexual dysfunction is present with an antidepressant, which drug can you switch to and why?

A

Buproprion

- Less sexual AEs

18
Q

What are the two SNRIs? In what way might they be preferred to SSRIs, and how are they NOT preferred?

A
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)

Can be used for neuropathic pain BUT more AEs

19
Q

What are two examples of MAOIs, and what is the MOA of each? Which is drug of last last choice?

A

Phenelzine = last last choice
- Inhibits MAO-A and MAO-B = increases all 3

Selegiline
- Inhibits MAO-B ONLY = increases DA only

20
Q

Which type of MAOI has an AE of HTN crisis, and what drug is an example? What foods should be avoided?

A

Inhibits MAO-A
- Phenelzine

Avoid foods with Tyramine

21
Q

What foods should be avoided with the use of Phenelzine and why?

A

Avoid foods with Tyramine

- Can cause HTN crisis because of MAO-A inhibition

22
Q

What is the MOA of Buproprion, and what is its alternative use?

A

Inhibit DA

- Can be used for smoking cessation

23
Q

What are the three AEs of Buproprion? In what instance might it be preferred to other antidepressants?

A
  • Seizures
  • CNS effects
  • Cardiac

Sexual dysfunction RARE = preferred if present

24
Q

What is the MOA of Mirtazapine, and what does this mean?

A

Blocks presynaptic a2 receptors

- Increase NE and 5-HT

25
Q

What drug can be used in conjunction with antidepressants, and why?

A

Mirtazapine

- Reduces antidepressant AEs

26
Q

What is the first non-stimulant ADHD tx?

A

Atomoxetine (Straterra)

27
Q

What is the MOA of Atomoxetine (Straterra), and what is its primary use? What population is it often considered for?

A

Selective inhibitor of 5-HT reuptake

Used for ADHD (NON-stimulant)
- Good for addicts because NO euphoria

28
Q

What is the MOA of Trazadone, and what is its primary use?

A

5-HT2A receptor antagonist

Used for sedation/sleep aid

29
Q

What is the primary serious AE associated with Trazadone?

A

Priapism

30
Q

What specific class of antidepressants should be avoided in combination with opioids?

A

SSRIs

Pharmacology III (25 decks)

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