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Year 2 Psych exam I > Pharm, antidepressants, Linger > Flashcards

Flashcards in Pharm, antidepressants, Linger Deck (58):
1

What are the sSRIs

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
setraline

2

what are the Selective serotonin NE reuptake inhibitors

duloxetine
venlafaxine

3

what tricyclic antideppressants are used in depression

amitriptyline
desipramine
imipramine
nortriptyline

4

what is the 5-HT2 antagonist used in depression

tazodone

5

what are the tetracyclic and unicyclic agents

buproprion
mirtazapine

6

what MAOI is used in depression

selegiline

7

forms MAOI selegiline is available in

transdermal patch
sublingual
bypass gut and liver for increased bioavialability

8

MOA SSRI

allosterically inhibit serotonin transporter to increase [ ] in cleft
80% SET blocked at therapeutic dose

9

what is MOA proposed for chronic use SSRI

down regulation post synaptic %-HT2a R density

10

SNRIs and tricyclic antidepressant MOA

inhibit SERT and NET increasing NT [ ]

11

affinity of tricyclic antidepressants for R

muscarinic too, Histamine and alpha adrenergic

12

5-HT2 antagonist MOA

trazodone and nefazodone
antagonize postsynaptic R to enhance tone

13

MOA Bupropion

selective inhibitor of dopamine transporter stimulates release NE and DA
no direct effect on serotonin reuptake or R

14

MAOI MOA

cause accumulation NE 5-HT and DA in vesiicles at nerve endings

15

MOA selefiline

selective irreversible MAO-B inhibitor at low doses
nonselective MAOA/B inhibitor at high dosese (depression)

16

MOA phenelzine and tranylcypromine

nonselective irreversible MAOIs

17

which tricyclic antidepressants stimulate muscarinic R the most

amitriptyline
protriptyline

18

which antidepressants work on SERT the most

citalopram
clomipramine
fluoxetine
flucoxamine
parozetine
sertraline

19

which antidepressants have highest affinity for NET

despramine
protriptyline

20

70-80% depressino patients achieve remission via what

switching to another agent or augmentation by addition of another drug

21

When adequate response for depression achieved, what is therapy recommendation

minimum 6-12 mo to reduce risk of relapse

22

patients considered for long term maintenance when

>2 MDD episodes in previous 5 years or >3 in lifetime

23

second most common use antidepressants

anxiety disorders
PTSD, OCD, social anxiety, generalized anxiety and panic disorder

24

OCD is known to respond to what agents

serotonergic agents like fluoxetine and fluvoxamine, paroxetine and clompramine

25

what antidepressants are used in pain disorders

TCA and SSRI

26

What antidepressants are used for premenstrual dysphoric disorder

SSRIs
fluoxetine
setraline

27

Tx schedule for premenstrual dysphoric disorder

2 weeks during luteal phase

28

which antidepressants are used in eatind disorders

fluoxetine and others
bulimia not anorexia

29

what antidepressants are used for insomina

amitriptyline and trazodone

30

Which TCA is used for pruritis

doxepin because works on histamine R

31

first line for Tx MDD and anxiety

SSRIs because fewer antimuscarinic effects and less cardiotoxic in overdose

32

What is a drug for depression in patients who cannot tolerate sexual dysfunction, weight gain and sedation

bupropion

33

2nd 3rd line agents for MDD

TCAs and MAOIs because potentially lethal in overdose
need titration to achieve therapeutic dose
serious effects and interactions

34

Adverse effects of all antidepressants

increased suicidality in patients under age 25

35

side effects SSRIs

mild sedation and antimuscarinic effects
GI: nuasea, vomiting, upset stomach, constipation
diminished sexual function libido delayed orgasm, diminished arousal
HA, insomnia, hypersomnia and weight gain

36

What is discontinuation syndrome

dizziness and paresthesia after sudden discontinuation
seen with SSRI and SNRI and TCA

37

Serotonin syndrome

overdose SSRI or concurrent MAOI use

38

CI to SSRI

patients displaying active manic Sx
paroxetine CI in pregnant patients

39

Adverse effects to SNRIs

serotonergic effects and! noradrenergic like insomnia, anxiety and agitation
inc BP and HR
venlafaxine inc bleeding risk and related with cardiac toxicity in overdose

40

adverse effects TCA

anticholinergic: dry mouth, constipation urinary retention, blurred vision and confusion
orthostatic hypotension
weight gain and sedation
cardiotoxicity arrhythmias and heart block
hepatic dysfunction
hyponatremima
hematologic abnormalities
sexual side effects like sSRI

41

which TCA exhibit marked antimuscarinic and cardiac side effects

imipramine and amitriptyline

42

CI to TCA

arrhythmias, recent MI, liver disease, glaucoma, mania

43

adverse effects 5-HT2 antagonist

sedation and GI disturbances
orthostatic hypotension

44

black box warning nefazodone

hepatotoxicity and potentially lethal hepatic failure

45

adverse effects bupropion

agitation and insomnia and anorexia

46

which antidepressants do not have significant sexual side effects

5-HT2 antagonists
bupropion and mirtazapine

47

adverse effects MAOIs

orthostatic hypotension and weight gain
highest rate sexual side effects!!!!!!!!

48

discontinuation syndrome in MAOI

delirium like presentation with psychosis, excitement and confusion

49

amitriptyline overdose

arrhythmia, altered mental status and seizures

50

amitriptyline overdose

arrhythmia, altered mental status and seizures
gastric decontamination is helpful up to 8 hr post ingestion

51

MAOI overdose

autonomic instability
hyperadrenergic Sx
psychotic Sx
confusion
delirium, fever and seizures

52

pharmokinetics of antidepressants

inhibitors of CYP450 or substrates

53

St Johns wort PK

herbal med that induces CYP450
used to Tx depression

54

Sx serotonin syndrome

cognitive: delirium, agitation coma
ANS: HTN, tachy, hyperthermia, diaphoreses
somatic: myoclonus, hyperreflexia, tremor

55

switching between SSRI and MAOI

current therapy needs to be discontinued for at least 2 weeks
***6 weeks for fluoxetine because longer half life***

56

Tx serotonin syndrome

withdraw offending drug, sedation with benzo, paralysis, intubation, ventilation
consider 5-HT2 block with cyproheptadine or clorpromazine

57

Foods with significant amounts tyramine

pickled, aged, smoked, marinated, meats (spoiled), chocolate, alcoholic beverages, fermented foods like cheese

58

CI with tyramine food

MAOI because normally metabolized by MAO so with large amounts leads to HTN crisis
NE release from peripheral nerves and inc HR and BP (potentially fatal!*)