Psychopharmacology: Anti-depressants Flashcards by Edward Larkin

Anti-histamine

Weight gain; sedation

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Anti-adrenergic

Orthostasis; arrythmias

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Anti-cholingeric

Blurry vision, cognitive changes; urinary retention; constipation; xerostomia

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Tx of Serotonin Syndrome

Stop drugs

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Hypertensive crisis cause

Eating tyramine while on a MAOI

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Extra-pyramidal side effects (nigrostriatal)

Acute dystonia; akithisia; parkinsonianism; tardive dyskinesia

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Can EPS be life-threatening? How?

Yes. One example is acute dystonia of the diaphragm, which can cause asphyxiation.

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What is one atypical antipsychotic that displays hyperprolactinemia

Risperidone

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What is tardive dyskinesia, and how long after starting neuroleptics does it happen?

Choreoathetoid muscle movements (esp of mouth and tongue); occurs after years of antipscyhotic use

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Neuroleptic malignant syndrome

Fever, tachycardia, HTN, tremor, elevated CPK (muscle breakdown); lead pipe rigidity

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How long after starting antipscyhotics does NMS happen

Either short or long time (increased risk with typicals)

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Is NMS benign?

Obviously not (malignant in name). 20% mortality rate.

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Inducers of P450

Smoking, carbamazepine, barbiturates, St. John’s Wort

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Inhibitors of P450

Fluvoxamine; Fluoxetine; Paroxetine; Duloxetine; Sertraline

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2 NTs involved in Anxiety

5-HT, NE

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3 NTs involved in mood

NE, 5-HT, DA

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NT involved in obsessions and compulsion

5-HT

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NT involved in alertness

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NT involved in attention, pleasure reward, and motivation

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TCAs that preferentially increase serotonin

Clomipramine; Imipramine

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What is the problem with TCAs in overdoses, and why is this problematic in depression?

Cause cardiac toxicity easily in overdoses. Problematic in depression because dont want to give potentially suicidal people easy means to overdose

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Why do patients not subjectively like TCAs?

Their anti-HAM properties

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What specific arrythmia is caused by an overdose of TCAs?

Torsade de Pointes

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In the real world, when do TCA overdoses tend to happen (i.e. when taking what other substance/drug?)

Alcohol (liver occupancy)

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What is a side effect of SSRIs associated with 5-HT2a

Sexual dysfunction

What is a side effect of SSRIs associated with 5-HT3

GI upset

Which SSRI has the widest dosing window?

Sertraline (Zoloft)

Which SSRI has the highest hepatic burden?

Fluvoxamine (Luvox)

Which SSRI is used for OCD?

Fluovoxamine (Luvox)

Which SSRI is most often discontinued?

Paroxetine (Paxil)

What strange receptor does Vortioxetine have affinity for that might make it good for cognition

5-HT7

Does sexual dysfunction to one SSRI predict sexual dysfunction to another?

Strangely, no

Is GI upset with SSRIs transient or chronic?

Transient

Name 3 NE preferential TCAs

Desipramine, Nortriptyline, Amoxapine

Name 2 Norepinephrine Reuptake Inhibitors

Reboxetine; Atomoxetine

What off-label uses do Reboxetine and Atomoxetine potentially have?

Anxiety, ADD

What are a couple common side effects that result from NRIs (this NE effect in body)

Tremor, tachycardia

Psychosis is a result of what disturbance to dopamine?

Too much

Attention deficit disorder and hyperactivity are a result of what disturbance to dopamine

Too little

What anti-depressant is a DA and NE agonist?

Buproprion (Wellbutrin)

What is a good and bad property of Wellbutrin as compared to other anti-depressants

Good - no sexual side effects. Bad - lowers seizure threshold.

In what type of patient should you not reach for Buproprion

Pts with eating disorders (electrolyte imbalance can predispose to seizures, as can Buproprion)

Which drugs are 5-HT and NE agonists?

Certain TCAs, venlafaxine, duloxetine, mirtazapine, nefazodone

What is unique about the mechanism of mirtazapine (Remeron)?

It is the only anti-depressant that enhances monoamine production. It is also a wafer (who gives a shit?)

Name 3 TCAs that preferentially agonize 5-HT and NE

Amitryptyline, Protritpyline, Trimipramine

Venlafaxine's complicated relationship with monoamines

Pro-5-HT at low doses; pro-NE at medium doses; pro-DA at high doses

If you are getting serotonin side effects on venlafaxine, what do you do to the doese?

Increase (get it in NE range)

What should you beware of when using venlafaxine

Idiopathic HTN

Duloxetine use?

Neuropathic pain

Let's talk about mirtazapine. What receptor does it block?

Alpha-2 receptor on presynaptic bouton (blocks negative feedback for 5-HT and NE).

What side effect does mirtazapine lack, like buproprion?

Sexual side effects

What side effects does mirtazapine have that make it particularly well-suited to some elderly depressed patients?

Pro-sleep and pro-appetite

Does mirtazapine (Remeron) give sedation at lower or higher doses?

Lower. More antidepressant at higher doses

Nefazadone toxicity

LIver - fulminant hepatic failure (black box)

What is a descendant of nefazadone that is often used for sleep and not really as an anti-depressant

Trazadone

Name 5 MAOIs

Tranylcypromine, Phenelzine, Isocarboxacid, Selegiline (Selective), Moclobemide (Reversible)

MAOIs can induce a what, when used with tyramine

Hypertensive crisis - incredibly high blood pressure

What are some drugs to turn to if you're worried about interactions?

Citalopram (Celexa), Escitalopram (Lexapro), Mirtazapine (Remeron), Sertraline (Zoloft), Venlafaxine (Effexor) - these all have the least P450 binding

What is good about venlafaxine that make it OK to use with drugs like warfarin and theophylline?

It has the least protein (albumin) binding of any anti-depressant

How should you select an antidepressant with regards to PMH/FH/SH

Choose based on personal/familial response OR response of an acquantaince (strange pseudo-Freudian placebo-ish effects going on here; very Oedipal)

If you're on a drug that increases NE like a MAOI, what should you already be prescribed in the event of a HTNsive crisis?

A Ca2+ channel blocker (Amlodipine [Lotrel])

Mirtazapine (Remeron) actively loses its pro-sleep properties as you increase the dose. Why?

At low doses, it's predominantly anti-histamine (pro-sedating) with few pro-NE effects. At higher doses, NE effects become greater (promoting alertness/wakefulness)

What is one side effect from trazadone that's particularly "hard" to deal with?

Priapism. Sometimes need to shoot dick with an Epi pen (Spare me the Trazadone, in that case)

How does trazadone work?

It antagonizes 5-HT2a-c. 5-HT2a-c usually inhibits 1A, so Trazadone inhibiting 2a-c relivees block on 1A and allows it to flourish`

What's the only official indication for buspirone?

GAD, as an adjunct

Psychopharmacology: Anti-depressants Flashcards

(65 cards)