Mood Med practice COPY

Question 1

SSRI MOA

Answer 1

decrease action of 5-HT reuptake pump which causes increased serotonin levels in the synapse

Question 2

SSRI Dosing AND CLEARANCE

Answer 2

Typically QAM can be halved if SE are bad. Metabolized mostly by the liver so caution in hepatic impairement.

Question 3

SSRI SE

Answer 3

GI (N/D/anorexia) sleep change, headaches, dizziness, decreased libido, anorgasmia, ED, anxiety, increased suicide risk, prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome

Question 4

SSRI CI

Answer 4

allergy to SSRI, use of MAOI within 2 weeks. Fluoxetine must wait 5 weeks.

Question 5

SSRI drugs

Answer 5

fluvoxamine
fluoxetine
sertraline
Citalopram/Escitalopram
Paroxetine

Question 6

Fluvoxamine special notes

Answer 6

SSRI with shortest half life, increased somnolence, DDIs

The 3 S Sounds
“Short, Somnolence, Cytochrome inhib”

Question 7

Fluoxetine special notes

Answer 7

SSRI with Longest halft life, increased insomnia, DO NOT TAKE w Tamoxifen

basically the opposite of fluvoxemine

Question 8

sertraline special notes

Answer 8

SSRI with increased GI upset mostly diarrhea, increased insomnia, decreased QT prolongation

Question 9

Citalopram/Escitalopram special notes

Answer 9

SSRI with MOST associated with QT prolongation, least impact on liver!

Question 10

Paroxetine special notes

Answer 10

SSRI with Only one to cause anticholinergic SE, orthostatis hypotension, weight gain, sexual dysfuntion are all increased. DO NOT TAKE w tamoxifen.

Question 11

SNRIs MOA

Answer 11

Blocks reuptake of 5-HT and NE, increasing their levels in synapse.

Question 12

SNRI dosing AND CLEARANCE

Answer 12

takes a few weeks to see full effects. Typically taken QD. Cleared through liver and kidneys.

Question 13

SNRI SE

Answer 13

N/V/D constipation, dry mouth. Sleep changes, HA, dizziness, anorgasmia, anxiety, suicide, diaphoresis, hypertension, serotonin syndrome.

Question 14

SNRI CI

Answer 14

allergy to SNRIs; use within 2 weeks of an MAOI, caution if using other serotonergic drugs, caution with angle closure glaucoma.

Question 15

SNRIs drugs

Answer 15

duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran/Levomilnacipran

Question 16

Duloxetine Special notes

Answer 16

Only SNRI with hepatic cytochrome inhibitors which leads to DDIs, LEAST associated w HTN, indicated for chronic pain relief

Question 17

Venlafaxine special notes

Answer 17

SNRI with higher risk of SE than others. MOST associated w HTN

Question 18

Desvenlafaxine special notes

Answer 18

SNRI with synthetic of venlafaxine, Less risk of HTN and other general SE than venlafaxine

Question 19

Milnacipran/Levomilnacipran special notes

Answer 19

SNRI with Greater effects on NE. most likely to have Psuedo anticholinergic SE (UR, const, dry mouth).

Question 20

Bupropion MOA

Answer 20

acts as dopamine-NE reuptake inhibitor (also antagonizes nicotinic receptors)

Question 21

patients with depression that may also want to quit smoking

Answer 21

bupropion

Question 22

Bupropion SE

Answer 22

Dry mouth
Insomnia
Nausea
Increased Seizure risk
SI

not associtated with weight gain or sesx dysf

cytochrome inhib!=DDI

Question 23

CI Bupropion

Answer 23

includes hepatic cytochrome inhibition causes DDIs
allergy
seizure disorder (HIGH RISK OF SEIZURE)
anorexia/bulemia ( causes weight loss and decreased appetite
use within 2 weeks of MAOI

Question 24

patients with depression who also have insomnia

Answer 24

mirtazapine

Question 25

Mirtazapine MOA

Answer 25

antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors which causes increased release of serotonin and NE.

Question 26

Mirtazapine SE

Answer 26

Dry mouth, increased appetite, weight gain (more than SSRI/SNRI), drowsiness, sedation, sexual dysfunction (less than SSRI). LOWER HTN RISK NO HEPATIC CYTOCHROME INHIB.= FEW DDIs

Question 27

Mirtazapine CI

Answer 27

Allergy MAOI w/i 2 weeks.

Question 28

what are the atypical antidepressants

Answer 28

bupropion and mirtazapine

Question 29

Serotonin Modulators MOA

Answer 29

blocks the reuptake of 5-HT = increased serotonin Nefazodone and trazodone also antagonize the 5-HT pump = increased serotonin Vilazodone and Vortioxetine partially antagonize 5-HT pump = mimic serotonergic effects

Question 30

Serotonin Modulators Dosing AND CLEARANCE

Answer 30

QD or BID, Cleared through liver

Question 31

Serotonin Modulators SE

Answer 31

nausea, diarrhea, headache, suicide, serotonin syndrome.

Question 32

Serotonin Modulators CI

Answer 32

allergy MAOI use W/I 2 weeks caution with other serotonergic drugs

Question 33

What are the Serotonin Modulator medications

Answer 33

Nefazodone Trazodone Vilazodone Vortioxetine

Question 34

SE: nefazadone

Answer 34

No sexual dysfunction, Less GI. increased Xerostomia, HA, Dizziness, insomnia or drowsiness, agitation, hypotension. Hepatic Cytochrome enzyme inhibition = MOST DDI RISK OF ALL 5-HT inhib. BBW = hepatotoxicity.

Question 35

Trazodone SE:

Answer 35

nausea, constipation, dry mouth, sedation, fatigue, sexual dysfunction (less than SSRIs or SNRIs.) Rare: priapism and cardiac arrhythmias

Question 36

Vilazodone

Answer 36

SE: Nausea, Diarrhea, HA, sexual dysfunction (less than SSRIs or SNRIs)

Question 37

Ketamine/Esketamine MOA

Answer 37

opioid and glutamate agonist. NMDA antagonist. mechanism for antidepression is unknown

Question 38

Ketamine/Esketamine use

Answer 38

for severe, refractory depression w/o psychosis that is not respondant to ECT. short term use only!

Question 39

ketamine/esketamine Dosing

Answer 39

ketamine - IV esketamine - Nasal rapid effects but effects end in about 2 weeks.

Question 40

Ketamine/Esketamine SE

Answer 40

abuse potential becuase of euphoric/intoxicated effects N/V, HA, dizziness, neurotoxicity, hepatotoxicity, bladder toxicity, tachycardia, HTN and abuse/addiction

Question 41

Ketamine/Esketamine CI

Answer 41

allergy aneurysmal disease or AV malformation hx of intracerebral hemorrhage inability to tolerate increase in BP

Question 42

MAOIs Use

Answer 42

usually only for treatment-resistant or atypical depression. selegiline = low dose used for parkinsons

Question 43

MAOI MOA

Answer 43

MOAa breaks down serotonin and NE MOAb works w MOAa to break down dopamine

Question 44

MAOI SE

Answer 44

hypotension, GI upset, urinary hesitancy, HA, myoclonic jerks, edema, suicidal ideation, hypertensive crisis w some foods (cheese, beer, tofu, cured meats)

Question 45

MAOI CI

Answer 45

includes allergy, CVD, pheochromocytoma (adrenal gland tumor), hepatic/renal impairment, use w serotonergic drugs. LOTS OF DDIs

Question 46

what medications are the MAOIs

Answer 46

Tranylcypromine Phenelzine Isocarboxazid Selegiline

Question 47

Tricyclic antidepressant MOA

Answer 47

inhibits reuptake of 5-HT and NE

Question 48

tricyclic antidepressants SE

Answer 48

includes: Anticholinergic, drowsiness, SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk

Question 49

this tricyclics antidepressants MOA includes more potent blocking of 5-HT reuptake rather than NE reuptake

Answer 49

tertiary amines amitryptiline doxepin imipramine clomipramine trimipramine

Question 50

SE Tetra cyclic antidepressants

Answer 50

includes: Anticholinergic (less than TCAs), drowsiness (more than TCAs), SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk

Question 51

Maprotiline MAOI

Answer 51

this tetracyclic antidepressant blocks reuptake of NE and 5-HT

Question 52

Amoxapine MAOI

Answer 52

this tetracyclic antidepressant blocks reuptake of NE and blocks dopamine receptors