Depression Flashcards Preview

Pharmacology > Depression > Flashcards

Flashcards in Depression Deck (41):
1

Major depression symptoms

depressed most of day, most days; diminished interest in activities, dec weight/wt inc; insomnia, hypersomnia, fatigue; feeling worthless, guilty; dec ability to concentrate, recurrent thoughts of death

2

Subgroups of depression

psychotic, atypical, seasonal, postpartum, melancholia, catatonic

3

Pathophysiology of depression

reduced neurotransmitters: serotonin, norepi, DA, mostly invloving limbic and hypothalamus

4

Treatment options for depression

psychotherapy, electroconvulsive therapy, antidepressants

5

Electroconvulsive therapy

unilateral/ bilateral seizures that change level of neurotransmitters, response faster than drugs, may need 6-12 months of therapy, most pts respond, be careful w/ stoke or MI

6

Antidepressant treatment

onset requires weeks, appears to restore the neurotransmitter mediated balance in the brain between serotonin, norepi, and DA, 60-70% efficacy no matter the agent, don't d/c abruptly, shouldn't be on 2 from same class

7

SSRIs

paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitaloprom (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), vortioxetine (Brintellix)

8

SSRI MOA

inhibits the reuptake of serotonin at the pre-synaptic serotonin transporter pump, inc brain serotonin levels, not fatal if overdose

9

SSRI ADRs

CNS abnormalities, GI upset, st change, hyponatremia, decreased libido

10

Fluoxetine (Prozac)

Long T1/2- active metabolites, , activating, causes insomnia, wt loss, minor dopamine antagonist

11

Fluoxetine (Prozac) dosage

20 mg PO daily, only one available once a week option, 90 mg PO weekly, good for noncompliant pts, must adhere first 2 weeks

12

Parocetine (Paxil)

wt gain and sedation prominent, take at bedtime, 20-40 mg PO once daily

13

Sertraline (Zoloft)

25-100 mg PO once daily, middle of the road in terms of effects on sleep and appetite, DA agonist (Minor), good for parkinson's

14

Citalopram (Celexa)

20-40 mg PO daily, only effects serotonin, not DA or Ach, fewest ADRs, better for mild to mod depression

15

Fluoxamine (Luvox)

50-100 PO daily, only indicated for OCD, can also be used to boost activity of antipsychotic agents

16

All SSRIs are

highly protein bound, inhibit P450 system, increase effects of TCAs, inc/dec lithium, dec clearance of trazodone and diazepam, inc toxicity of MAOIs, may displace protein bound drugs

17

SNRIs

Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafacine (Pristiq)

18

SNRI MOA

inhibit neuronal serotonin and nor epi reuptake results in inc brain serotonin and norepi levels

19

Venlafaxine (effexor)

take with food, may be effective for resistant depression, ADR exceptions, less sexual side effects, HTN

20

Venlafaxine (effexor) dosage

75-150mg PO BID, used most frequently as XR formulation: 75-150 PO daily

21

Desvenlafaxine sodium (Pristiq)

Longer T1/2 than venlafaxine,, requires adjustment for impaired renal function, ADR profile is very similar to venlafaxine

22

Duloxetine (Cymbalta)

40-60 mg PO daily, quicker onset, effective in one week? used reg for diabetic peripheral neuropathy, hepatoxic

23

Tricyclic antidepressants

Amitriptyline (Elavil), doxepin (sinequan), nortriptyline (Pamelor), imipramine (tofranil), clomipramine (Anafranil), desipramine (Norpamin)... and more

24

MOA of TCA

inhibit the of reuptake of norepi and/or serotonin, causing a relative inc in [neurotransmitter], can be fatal in overdose

25

TCA ADRs

most common: ach effects, sedation and orthostatic hypotension, TCAs lower the seizure threshold and may precipitate seizures, tachycardia, arrhythmias, elderly are at risk of sedation and hyTN

26

Amitriptyline

10-100mg PO daily, generally at bedtime, used reg for insomnia in young pop

27

Trazodone (Desyrel)

inhibit serotonin reuptake, 100 mg PO once daily at bedtime, often used in combo w/SSRIs for insomnia, no ACh ADRs, may cause priapism, take w/ food

28

Bupropion (Wellbutrin) MOA

mild DA reuptake inhibitor, little effect on norepi, no effect on seritonin or monoamine oxidase

29

Bupropion (Wellbutrin)

Contraindicated in pts w/ seizure disorders and psychosis, lack of cardiovascular, ACh, and sexual side effects, Wt loss, insomnia, agitation, HA, a DOC for smoking cessation, also available as wellbutrin SR/XL

30

Mirtazapine (Remeron)

enhances central norep and serotonin activity by antagonizing central pre-synaptic a2 receptors, often as adjunct (30mg), monotherapy for insomnia, possibly faster onset

31

Mirtazapine (Remeron) ADRs

somnolence, at low dose, dizziness, increased appetite/wt gain, orthostatic hyTN, and hallucinations

32

MAOIs

Phenelzine (Nardil), Selegiline (Eldepryl, Zelapar), tranylcypromine (parnate)- none use very often, must have 2 week washout period when switching from other vice versa

33

MAOI MOA

impair degradation of norepinephrine, serotonin, and dopamine leading to inc neurotransmitter conc; prevents metabolism of tyramine in GI and liver causing release of norepi and severe HTN, rarely use w/ another class

34

MAOI ADRs

orthostatic hypotension, delayed ejaculation, wt gain, and edema, can switch bipolar pts into mania, liver toxic, lot of DIs

35

Withdrawal of antidepressants

1-5 days after d/c, fatigue, insomnia, dizziness, tremor, confusion, agitation, memory probs

36

Treatment of withdrawals

resume antidepressant if possible, reassurance and supportive care, not life threatening rxns, can be disturbing

37

Serotonin syndrome

symptoms complex characterized by mental status changes, agitation, diaphoresis, diarrhea*, incoordination and tachy

38

Cause of serotonin syndrome

believed to be from serotonergic hyperstimulation, can develop when taking a combo of serotonergic meds or when changing from one serotonergic drug to another, also from DI that applify the seroonergic effect of single drug

39

Treatment serotonin syndrome

d/c all serotonergic meds, supportive care

40

Suicide warning for antidepressants

boxed warning on most if not all agents, inc in suicide thinking and behavior, not completed attempts

41

Treatment resistance

clinical trial have documented that most persons do not recover completely from depression w/ 1st drug therapy, many will require therapy w/ 2 or more concurrent agents, for recurrent disease, must treat x2years