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T&D II exam 1 > Mood > Flashcards

Mood Flashcards

1
Q

first line drugs for depression and most anxiety disorders

A

SSRIs

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2
Q

Common characteristics of SSRIs

A
  • fewer autonomic side effects than TCA
  • INCREASE ALERTNESS, taken in AM
  • seldome cause cardiac arrhythmias
  • less sedation than TCAs
  • WIDE THERAPEUTIC WINDOW
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3
Q

How fast do SSRIs work

A
  • Inhibition is RAPID after starting tx
  • Effects take 3-6 weeks = gradual down regulation or dec in postynaptic receptors in respo on inc serotonin in synaptic cleft
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4
Q

SSRI

  • absorption
  • metabolism
  • protein bound or unbound?
A
  • gut
  • hepatic cyp-450
  • pr binding - 80-90%
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5
Q

ADR SSRIs

A
  • Nausea, diarrhea abdominal pain
  • appear early, improves end of first week

SSRIs are relatively safe/few SE

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6
Q

Black box warning for SSRI

A
  • in children up to 24 yo taking antidepressants = inc risk of suicidal thinking/behavior

with major depressive disorder and other psych disorders

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7
Q

Fluoxetine is FDA approved for tx of

A

OCD in children above 7 yoa

MDD in children above 8 yoa

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8
Q

Drug interaction - SSRI

A

MOAIs

allow 1-3 mos of washout after discont. SSRI to start MAOI

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9
Q

Drug that can lead to serotonin syndrome

A

Linezolid

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10
Q

Prototype SSRI

A

Fluoxetine

  • free of anticholinergic effects, orthostatic hypotension, weight gain

Inhibits cyt p450 isozymes

large number of drug intrxn

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11
Q

what has less SE and drug drug intrxn than fluoxetine

A

Citalopram

Escitalopram

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12
Q

tx of bulimia, anorexia, etc

A

Fluoxetine

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13
Q

SNRIs (like Duloxetine) are given when ___ is an associated issue

A

PAIN

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14
Q

SNRI

A

NE and serotonin reuptake inhibited

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15
Q

SE of Duloxetine

A

Nause
Constipation
abdominal pain

Jitters
sexual side effects

dont use in ptns with end stage renal disease

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16
Q

What typically affects compliance of a drug in tx of moods

A

Sexual side effects of drugs

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17
Q

TCAs lead to

A
  • dec depression, agitation, anxiety, insomnia, suicidal tendency
  • inc mood, appetite
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18
Q

MOA TCAs

A
  • inh presynaptic neurotransmitter reuptake - NE and 5-HT

Secondary Amines: block NE reuptake > 5HT

Tertiary Amines: block 5HT> NE

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19
Q

TCA use

A

Enuresis

  • use imipramine

not first line drug

20
Q

SE of TCA

A
  • Cardiac fast sodium channels - blocks it – arrhythmia. QRS prolongation

Cholinergic - blocked - DRY MOUTH, CONSTIPATION

Adrenergic -blocked- weight gain ( good for anorexic ptns?)

21
Q

are MAOIs selective or not selective

A

Not slective

22
Q

Use of MAOIs

A

highly resistant depression

TCAs and SSRIs have failed

23
Q

ADR MAOIs

A

Tyramine – hypertnesive crisis

24
Q

Buproprion

A

Fewer sexual dysfunction
weaker

may cause agitation, insomnia, nausea, WEIGHTLOSS, seizures - CI in epilepsy/seizures, anorexia nervosa

25
Q

used for smoking cessation

why

A

Bupriopion

take place of nicotine that may act as antidepressants

26
Q

Hypericum

A

st. John’s wort
- MAO and serotonin reuptake inhibitor

Hypertensive crisis if taken w/ SSRIs

27
Q

Trazodone

A

serotonin?

  • no anticholinergic SE
  • priapism - impotence
  • persistent clitoral erection in women

therapeutic index higher than TCA

28
Q

Nefazodone

A
  • blocks NE, 5HT
    little effect on cholinergic/histaminergic receptors

blocks alpha-1 receptors - Dry mouth, constipation, SEDATION

lack of sexual side effects

hepatotoxicity

may inc REM sleep

29
Q

Mirtazapine

A

Tetracyclic antidepressant

STIMULATES NE, 5HT release by blocking alpha-2 and 5HT-1 receptor (autoreceptors)

INC APPETITE + weight gain early in therapy

SEDATING

fewer sexual side effects

30
Q

High suicide risk

A

avoid TCAs, MAOI

31
Q

Concurrent depression and panic attacks/ OCD

A

Use SSRI

32
Q

Depression associated with chronic pain

A

use SNRI or TCA

33
Q

Weight gain on other anti-depressants

A

Use bupropion or SSRI, avoid mirtazapine

34
Q

Sensitive to anticholinergic side effects

A

avoid TCA

35
Q

Sexual dysfunction

A

Bupropion, nefazadone

36
Q

Eating disorder and depression

A

Avoid bupropion

37
Q

MOA lithium

A

reduces IP3 formation by inhibiting phophatase,
interferes w/ cAMP formation
reduces neuronal response to 5HT, NE
Inc glutamate reuptake

38
Q

Use Lithium

A

mood stabilizer

  • tx of mania

reduces depressive and manic sx

LOW therapeutic index

39
Q

what must be done during tx of acute mania with lithium

A
  • monitoring serum or urine levels daily
40
Q

SE Lithium

A

Weight gain
tremor

POLYURIA, POLYDIPSIA - Li inh ADH, NEPHROGENIC diabetes insipidus

41
Q

Anticonvulsants to tx Mania

A
  • Carbamazepine
  • Valproate
  • Lamotrigine

monitor hepatic function

42
Q

Carbamazepine

A

blocks Na channel

43
Q

Valproic acid

A

block Na channel and inc GABA

very effective in “rapidly cycling” patients

44
Q

Lamotrigine

A

Block Na channel and inh glutamate release

45
Q

Omega-3 fatty acids decrease activity of ______

A

MAO-B

46
Q

Omega-3-FA deficiency can lead to what

A

altered delivery of AA and sugars into CNS

T&D II exam 1 (8 decks)

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