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PHRM 845 Exam 5 > Depression > Flashcards

Depression Flashcards

1
Q

Risk of reoccurance

A

Episode 1: 50-60%

Episode 2: 70%

Episode 3: 90%

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2
Q

Diagnosis

A

> or equal 5 with at least 1 being depressed or loss of interest

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3
Q

SIGE CAPS

A

Sleep, intertest decrease, guilt/worthlessness, energy loss, concentration difficulties, appetite loss, psychomotor agitation, suicidal ideation

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4
Q

Physiological

A

sleep, appetite, fatigue, clumsiness

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5
Q

Phycological

A

dysphoric mood, loss of interest, guilt, worthlessness

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6
Q

Cognitive

A

concentration difficulties, suicidal ideation

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7
Q

Biogenic amine

A

Reserpine causes depression by depleting NE and 5-HT from vesicles

NE and 5-HT are effective in depression

Genetic polymorphisms in SERT

Alterations in 5-HT1A/C and alpha 2 receptors

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8
Q

Neuroendocrine

A

Alterations in Hypothalamic-pituritary-adrenal axis (HPA)

Overactivity of the axis that causes increased activity of CRF

CRF1:arousal, anxiety, disruption in sex and sleep

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9
Q

Neurotropic

A

Depression, stress and pain patients have decreased BDNF levels

Loss of sprouts and hippocampal volume leads to depression

Antidepressant increase BDNF levels and hippocampal volume

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10
Q

MAO-I

A

MAO normally degrades NE and 5-HT

MAO-A: NE AND 5-HT
MAO-B: DA

Inhibition: increased amount of NE and 5-HT in vesicles released in synapse

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11
Q

Phenelzine and Tranylcypromine

A

drug resistant depression

Non-selective (irreversible)

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12
Q

Moclobemide

A

MAO-A selective (reversible)

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13
Q

Selegiline

A

MAO-B selective (reversible)

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14
Q

SE of MAO-I

A

HA, drowsiness, dry mouth, weight gain, orthostatic hypotension, sexual dysfunction

Hypertensive crisis: AVOID TYRAMINE

MAO normally degrades tyramine

Except selegiline 6 mg/24hr patch

Risk of serotonin syndrome: TCA, SSRI, L-DOPA

MUST HAVE 2 WEEK WASHOUT PERIOD BEFORE SWITCHING ANTIDEPRESSANT (5 WEEKS FOR FLUOXETINE)

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15
Q

TCA

A

Tertiary amines

Block SERT, NET, histamine 1, muscarinic, alpha -1

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16
Q

Imipramine

A

tertiary amine

metabolized to desipramine

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17
Q

Trimipramine

A

tertiary amine

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18
Q

Clomipramine

A

tertiary amine

causes orgasm when yawning

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19
Q

Amitriptyline

A

metabolized to nortriptyline

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20
Q

Doxepin

A

tertiary amine

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21
Q

SE of TCA tertiary amines

A

sedation, confusion, reduced seizure threshold

anticholinergic

orthostatic hypotension, tachycardia

weight gain, sexual dysfunction

22
Q

MOA of TCA secondary amines

A

blocks NET and SERT

23
Q

Desipramine

A

secondary amine

24
Q

Nortriptyline

A

secondary amine

25
Q

Maprotiline

A

secondary amine

26
Q

SE of TCA secondary amines

A

less side effects

27
Q

SSRI MOA

A

inhibit SERT that increases amount of 5-HT in synapse

28
Q

Fluoxetine

A

take in the morning

little sedation, autonomic

weight loss

long t1/2

activating potential

29
Q

Paroxetine

A

take at bedtime

sedation, weight gain

Must taper due to ANTICHOLINERGIC EFFECTS

Septal wall defect risk in fetus–>caution in pregnancy

30
Q

Citalopram

A

QTc prolongation

31
Q

Escitalopram

A
32
Q

Sertraline

A

GI upset

33
Q

Fluvoxamine

A
34
Q

Vilazodone

A

SSRI +5-HT1A partial agonist

Reduce sexual dysfunction effects of SSRI

Take with food: nausea and increases bioavailability

Cannot be used with SSRI/SNRI

35
Q

Vortioxetine

A

SSRI + 5-HT1A partial agonist

Reduces sexual dysfunction
Nausea, vomiting, constipation
Cannot be used with SSRI/SNRI

36
Q

SSRI Side effects

A

Headache, N/V, sexual dysfunction, insomnia, tremor, anxiety, increased bleeding risk, hyponatremia, decreased bone density

37
Q

Withdrawal from SSRI

A

brain zaps, vertigo, dizziness, sweating, insomnia, confusion

SLOW TAPER (10-25%) 1-2 WEEKS

38
Q

Serotonin syndrome symptoms

A

hyperthermia, muscle rigidity, restlessness, myoclonus, hyperreflexia, sweating, shivery, seizures

39
Q

Serotonin syndrome treatment

A

d/c treatment and manage symptoms
serotonin antagonists
BZD to manage myoclonus

40
Q

MOA of SNRI

A

Blocks NET and SERT

41
Q

Venlafaxine

A

> 150mg/day to have NE effects

42
Q

Desvenlafaxine

A

active metabolite of venlafaxine
nausea (50%)
No CYP interactions

43
Q

Duloxetine

A

Nausea

Hepatotoxicity

baseline LFT
every 6 months

44
Q

Maprotiline

A

blocks NET

45
Q

Mirtazapine

A

5-HT2/3, H1, Alpha 2 antagonist

Sedation, weight gain
Agranulocytosis
Increase cholesterol

can be taken with SSRI/SNRI

46
Q

Bupropion XL

A

Blocks NET, DAT

Stimulating–> insomnia, appetite suppression

CI in seizures and eating disorders
Can be used with SSRI/SNRI

47
Q

Trazodone

A

5-HT2A antagonist + blocks SERT

Sedation
Orthostatic hypotension
priapism

48
Q

Filbanserin

A

5-HT2A/C antagonist
5-HT1A agonist
RAPID ACTING

49
Q

FDA Approved augmentation agents

A

Aripiprazole
Brexpiprazole
Cariprazine
Quetiapine

50
Q

Treatment of Postpartum depression

A

SSRI (Fluoxetine or Paroxetine) SNRI (Venlafaxine)

51
Q

Brexanolone

A

postpartum depression

Allopregnanolone levels are increased during pregnancy–>desensitizes GABA-A receptors

After birth, allopregnanolone levels return to normal –>brexanolone resensitizes GABA-A receptors

REMS
60 hr infusion

PHRM 845 Exam 5 (13 decks)

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