Exam 10: Antidepressants Flashcards
(82 cards)
1
Q
What are two Tricyclic Antidepressants?
A
Imipramine
Amitriptyline
2
Q
What are Imipramine and Amitriptyline?
A
Tricyclic Antidepressants
3
Q
Name 6 SSRIs
A
Fluoxetine Fluvoxamine Sertraline Paroxetine Citalopram Escitalopram
4
Q
Name 2 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
A
Venlafaxine
Duloxetine
5
Q
Name 4 second generation (atypical) antidepressants
A
Trazodone
Nefazodone
Bupropion
Mirtazepine
6
Q
Name 1 Selective Norepinephrine Reuptake Inhibitor
A
Atomoxetine
7
Q
Name 3 MAO Inhibitors
A
Phenelzine
Tranylcypromine
Selegiline
8
Q
Name 4 Mood Stabilizers
A
Lithium carbonate
Valproic Acid analogs
Carbamazepine
Clonazepam
9
Q
Fluoxetine category
A
SSRI
10
Q
Fluvoxamine category
A
SSRI
11
Q
Sertraline category
A
SSRI
12
Q
Paroxetine category
A
SSRI
13
Q
Citalopram category
A
SSRI
14
Q
Escitalopram category
A
SSRI
15
Q
Venlafaxine category
A
SNRI
16
Q
Duloxetine category
A
SNRI
17
Q
Atomoxetine category
A
Selective Norepinephrine reuptake inhibitor
18
Q
Phenelzine category
A
MAO Inhibitor
19
Q
Tranylcypromide category
A
MAO Inhibitor
20
Q
Selegiline category
A
MAO Inhibitor
21
Q
Lithium category
A
Mood stabilizer
22
Q
Valproic acid analog category
A
Mood stabilizer
23
Q
Carbamazepine category
A
Mood stabilizer
24
Q
Clonazepam category
A
Mood stabilizer
25
What are three first line drug categories for depression?
Tricyclics
SSRIs
Miscellaneous Second gen antidepressants (Atypical)
26
What is a second line category of drug for depression?
MAO Inhibitors
27
What is an anti anxiety drug that is thought to have antidepressant activity?
Alprazolam (Xanax)
28
What is a problem with the use of antidepressants in Manic Depressive Disorders?
They can help with depression, but may trigger a switch to the manic phase
29
What is the main benefit of SSRIs over Tricyclics?
They are safer, not really more efficacious.
30
What can't you eat if you're on MAO inhibitor?
foods that contain Tyramine will cause a massive release of catecholamines
31
What is a side effect that is pronounced in Trazodone and Nefazodone?
Very sedating
32
Imipramine Pharmacological Effects (5) (prototype for antidepressants)
1. Sedation
2. Antidepressant effects develops slowly over 2-4 weeks
3. Can also treat OCD, panic attacks, generalized anxiety disorder, social phobias
4. CNS Stimulation (usually at higher doses)
5. Decreased seizure threshold
33
Imipramine mechanism of action (2) (other antidepressants)
1. Inhibits reuptake of NE, 5-HT and/or DA
| 2. Adaptive changes in receptors and signaling pathways
34
What is special about Bupropion?
It has the most major effect on DA reuptake inhibition (most others barely affect this or don't at all)
35
What side effects are not seen in SSRIs?
Cardiovascular side effects because they don't affect NE and don't have anticholinergic activity
36
What is an additional mechanism seen in second gen antidepressants (not SSRIs or Tricyclics)?
Blockage of alpha 2 receptors
| Can affect the cardiovascular system
37
Which of the first line antidepressants has the worst anticholinergic effect? the least?
Amitriptyline is the worst
| SSRIs have the least effect
38
What are cardiovascular effects of antidepressants? Why?
Postural hypotension due to alpha blockade
Tachycardia (NE, anticholinergic)
Arrhythmias
39
CNS side effects of antidepressants
```
Tremor
Agitation, anxiety, irritability
switch to manic phase
parkinsonism
increased risk of seizures
```
40
What antidepressants are most/least likely to cause weight gain?
```
Most = tricyclics
Least = SSRIs
```
41
What is a potentially fatal side effect of antidepressants?
blood dyscrasias
42
How can antidepressants affect sex?
Impotence or delay of orgasm in males due to alpha blockade (very common)
retrograde ejaculation can occur
43
What is the traditional antidote to tricyclic toxicity?
Bicarb (alkalinize the urine)
44
What is a major consideration when prescribing drugs to a depressed person?
They may be suicidal. The drugs you give them may be used to commit suicide
45
What is a potential interaction of MAO inhibitors?
Serotonin syndrome can happen if switch patients between MAOIs and tricyclics/SSRIs too quickly
46
What are some other uses of antidepressants?
```
Enuresis (imipramine)
intractable pain from neuropathies
chronic pain
cocaine/amphetamine dependence
Anxiety/panic disorders
OCD
```
47
What is a consideration when prescribing antidepressants to children?
May increase suicidal ideation, especially shortly after drug therapy is initiated.
48
What effects are different about Amitryptiline vs Imipramine
Amitriptyline has more sedative and anticholinergic activity than imipramine
49
Fluoxetine
Prototype SSRI
Treats depression, OCD, GAD, PMMD, eating disorders
Long acting, takes a while to work
Liver metabolism- drug interactions (CYP)
50
sertraline
SSRI
| Less drug interactions than Fluoxetine
51
Paroxetine
SSRI
SHORTER ACTING than Fluoxetine and Sertraline
More weight gain than other SSRIs
52
Citelopram and Escitalopram
Newest SSRIs
| Similar to Sertraline (fewer drug interactions than Fluoxetine)
53
What is an advantage of Fluoxetine?
Longer acting, protects against discontinuation symptoms
54
Fluvoxamine uses (2)
1. Antidepressant used in foreign countries
| 2. Used of Obsessive Compulsive disorder in the USA
55
Bupropion mechanism
Selectively blocks DA reuptake
56
Bupropion effects
"Psychic energizer" with mild stimulant activity
57
Disadvantage of Bupropion
More likely to cause seizures than other antidepressants
58
Bupropion use
Treatment of nicotine, cocaine, amphetamine dependence
59
Bupropion advantage
Less likely to cause sexual side effects than other antidepressants
60
Uses of Venlafaxine (2)
1. Depression
| 2. Generalized anxiety disorder
61
Venlafaxine effects
Improve mood, energize depressed patients
| May work in patients who do not respond to SSRIs
62
Venlafaxine side effects
Stimulant-like effects (sweating, nausea, anxiety, nervousness)
63
Duloxetine uses
Musculoskeletal and neuropathic pain as well as depression/anxiety
64
Trazodone/Nefazadone mechanism
Serotonin reuptake inhibitor that also blocks 5-HT receptors (idk how this makes sense)
65
Trazodone/Nefazadone side effects (2)
1. Priapism/sexual dysfunction in males
| 2. highly sedating
66
Mirtazapine mechanism
Blocks alpha-2 receptors, enhancing serotonin and NE release
| Also blocks some types of serotonin receptors
67
Mirtazapine side effects
Anticholinergic, hypotension, tachycardia (similar to tricyclics)
68
In whom is Mirtazapine especially effective
Depression with high levels of anxiety
69
Atomoxatine use
ADHD in children and adults
70
Atomoxatine side effects
Appetite suppression, increased BP, tachycardia, sexual dysfunction in adult males
71
How do MAO inhibitors take effect?
Slowly, take weeks to develop
72
MAO inhibitors side effects
Orthostatic hypotension, hypertension, GI effects, CNS stimulation, liver damage
73
What is a severe problem with MAO inhibitors?
If taken with foods containing lots of Tyramine can cause hypertension, fever, convulsions.
Same can happen if the patient has a pheochromocytoma or is on sympathomimetics
74
MAO inhibitor uses (3)
1. Depression (second line)
2. Bulimia, OCD, PTSD
3. Narcolepsy
75
Lithium effects on the CNS
On most people it has no affect
| On people with bipolar disorder it is a mood stabilizer
76
Lithium Mechanism
May alter metabolism of phospholipids that are involved in the phospholipid signaling pathway
May also affect distribution of ions or the release of neurotransmitters
77
Pharmacokinetic consideration of Lithium
Excreted by kidney, use with caution in patients with impaired renal function
78
What can early lithium toxicity mimic?
Alcohol intoxication
79
What are 4 patents who shouldn't get Lithium?
1. Pregnancy
2. Renal impairment
3. CV disease
4. thyroid disease
80
What are 4 drugs used to treat manic depression?
1. Lithium
2. Carbamazepine
3. Valproic Acid
4. Clonazepam
81
What do you need to do before giving an MAO inhibitor?
Make sure that they've stopped taking tricyclics long enough
82
What drug is preferred for MILD depression with anxiety?
Alprazolam (Xanax)
