!Neuropharm Antidepressants Flashcards
(108 cards)
1
Q
Selective serotonin reputable inhibitor (SSRI)
A
For depression, anxiety, OCD, buimia, PTSD
2
Q
Specific SSRI such as ___ can even be used to improve cognitive recognition post stroke
A
Escitalopram
3
Q
Examples of SSRI
A
Fluozetine, paroxetine, sertraline, citalopram, escitalopram, vilazonone, vortioxetine
4
Q
MOA SSRI
A
Selectively inhibiting reputable of serotonin by presynaptic cells leading to an increased availability of serotonin in the synaptic gap, allowing it to repeatedly stimulate the post synaptic receptors
5
Q
Side effect of SSRI
A
Sexual dysfunction (erectile dysfunction, anorgasmia, decreased libido) Serotonin syndrome
6
Q
What is serotonin syndrome
A
SSRI combined with other medications promoting serotonin availability
7
Q
How does serotonin syndrome present
A
Hyperthermia, hypertension, myoclonus, mydriasis, overactive bowels, mental agitation
8
Q
How can you treat serotonin syndrome
A
Cyproheptadine
9
Q
Indications forSSRI
A
Depression and anxiety (social phobia, panic disorder, PTSD)
10
Q
MOA SSRI
A
Inhibit the reputable of the NT serotonin by the presynaptic cells . Serotonin stays in synaptic gap longer and may repeatedly stimulate the receptors of the post synaptic cell
11
Q
How long do u have to take SSRI before effect
A
4-8 weeks
12
Q
Examples of SSRI
A
Paroxetine, sertraline, escitalopram, fluoxetine, citalopram, vortioxetine, vilazonone
13
Q
Paroxetine
A
SSRI for social phobia
Panic attacks, depression OCD and PTSD
14
Q
Sertraline
A
SSRI for PTSD(soldier says SIR)
Anxiety disorders, depression, OCD, panic disorder
15
Q
Escitalopram
A
Cognitive recovery post stroke also for depression and anxiety treatment
16
Q
Fluoxetine
A
SSRI for depression , OCD, bulimia and panic disorder
17
Q
Side effects SSRI
A
Sexual dysfunction, serotonin syndrome,
18
Q
What drugs taken with SSRI cause serotonin syndrome
A
TCAs, SNRIs, MAOIs (any medication increasing serotonin availability)
19
Q
How treat serotonin syndrome
A
Hyperthermia, hypertension, myoclonus, mydriasis, overactive bowels and mental agitation
Treat with cyproheptadine
20
Q
What does cyproheptadine do
A
Acts as a serotonergic (5-HT2) receptor antagonist
21
Q
Fluoxetine (prozac)
A
SSRI maintains mental balance in the brain by decreasing the reputable of serotonin back into presynaptic cell
increase serotonin in synaptic cleft which bind to postsynaptic receptors and create more transmission
22
Q
Serotonin
A
NT involved in transmission of nerve impulses
23
Q
Indication for fluoxetine (Prozac)
A
Depression
-believed to be a defiency in freely available serotonin in brain
OCD, panic disorder, premenstrual dysphoric disorder
24
Q
Side effects fluoxetine
A
Sexual dysfunction, CNS stimulation, wight gain, serotonin syndrome
25
What is CNS stimulation
Headache, nervousness, anxiety, insomnia
26
Contradictions for fluoxetine
Do not take with monoamine oxidase inhibitors (MAO-Is) as it increases the available pool of serotonin int he brain and increases the risk of developing serotonin syndrome
27
Contradiction 2 for fluoxetine
SSI decrease aggregation of platelets and increase GI bleeding risk up to 3 times . Patients should be advised to avoid anticoagulants and antiplatelets while taking these medication s
28
Considerations for fluoxetine
Suicide risk
| Delayed onset of action
29
Why SSRI increase suicide risk
Side effects violent behavior , mania or aggression which can increase siucidal thoughts or actions suicide risk increases during the initial phase of starting on the meds
30
How long does it take SSRI to work
1-3 week weeks
| Longer if depression more severe
31
Serotonin norepinephrine reputable inhibitors (SNRIs)
Class of drug indicated for the use of major depression, diabetic peripheral neuropathy, panic and anxiety.
32
Examples of SNRI
Duloxetine
| Venlafaxine
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Duloxetine
SNRI for diabetic peripheral neuropathy and depression
34
Venlafaxine
Panic and anxiety disorders
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MOA SNRI
Inhibiting reputable of the NT serotonin and norepinephrine thus increasing their bioavailability, yielding increased NT
36
Side effects SNRI
Increase NE
Nausea , vomiting , decreased libido and anorgasmia
Bad compliance
37
Indications for SNRI
Depression, diabetic peripheral neuropathy, panic and anxiety
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Which SNRI for diabetic peripheral neuropathy
Deluxetine
39
Other indications for duloxetine
Anxiety, chronic pain and fibromyalgia
40
Which SNRI for panic and anxiety
Venlafaxine
41
Venlafaxine
Works on serotonergic and noradrenergic receptors
42
MOS SNRI
Inhibits reputable of serotonin and NE
| Increases in NT by increasing availability of extracellular concentrations of serotonin and NE
43
Side effects SNRI
Hypertension, insomnia, nausea and vomiting, decreased libido
44
Why get insomnia with SNRI
Increasing circulating NE
45
Bupropion
Atypical antidepressant for smoking cessation often combined with SSRI for depression therapy
46
MOA bupropion
Increased availability of dopamine and NE
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How does bupropion lead to smoking cessation
Blocking nicotonic acetylcholine receptors in the brain
48
Side effects bupropion
Insomnia, tachycardia, seizure(lowers seizure threshold)
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Indication s for bupropion
Depression and smoking cessation
50
Smoking cessation and bupropion
Reduce severity of nicotine cravings and ithdrawal symptoms
51
MOA bupropion
Increase dopamine and NE
| Block of nicotonic acetylcholine receptors in brain
52
Side effects of bupropion
Tachycardia insomnia, seizure , epilepsy
53
Tricyclics antidepressants (TCAs) overview
Three ring chemical structure
| Wide range of presentations, including depression, bed wetting, OCD, fibromyalgia
54
MOA TCA
Lipi soluble and rapidly absorbed and exhibit their effects by blocking serotonin and NE reputable transporters leading to increased availability of serotonin and NE
55
Side effects TCA
Convulsion, coma, cardiotoxicity (arrhythmias), anti histamine and anticholinergic effects of this drug , adverse CNS stimulant effects, such as mania, agitation, seizure, confusion and tremor.
Impaired gastric motility, dry mouth, blurry vision, increased temp, urinary impairment
Postural hypotension
56
MOA TCA
Blocks serotonin and NE reputable by blocking 5-HT and NE
Elevated synaptic concentrations of the neurotransmitters
*no affinity for dopamine transporters thus limited effect on dopamine
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TCA is lipid soluble. Significance?
Rapidly absorbed
58
Side effects TCA
```
Adverse CNS effects
Anticholinergic
Antihistamine
Tri-c: convulsion, coma, cardiotoxicity
Blocks alpha1 receptors
```
59
Adverse CNS effects TCA
CNS stimulation
| Confusion, mania, agitation, tremor, seizures, sedation
60
Anticholinergic TCA
Impaired gastric motility, dry mouth, blurry vision, increased temp, and urinary impairment
61
Cholinergic actions eye
Contraction muscle of iris (miosis)
| Contraction of ciliary muscles (accommodation for near vision
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Anticholinergic actions eyes
Relaxation of circular muscle of iris (mydriasis)
| Relaxation of ciliary muscles (cycloplegia, loss of accommodation)
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Cholinergic effects heart
Bradycardia
| Decrease HR
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Anticholinergic actions heart
Tachycardia increased HR
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Cholinergic actions urinalysis bladder
Contraction of muscles in urinary bladder
Relaxation of sphincter bladder
Urination
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Anticholinergic actions urinary bladder
Relaxation of muscles
Contraction of sphincter
Urinary retention
67
TCA antihistamine
Seizures and arrhythmias
| Mostly mimic anticholinergic effects
68
Tri-c : convulsion, coma, cardiotoxicity TCA
Cardiac-na channel block (widening QRS, QT prolongation and torsades de points)hyperpyrexia and respiratoy depression
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Tca blocks alpha1 receptors
Postural hypotension
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Indications for tCA
Major depression, bed wetting, fibromyalgia, OCD
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Suffix of TCA
Iptyline or ipramine
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TCA examples
Amitriptyline, desipramine, clomipramine, imipramine, nortiptyline
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Amitriptyline
For depression and first line for fibromyalgia and chronic pain
74
Amitriptyline has more __ effects than other TCA. Causing what
Anticholinergic
Stiffness, nausea, constipation, nervousness, dizziness, tremor, blurred vision, urinary retention and changes in sexual function
75
Desipramine
TCA for OCD, also depression and anxiety disorders
76
Imipramine
TCA for nocturnal enuresis (bed wetting)
77
Why is imipramine used for bed wetting
Decrease the delta wave stage of sleep (when bed wetting occurs)
78
Nortriptyline
TCA for depression, less side effects than 1st generation TCA medications.
79
Why does nortriptyline have less influence on hypotension than other TCA
Stilll blocks a1, but less?
| Nortriptyline keeps blood pressure NORmal
80
Tricyclic antidepressants (TCA)
Older generation of antidepressants that block the reputable of norepinephrine and serotonin.
81
Why aretricyclic antidepressants called dirty drugs
Cause a wide variety of side effects
82
Side effects of tricyclic antidepressants
```
Antimuscarinic
Alpha blocking
Antihistamininc
Cardiac arrhythmias
Lower seizure threshold
Long QQT-lead to torsades
```
83
How do we treat tricyclic antidepresssant toxicity
Sodium bicarbonate
84
How does sodium bicarbonate treat tricyclic antidepressant toxicity
1. Alkalinization of the plasma can increase protein binding of them and decrease their bioavailability
2. Sodium load is thought to reverse the Na channel blocking effects of TCA
85
Monoamine oxidase inhibitors (MAOIs)
Group of drugs that work by inhibiting the breakdown of the neurotransmitters serotonin, NE and dopamine, thereby increasing their availability
86
Indication for MAOI
Atypical depression by also anxiety and panic disorders
87
___, a monoamine oxidase type B inhibitor, may be effective int he treatment of parkinson disease
Selegiline
88
What food should u avoid with MAOI
Tyramine-containing foods, such as large amounts of wine and cheese , as the combination of MAOIs with excess tyramine can lead to a hypertensive crisis
Severe increase in bp occurs due to the release of large amounts of amine NT (serotonin, NE and dopamine) triggered by excess tyramine
89
What drugs should not be used with MAOI
SSRI, TCA< meperidine, dextromethorphan, St. John’s wort, as this may lead to serotonin syndrome
90
Wine and cheese and MAOI
Tyramine is metabolized by monoamine oxidase, and when foods high in tyramine are combined with therapy that inhibits MAO, excess stored monoamine are released.
91
What foods are high n tyramine
Wine cheese, red wine, beer, soy, over ripened bananas, cured smoked aged or pickled meats
92
What will tyramine rich food and MAOI lead to
Hypertensive crisis
| -severe bp increase which can lead to stroke
93
What other drugs should not be given with MAOI
SSRI, TCA, meperidine, and dextromethorphan
94
What happens when have MAOI and serotonin drug
Risk of serotonin syndrom e
95
Monoamine oxidase inhibitors (MAO-Is)
Group of drugs that work by inhibiting the breakdown of the NT serotonin, NE and dopamine, thereby increasing their availability
96
Indication for monoamine oxidase inhibitors
Atypical depression, but have been used for anxiety and panic disorders, bulimia, personality disorders and Parkinson’s disease (selegiline)
MAO “takes pride in shanghai”
97
MAO-Is meds
| Takes Pride in shanghai
Tranylcypromine
Phenelzine
Isocarboxasid
Selegiline
98
What should we not give MAO-Is with
Tyramine containing food——hypertensive crisis
99
What happens in hypertensive crisis
Severe increase in bp occurs due to the release of large amounts of amine NT (serotonin, NE and dopamine),triggered by excess tyramine
100
What drugs should MAO-Is not be given with
SSRI, TCA, meperadine, dextromethorphan, St. John’s wart may lead to serotonin syndrome
101
Indication for MAO-is
Atypical depression
102
MOA MAO-Is
Increased levels of amine NT (serotonin, NE, dopamine)
103
Tranylcyrpomine
Nonselective
Major depression
Mood disorders
104
Phenelzine
Nonselective
| Failed first and second lines of treatments for depression
105
Isocarboxazid
Non selective MAO-I indicated for depression, anxiety and panic disorders
106
Selegiline
Selectively inhibits MAO-B at low doses which metabolizes dopamine over NE and serotonin. This leads to increased levels of dopamine availability.
107
Selegiline is typically used with what
L Dopa for parkinsons treatment as it enhances effects of L dopa treatment and decreases motor complications
108
At high doses, selegiline loses its selectivity for ___
MAO-B
