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Flashcards in Pharm 18 Deck (36)
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1

List MC to least common antidepressants used

SSRIs are MC

SNRIs (2nd MC)

Miscellaneous (2nd MC)

Tricyclic (TCA) (Common but rarely use for depression)

Monoamine oxidase inhibitors (MAO-Is) (Least common d/t MOST ASEs)

2

Who are the most risk for depression and death of despair?

40-59 yr old white American women.

3

Time course of therapy (including onset of action of antidepressants) for most patients with depression

Initial :6-12 wks for symptoms remission.
- Medications typical take 4 wks to "kick in"
- 8 wks to determine efficacy

Continuous phase: 4-9 mo after symptom remission

Optional/relapse prevention: 12-36 mos

4

Long term effects of reuptake inhibitors

Increased synaptic concentrations of 5-HT

Down regulation of presynaptic auto receptors

Increase the firing rate of raphe neurons

5

Why are SSRIs are usually the preferred first line antidepressant?

They are as effective as TCAs but cause fewer autonomic ASEs and less sedation.

Safer in regards to OD.

Less cardiac arrhythmias and less likely to induce a seizure

6

ASEs for SSRIs when discontinued rapidly

Dizziness, nausea, fatigue, muscle aches, chills, anxiety, irritability, paresthesia, insomnia, electric shock phenomena.

7

Common clinical applications for TCA

MDD (unipolar)
Insomnia
Neuropathy
Migraine prevention

8

Common clinical applications for misc. antidepressants

MDD
Seasonal affective disorder
Smoking cessation (Bupropion)
Cognitive dysfunction w/ depression

9

Unique applications of Nefazodone

Only indicated for depression

Less rates of sexual dysfunction

May be added with other meds to counteract the sexual dysfunction

10

Unique applications of Bupropion

Seasonal affective disorder

Smoking cessation

Less risk for sexual dysfunction

Stimulant properties

Add to SSRI: decrease SSRI dose + bupropion

11

Unique applications of Mirtazapine

"tricyclic antidepressant"

Fewer anticholinergic, sexual dysfunction, CV and GI effects

More sedating and more weight gain= good to use in older pts w/ eating/ weight issues

12

Unique applications of Trazodone

Insomnia but only FDA approved for depression

ASE: Priapism

13

Black box warning(s) present on all antidepressant drugs

Antidepressants (under age 24) can increase risk for suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders.

14

Recall the names of the non-selective monoamine oxidase inhibitors used for depression

Phenelzine
Tranylcypromine
Isocarboxazid

15

Why have MAO-I fallen out of favor for tx of depression?

Cannot use: SSRIs, TCAs, SNRIs, etc. within 14 days of MAO-I

Cannot use: dextromethorphan, pseudoephedrine, tramadol, meperidine, etc.

Ingestion of Tyramine food = hypertensive crisis.

16

Serotonin syndrome risk factors

multiple serotonergic drugs used at once
ex. SSRI + Tramadol + sumatriptan

17

S/s of serotonin syndrome

Hyperlexia, muscle spasms of lower limbs, diarrhea, confusion

18

3 MC used to assist pts w/ tobacco cessation?

Nicotine replacement products

Bupropion

Varenicline

19

Which tabacco cessation is most effective?

Varenicline

20

Black box warning of bupropion?

Neuropsychiatric changes in behavior, hostility, agitation, depressed mood, and suicide related events.

contraindicated for pts with seizures

21

Inhaled nicotine ASES

nasal irritation, throat irritation, rhinitis.
Contraindicated in pts with reactive airway disease

22

Nicotine gum ASEs

Gastric and esophageal irritation
Contraindicated in TMJ disease, dentures, or inadequate dentation.

23

Nicotine patch ASEs

Skin irritations and GI disturbances

If worn at night=vivid dreams and insomnia occur

24

Bupropion ASEs

Insomnia, agitation, dry mouth, and HA

25

Bupropion trade name for smoking cessation?

Zyban

26

OTC nicotine patches dosing for step 1

21 mg

start with step 1 for pts that smoke more than 10 cig a day.

6 wk long tx

27

OTC nicotine patches dosing for step 2

14mg

start with step 2 if pt smoked less than 10 cigs a day

2 wk long tx

28

OTC nicotine patches dosing for step 3

7mg

2 wk long tx

29

Name all the SSRIs

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline (Zoloft®).

30

CYP enzymes inhibited by Nefazodone

3A4