Exam 10: Antidepressants Flashcards Preview

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Flashcards in Exam 10: Antidepressants Deck (82):
1

What are two Tricyclic Antidepressants?

Imipramine
Amitriptyline

2

What are Imipramine and Amitriptyline?

Tricyclic Antidepressants

3

Name 6 SSRIs

Fluoxetine
Fluvoxamine
Sertraline
Paroxetine
Citalopram
Escitalopram

4

Name 2 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Venlafaxine
Duloxetine

5

Name 4 second generation (atypical) antidepressants

Trazodone
Nefazodone
Bupropion
Mirtazepine

6

Name 1 Selective Norepinephrine Reuptake Inhibitor

Atomoxetine

7

Name 3 MAO Inhibitors

Phenelzine
Tranylcypromine
Selegiline

8

Name 4 Mood Stabilizers

Lithium carbonate
Valproic Acid analogs
Carbamazepine
Clonazepam

9

Fluoxetine category

SSRI

10

Fluvoxamine category

SSRI

11

Sertraline category

SSRI

12

Paroxetine category

SSRI

13

Citalopram category

SSRI

14

Escitalopram category

SSRI

15

Venlafaxine category

SNRI

16

Duloxetine category

SNRI

17

Atomoxetine category

Selective Norepinephrine reuptake inhibitor

18

Phenelzine category

MAO Inhibitor

19

Tranylcypromide category

MAO Inhibitor

20

Selegiline category

MAO Inhibitor

21

Lithium category

Mood stabilizer

22

Valproic acid analog category

Mood stabilizer

23

Carbamazepine category

Mood stabilizer

24

Clonazepam category

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)