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Meds > SNRIs, MAOIs, thyroid hormones, and novel agents > Flashcards

SNRIs, MAOIs, thyroid hormones, and novel agents Flashcards

1
Q

what are the three most commonly used SNRIs

A

duloxetine
venlafaxine
sdesvenlafaxine

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2
Q

Brand name of milnacipran

A

Savella

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3
Q

Band name of levomilnacipran

A

fetzima

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4
Q

Name all 5 SNRIs

A

Duloxetine
venlafaxine
desvenlafaxine
milnacipran
levomilnacipran

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5
Q

brand name of duloxetine

A

cymbalta

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6
Q

brand name for venlafaxine

A

effexor

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7
Q

brand name for desvenlafaxine

A

pristiq

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8
Q

which SNRIs cause increased sweating

A

duloxetine
venlafaxine

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9
Q

dosage range for duloxetine

A

30-120mg daily in 1-2 doses

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10
Q

FDA approved uses for duloxetine

A

MDD
peripheral neuropathy
fibromyalgia
GAD
musculoskeletal pain

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11
Q

geriatric considerations for duloxetine

A

lower doses

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12
Q

labs to monitor with duloxetine

A

BP
LFTs
baseline creatinine

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13
Q

pregnancy risk of duloxetine

A

low

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14
Q

which SNRIs must be tapered to dc

A

duloxetine
venlafaxine
desvenlafaxine

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15
Q

what conditions would cause you to avoid duloxetine

A

angle-closure glaucoma
heavy alcohol use
severe renal/hepatic impairment

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16
Q

which SNRI decreases the effectiveness of narcotic pain medications

A

duloxetine

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17
Q

interaction between duloxetine and THC

A

THC decreases concentration of duloxetine

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18
Q

which SNRIs increase bleeding risk when taken with NSAIDs, ASA, or anticoagulants

A

duloxetine
venlafaxine

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19
Q

dosage range for ER venlafaxine

A

37.5-225 qd

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20
Q

what considerations are there with dosing IR venlafaxine

A

divided in 2-3 doses
max is 375mg

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21
Q

FDA approved uses for venlafaxine

A

depression
GAD
social phobia
panic disorder

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22
Q

geriatric considerations with venlafaxine

A

lower doses
caution with cardiovascular disease

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23
Q

labs to monitor for venlafaxine

A

baseline creatinine

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24
Q

pregnancy risk for venlafaxine

A

low

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25
Q

when would you avoid venlafaxine

A

angle-closure glaucoma

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26
Q

venlafaxine dosage with renal/hepatic impairment

A

decrease by 50%

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27
Q

dose related side effects of venlafaxine

A

increased BP and HR

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28
Q

dosage range for desvenlafaxine

A

50-100mg qd

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29
Q

FDA-approved uses for desvenlafaxine

A

MDD

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30
Q

Which geriatric conditions should you be cautious with desvenlafaxine

A

caution with CV disease, HTN, liver/renal failure, glaucoma

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31
Q

labs to monitor for desvenlafaxine

A

baseline creatinine

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32
Q

pregnancy risk of desvenlafaxine

A

low

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33
Q

desvenlafaxine effect on UDS

A

false positive for PCP and amphetamines

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34
Q

contraindications for desvenlafaxine

A

angle-closure glaucoma
MAOIs
ETOH abuse
CNS depressants

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35
Q

desvenlafaxine dosage adjustment for renal impairment

A

50mg qd for moderate
50mg qod for severe

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36
Q

desvenlafaxine dosage adjustment for hepatic impairment

A

max 100mg qd

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37
Q

FDA approved indications for venlafaxine

A

MDD
GAD
social anxiety
panic disorder

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38
Q

FDA approved indications for desvenlafaxine

A

MDD

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39
Q

off-label indications for venlafaxine

A

OCD
ADHD
panic disorder
depression w/ cocaine addiction
chronic pain

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40
Q

most common SE of venlafaxine and desvenlafaxine

A

nausea

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41
Q

do venlafaxine and desvenlafaxine have anticholinergic side effects?

A

side effects that are suggestive but these medications have no affinity for muscarinic or nicotinic receptors

42
Q

are venlafaxine and desvenlafaxine associated with discontinuation syndrome

A

yes

43
Q

CYP enzyme that primarily metabolizes venlafaxine and desvenlafaxine

A

CYP2D6

44
Q

initial dose of venlafaxine

A

75mg
may begin at 37.5mg x4-7 days to reduce GI side effects

45
Q

how often can you increase venlafaxine and by how much

A

75mg q4 days

46
Q

upper limit and max dosage of venlafaxine

A

225mg and 375mg

47
Q

are dosages of venlafaxine typically higher or lower when used for anxiety

A

lower

48
Q

duloxetine and food

A

delays max concentration by 6-10 hours and reduces absorption by 10%

49
Q

which hepatic enzymes metabolize duloxetine

A

CYP2D6
CYP1A2

50
Q

excretion of duloxetine

A

70% as metabolites in urine
20% in feces

51
Q

duloxetine and blood glucose

A

risk for DM with long-term use d/t elevated glucose and A1C

52
Q

why should you avoid duloxetine in patients with alcohol abuse

A

increased risk of hepatic impairment

53
Q

contraindications for duloxetine

A

hepatic insufficiency
ESRD
uncontrolled narrow-angle glaucoma

54
Q

is duloxetine associated with discontinuation syndrome

A

yes

55
Q

duloxetine in pregnancy

A

not recommended

56
Q

recommended therapeutic dose of duloxetine

A

60mg (also max dose)

57
Q

what is milnacipran approved for in the US

A

only fibromyalgia

58
Q

FDA approved indications for levomilnacipran

A

MDD

59
Q

does levomilnacipran have greater potency for norepinephrine or serotonin

A

norepinephrine

60
Q

6 available MAOIs

A

phenelzine
isocarboxazid
tranylcypromine
rasagiline
moclobemide
selegiline

61
Q

MAOA primarily metabolizes which neurotransmitters

A

NE, serotonin, and epinephrine

62
Q

which MAO enzymes metabolize dopamine and tyramine

A

MAOA and MAOB

63
Q

for which indications are MAOIs more effective than TCAs

A

-atypical depression
-bipolar depression

64
Q

switching from one MAOI to another

A

taper and dc 1st drug x14 days before starting new one

65
Q

MAOIs with bipolar

A

associated with the induction of mania

66
Q

MAOIs with schizophrenia

A

associated with psychotic decompensation

67
Q

MAOIs in pregnancy

A

contraindicated as well as during lactation

68
Q

how do MAOIs lead to tyramine induced HTN crisis

A

MAOI inactivates GI metabolism of dietary tyramine allowing intact tyramine to enter blood stream where it exerts a powerful pressor effect

69
Q

how long do tyramine-containing foods have to be avoided in association w/ MAOIs

A

for at least 2 weeks after last dose

70
Q

tyramine-containing foods

A

cheese
fish
cured meats and sausage
alcohol
sauerkraut
bananas
avocados

71
Q

which medications can cause HTN crisis when administered with MAOIs

A

sympathomimetic amines:
ephedrine
pseudoephedrine
dextromethorphan

72
Q

what else can precipitate HN crisis in those treated with MAOIs

A

bee stings

73
Q

other sx requiring immediate clinical intervention when taking MAOIs

A

headache
stiff neck
diaphoresis
N/V

74
Q

discontinuation of MAOIs

A

taper slowly over several weeks to avoid discontinuation syndrome

75
Q

s/s MAOI OD

A

agitation that can progress to coma
hyperthermia
HTN
dilated pupils
hyperactive deep tendon reflexes

76
Q

drugs that have fatal interaction with MAOIs

A

demerol
fentanyl

77
Q

which thyroid hormones can be used to tx depression or rapid cycling

A

levothyroxine
liothyronine

78
Q

thyroid hormones and food

A

absorption increased if taken on empty stomach

79
Q

main uses of thyroid hormones as adjunctive tx

A

convert nonresponders to responders
lithium-induced hypothyroidism

80
Q

contraindications to thyroid hormone use

A

cardiac disease
angine
HTN
adrenal insufficiency
acute MI

81
Q

thyroid hormones and pregnancy

A

safe
minimally excreted in breast milk

82
Q

medications that are contraindicated w/ thyroid hormones d/t risk of cardiac decompensation

A

sympathomimetics
ketamine
maprotiline

83
Q

how long is an adequate trial of liothyronine

A

2-3 weeks

84
Q

ketamine medication class

A

NMDA receptor antagonist

85
Q

time frame of therapeutic effects of ketamine

A

relief within 4 hours and lasts several weeks but then depression will relapse w/o further intervention

86
Q

approved ketamine enantiomer

A

esketamine

87
Q

administration of esketamine

A

in clinical setting w/ observation for 2 hours post administration

88
Q

medication class of brexanolone

A

neurosteroid

89
Q

allosteric modulation of brexanolone

A

-positively modulates GABAA receptors
-negatively modulates nicotinic acetylcholine receptors

90
Q

timeframe for response to brexanolone

A

within 2-3 days

91
Q

schedule and availability of brexanolone

A

schedule 4
available only through national registry

92
Q

administration of brexanolone

A

IV x60 hours in clinical setting

93
Q

General contraindications for SNRIs

A

Renal/hepatic impairment
Glaucoma
Heavy alcohol use
CNS depressants

94
Q

what distinguishes SNRIs from TCAs

A

SNRIs have a relative lack for of affinity for muscarinic, histaminergic, and a- and b-adrenergic receptors

95
Q

What enzyme primarily metabolizes venlafaxine and desvenlafaxine

A

2D6

96
Q

initial dose of duloxetine

A

20-30mg

97
Q

which MAOI is a reversible inhibitor

A

moclobemide

98
Q

which enzyme primarily metabolizes norepinephrine, serotonin, and epinephrine

A

MAOA

99
Q

which enzymes primarily metabolize dopamine and tyramine

A

MAOA and MAOB

100
Q

what is used to tx HTN crisis with MAOIs

A

a-adrenergic antagonists
(pentolamine or chlorpromazine)

101
Q
A

Meds (11 decks)

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