Depression Flashcards by Kaylyn Freeman

5 SSRI’s

fluoxetine
sertraline
paroxetine
citalopram
escitalopram

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ADR of SSRI’s

Sexual
Wt gain
long QT
SIADH
Serotonin Syndrome
FINISH syndrome

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what is finish syndrome?

flue like sxs
insomnia
imbalance
sensory disturbances
hyperarousal

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what drug specifically causes FINISH syndrome

paroxetine

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what SSRI can be used in pregnancy

sertraline

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SSRI with shortest 1/2 life

paroxetine

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SSRI with highest risk of QT prolongation with high dose

citalopram

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SSRI’s that inhibit 2D6

Fluoxetine

Paroxetine

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what CYP does citalopram inhibit

2C19

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what drugs shouldn’t be combined with citalopram

omeprazole/esomeprazol

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3 SNRI’s to know

venlafaxine
desvenalfaxine
duloxetine

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MOA of SNRI

inhibit serotonin and NE reuptake

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what SNRI’s have ghost tablets

venlafaxine

desvenlafaxine

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ADR of SNRI’s

increase BP/HR
Nausea
Constipation
Insomnia
Serotonin syndrome

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specific ADR of duloextine

hepatotoxicity

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what is discontinuation syndrome?

after 1 missed dose–anxiety, dizziness, flu-like symptoms

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what SNRI causes discontinuation syndrome

venlafaxine

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what SNRI inhibits 2D6

duloxetine

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Theory behind SSRI and 5HT agonist drugs MOA

Provide direct stimulation of postsynaptic cleft in addition to blocking reuptake of serotonin -> QUICKER than SSRI (reuptake only)

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What the 3 things to know about SSRI and partial 5HT agonists?

Names (vilazodone, vortioxetine)
NOT quicker
NOT more efficacious
May have less side effects (esp. sexual dysfunction)

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Bupropion should be avoided in what pts

anxious pts (it is amphetamine-like) 
seizure pts

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what CYP does bupropion inhibit?

2D6

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Trazadone MOA

SSRI
agonist @ 5HT
antagonist of histamine
alpha-1 antagonist

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what is trazadone really good at treating w/ depression

insomnia

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ADR's of trazadone

QT prolongation hypotension **Priapism sedation

what does trazadone induce?

P-gp

MOA of mirtazapine

antagonist of Alpha-2 receptors and serotonin receptors-increase NE and serotonin

Mirtazapine is good in patients with depression + ?

anorexia--helps old ppl eat | insomnia

Tertiary Amine TCAs

imipramine Clomipramine Amitriptyline Doxepin

Secondary Amine TCAs

Desipramine | Nortiptyline

3* TCA ADR

orthostasis sedation wt gain anti-cholinergic

use of imipramine not in depression

nocturnal enuresis in kids

TCA used with insomnia

doxepin

TCA used with OCD

clomipramine

unlabeled use of TCA's

neuropath pain

TCA used in migrane prophylaxis

amytripyline

monitoring for TCA's

ECG if >40 y/o

signs of TCA OD

cardiac arrhythmia d/t QT prolongation

why do ppl die of TCA od?

d/t hypotension and ventricular arrhythmia b/c fast Na+ channels get blocked

which TCA's are better tolerated

secondary

extra ADR's of 2* TCA's

gynecomastia sexual function SIADH

3 MAOI-A

isocarboxazid tranylcypromine phenelzine

MOA of MAOI

increase NE, dopamine, serotonin

clinical indications for MAOI-A use

MDD w/ hyperphagia or hypersomnia

ADR's of MAOI-A

dizziness xerostomia nausea HA

what foods need to be avoided while on MAOI-A's?

tyramine rich foods

what drugs can you not combine MAOI-A's with?

serotonin drugs, CNS depressants, sympathomemetics

MAOI-B drug

Selegilne

what pts is selegine best for? why?

parkinson pt's who cannot swallow pills b/c this is a PATCH

what foods need to be avoided when selegiline is taken at high doses?

tyramine rich foods

Step 1 of depression Tx

lifestyle changes

step 2:

``` SSRI; adults= citalopram or sertraline kids; fluoxetine OR SNRI; bupropion/mirtazapine ```

mild-mod depression tx

antidepressant

severe depression tx

antidepressant + psychotherapy

depression + psychotic symptom tx

antidepressant + psychotherapy + atypical antipsychotic

how long should pts be on depression meds

minimum 6-9months for 1st episode

best drug for depression + anxiety

SSRI

drugs with lowest wt gain

fluoxetine | bupropion

drugs with lowest sexual dysfunction

bupropion> mirtazapine

drugs that increase energy w/ depression

bupropion or SNRI

what can anti-depressant induce..

mania

how do we avoid inducing mania

screen for bipolar before starting antidepressants

drugs for postpartum depression

Sertraline or escitalopram

when do we screen kids for depression

12 years old

after 4-8wks of optimization that isn't working how do we handle tx

can switch to other SSRI or SNRI

when do we have to cross-taper?

SSRI or SNRI--> bupropion, mirtazapine, or TCA

when do we refer?

when we start to use more than 1 agent switching to TCA or MAO-I atpical antipsych use

what drug can you not taper fluoxetine to?

MAOI

how long do you need to give fluoxetine to be 100% gonezo?

7 days

Depression Flashcards

(69 cards)