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USMLE Step 2 > Psychiatry: Antidepressants > Flashcards

Psychiatry: Antidepressants Flashcards

(74 cards)

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1
Q

What CNS Neurotransmitter changes are associated with Depression

A

Decreases 5HT, DA, NE

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2
Q

What are the Monoamines

A

Serotonin
Norepinephrine
Histamine
Dopamine

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3
Q

What are anti-histamine effects

A

Sedation
Dry mouth

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4
Q

What are effects of NE blockades

A

Hypotension (a1)

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5
Q

What are effects of Muscarinic blockades

A

tachycardia
Urinary retention

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6
Q

What is the MOA of Tricyclic Antidepressents (TCA)

A

Block re-uptake of 5-HT and NE

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7
Q

What other monoamines effects do TCAs cause

A

Anti-histamine

Anti-cholinergic

Alpha-1 block

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8
Q

What are the 2 classes of TCAs

A

Tertiary Amines

Secondary Amines

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9
Q

What TCAs are Tertiary amines

A

Amitriptyline
Imipramine
Clomipramine
Doxepin

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10
Q

What is the greater effect of Tertiary Amine TCAs

A

More sedating
-anti histamine

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11
Q

What TCAs are secondary amines

A

Desipramine
Nortriptyline

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12
Q

What is the greater effect of Secondary Amine TCAs

A

More activating
-NE effects

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13
Q

How does a TCA Overdose present

A

Seizures and coma
Anticholinergic toxicity
Hypotension
Prolong QT

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14
Q

What Anticholinergic effects are seen in TCA overdose

A

Hyperthermia
-loss of sweating

Skin flushing

Dilated Pupils

Ileus

Urine Retention

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15
Q

What must you monitor in TCA overdose

A

ECG for increased QRS interval

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16
Q

How do you treat TCA overdose

A

Sodium Bicarbonate
-Extra Na overcomes the Na-channel blockade

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17
Q

What are non-depression uses of TCAs

A

OCD
Diabetic peripheral neuropathy
Chronic pain
Prevention of migraines
Bedwetting
insomnia

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18
Q

What TCA is used for OCD

A

Clomipramine

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19
Q

What TCAs are used for Diabetic Peripheral Neuropathy

A

Amitriptyline

Desipramine

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20
Q

What TCAS are used for Chronic Pain

A

Amitriptyline
Doxepin
Imipramine
Nortiptyline
Desipramine

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21
Q

What TCA is used for migraine prevention

A

Amitriptyline

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22
Q

What TCAs are used for bedwetting (Enuresis)

A

Second-line therapy
-Imipramine
-amitriptyline
-desipramine

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23
Q

What TCA is used for insomnia

A

doxepin

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24
Q

What is the MOA of MAO-Inhibitors

A

Inhibit Monoamine Oxidase to prevent breakdown of monoamines

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25
What Monamines are affected by MAO-A
Dopamine Serotonin Norepinephrine
26
What monoamines are affected by MAO-B
Dopamine
27
What are the non-selective MAO-I Drugs
Tranycypromine Phenelzine Isocarboxazid
28
What is the MAO-B Selective MAO-I Drug
Selegiline
29
What is a common use for Selegiline
Parkinson's
30
When are TCAs usually used
rarely -refractory depression -anxiety
31
What classic triad is commonly seen in Serotonin Syndrome
Mental Status Changes Autonomic Hyperactivity Neuromuscular hyperactivity
32
What Mental status changes are seen in serotonin syndrome
Agitation Restlessness Disorientation
33
What Autonomic Hyperactivity symptoms are seen in serotonin syndrome
Diaphoresis Tachycardia Hyperthermia
34
What symptoms of Neuromuscular Hyperactivity are seen in Serotonin Syndrome
Tremor Clonus Hyperreflexia Bilateral Babinski
35
What is the treatment for Serotonin Syndrome
Cyproheptadine
36
What is the MOA of Cyproheptadine
5-HT antagonist
37
What is a common cause of Serotonin Syndrome
MAO-I + another serotonin drug
38
How long is the washout when switching from MAOI to SSRi
2 weeks
39
How long is the washout when swithing from SSRI to MAOI
usually 2 weeks Fluoxetine is 5 weeks
40
What is the risk of Tyramine
Natural Monoamine and sympathomimetic can cause Hypertensive crisis in patients on MAO-I
41
What are the 6 common SSRI drugs
Fluoxetine Sertraline Paroxetine Citalpram Escitalopram Fluvoxamine
42
What is the MOA for SSRI drugs
inhibit 5-HT reuptake leading to increased synaptic levels
43
How long do SSRI drugs take to have effect
4 to 8 weeks
44
What Psychiatric disorders commonly use SSRI drugs
Depression GAD Panic disorder OCD PTSD Bulimia Social anxiety disorder
45
What are common adverse effects of SSRI drugs
Headache Insomnia GI upset Drowsiness Sexual dysfunction
46
What are rare adverse effects of SSRI drugs
SIADH and hyponatremia QT prolongation Serotonin Syndrome
47
What causes Sexual Dysfunction with SSRI use
increased serotonin in the spinal cord
48
How does sexual dysfunction present in SSRI use
Decreased libido Anorgasmia Erectile dysfunction
49
What Antidepressant drug class can be used to treat premature ejaculation
SSRIs
50
What causes discontinuation syndrome
abrupt stop of an antidepressant
51
What drug class most commonly leads to discontinuation syndrome
SSRI
52
How does discontinuation syndrome present
Dizziness Fatigue Headache Nausea
53
How do you avoid discontinuation syndrome
Slowly tapering off the drug
54
What are the 5 common SNRI drugs
Venlafaxine Desvenlafaxine Duloxetine Milnacipran Levomilnacipran
55
What is the MAO of SNRI drugs
Inhibit 5-HT and NE reuptake
56
How long do SNRI drugs take to have effect
4 to 8 weeks
57
What SNRI is used for Fibromyalgia
Duloxetine
58
What SNRI drug is used for Diabetic Neuropathy
Venlafaxine
59
What are common adverse effects of SNRI drugs
Increase BP Sexual dysfunction
60
What SNRI drug most often causes sexual dysfunction
Venlafaxine
61
What is the mechanism of Bupropion
Blocks reuptake of NE and DA
62
What is Bupropion used for
Depression Smoking Cessation
63
What drug may improve the sexual dysfunction of SSRI
Bupropion
64
What are the adverse effects of Bupropion
Anxiety Insomnia Lowers seizure threshold
65
What is the Mechanism of Mirtazapine
Blocks presynaptic a-2 receptors leading to more release of NE and 5-HT
66
What are the side effects of Mirtazapine
Anti-histamine -sedation -dry mouth -increased appetite -weight gain
67
What is the MOA of Trazadone
weak Serotonin reuptake inhibitor
68
What is the main clinical use of Trazadone
Insomnia (Sedating)
69
What is the MOA of Nefazodone
Weak serotonin reuptake inhibitor
70
What adverse effects are associated with Nefazodone
Liver failure
71
What must you monitor in a patient on Nefazodone
AST/ALT
72
What is a dangerous adverse effect of Trazadone
Priapism : usually within 1 month of starting
73
What does Priapism require
Urgent urology evaluation
74
How do you treat Priapism
Intracavernosal Vasoconstrictor injection -epinephrine -phenylephrine

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