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NMSP Exam III > Antidepressants & Mood Stabilizers (Segars) > Flashcards

Antidepressants & Mood Stabilizers (Segars) Flashcards

1
Q

What antidepressant drug is also used for nicotine withdrawal?

A

bupropion

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2
Q

What antidepressant drug is also used for enuresis?

A

imipramine

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3
Q

What antidepressant drug is also used for diabetic peripheral neuropathy, fibromyalgia and chronic musculoskeletal pain?

A

duloxetine

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4
Q

What antidepressant drug is also used for stress incontinence?

A

duloxetine

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5
Q

What is the first choice of treatment for depression?

A

psychotherapy

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6
Q

What are the 3 depression hypotheses?

A
  1. monoamine hypothesis***
  2. neurotrophic hypothesis
  3. steroids hypothesis
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7
Q

What are the 3 main neurotransmitters in the monoamine hypothesis?

A

norepinephrine (NE)
serotonin (5-HT)
dopamine (DA)

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8
Q

Which steroid in the steroid hypothesis may be used to supplement in low doses to treat patients with depression?

A

thyroid hormones (T3/T4)

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9
Q

What are the 5 R’s in antidepressant efficacy?

A
  1. Response = 50% reduction in symptoms from baseline (not enough)
  2. Remission = symptom free (the goal)
  3. Recovery = 6-12 months in ongoing remission
  4. Relapse = return of symptoms after remission
  5. Recurrence = return of symptoms after recovery
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10
Q

Which if the 5 R’s is the goal in general antidepressant efficacy?

A
  1. Remission = symptom free (the goal)
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11
Q

What is the typical timeframe that the patient tends to respond to the anti-depressant drug?

A

3-4 weeks

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12
Q

What are the SNRI’s ?

A

All the TCA’s and then:
Desvenlafaxine
Duloxetine
Venlafaxine
Levomilnacipran

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13
Q

What are the 7 SSRI’s?

A

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodone
Vortioxetine

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14
Q

What is the one NDRI?

A

Bupropion

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15
Q

What is the NDRI mixed with the MOA of NMDA antagonist?

A

Esketamine - treatment-resistant depression

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16
Q

What are the 3 SARA’s

A

Mirtazapine - watch for weight gain
Nefazodone - avoid due to hepatic toxicity
Trazodone - can aide as a good sleep agent

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17
Q

What is the one Neurosteroid/GABA Modulator?

A

Brexanolone - postpartem depression

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18
Q

What is the one SNRI + dopamine antagonist (DAn)?

A

Amoxapine

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19
Q

What are the 4 MAOI’s?

A

Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

20
Q

Which drug category is the drug of choice in depression?

A

the selectively serotonin reuptake inhibitors (SSRI’s) - Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

21
Q

Which two SSRI’s have an extra MOA on serotonin receptors?

A

Vilazodone - partial agonist on 5-HT1a
Vortioxetine - full agonist on 5-HT1a, full antagonist on 5 HT-1d,3,7 and partial agonist on 5-HT1b

22
Q

What is a concerning side effect of SSRI’s?

A

sexual dysfunction (a serotonin problem)

23
Q

What is a rare dose-dependent side effect of SSRI’s?

A

Serotonin syndrome (very unpleasant); abdominal pain, flushing, hyperreflexia, hyperthermia, mental status changes

24
Q

What are the typical symptoms seen in withdrawal syndrome?

A

FINISH
F - Flu-like symptoms
I - Insomnia
N - Nausea
I - Imbalance
S - Sensory disturbances
H - Hyperarousal

25
Q

What is the Black Box Warning for ALL anti-depressant drugs?

A

suicidal ideation

26
Q

What is the strongest CYP inducer in the SSRI family and should be avoided in patients who are on multiple medications?

A

fluoxetine

27
Q

What are the 3 receptors that are modulated by SNRI’s?

A

histamine (H1) - causes CNS probs (sedation, fatigue, dizziness, seizures)
muscarinic (m3) - anticholinergic (dry mouth, urinary retention, blurred vision)
adrenergic (a1) - CV )tachycardia, hypotension, dysrhythmias)

28
Q

What are the 3 C’s in TCA toxic ingestion?

A

Coma
Cardiotoxicity (conduction abnormalities)
Convulsions

29
Q

Amoxapine

A

the one SNRI + dopamine antagonist (DAn);

30
Q

Which one of the SARA’s are to be avoided and why?

A

Nefazodone; hepatic toxicity

31
Q

Mirtazapine

A

an adrenergic and serotonin blocker; watch for weight gain

32
Q

Which SARA are you concerned with significant weight gain?

A

Mirtazapine

33
Q

Bupropion

A

NE and DA reuptake inhibitor and also stimulates VMAT2 release of more neurotransmitters; side effects of stimulation and seizures at high doses

34
Q

What is the only MAOI that is B-selective?

A

Selegiline

35
Q

MOA of MAOI’s?

A

irreversibly inhibits MAOI’s

36
Q

What is the major concern for MAOI’s?

A

a hypertensive crisis; watch for tyramine containing foods/beverages (pt at a party night before and then crashes and ends up in the ER)

37
Q

When is it ONLY clinically indicated to use Esketamine?

A

for treatment-resistant depression in conjunction with ongoing antidepressant therapy AND acute suicidal ideations/behaviors

38
Q

Brexanolone

A

a Neurosteroid/GABA Modulator; indicated in postpartem depression; 60 hour IV infusion with q2h patient observation

39
Q

Which drug is indicated for postpartem depression and treated with 60 hour IV infusion with q2h patient observation?

A

Brexanolone; a Neurosteroid/GABA Modulator

40
Q

What are the 4 MOAs of Lithium?

A
  1. inhibits dopamine transmission
  2. down regulates the NMDA receptor
  3. promotes GABAergic transmission
  4. inhibits intraceullar enzymes
41
Q

Lithium can cause what renal disorder?

A

Nephrogenic Diabetes Inspipidus (resistance to ADH)

42
Q

What is the serum trough concentration of lithium?

A

0.6-1.5 mEq/L

43
Q

What is the serum trough concentration of valproic acid/divalproex?

A

60-120 mcg/mL

44
Q

What is the serum trough concentration of carbamazepine?

A

6-12 mcg/mL

45
Q

What is the mood stabilizer drug used for maintenance of bipolar ONLY?

A

Lamotrigine

NMSP Exam III (6 decks)

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