SNRIs, MAOIs, thyroid hormones, and novel agents Flashcards
(101 cards)
1
Q
what are the three most commonly used SNRIs
A
duloxetine
venlafaxine
sdesvenlafaxine
2
Q
Brand name of milnacipran
A
Savella
3
Q
Band name of levomilnacipran
A
fetzima
4
Q
Name all 5 SNRIs
A
Duloxetine
venlafaxine
desvenlafaxine
milnacipran
levomilnacipran
5
Q
brand name of duloxetine
A
cymbalta
6
Q
brand name for venlafaxine
A
effexor
7
Q
brand name for desvenlafaxine
A
pristiq
8
Q
which SNRIs cause increased sweating
A
duloxetine
venlafaxine
9
Q
dosage range for duloxetine
A
30-120mg daily in 1-2 doses
10
Q
FDA approved uses for duloxetine
A
MDD
peripheral neuropathy
fibromyalgia
GAD
musculoskeletal pain
11
Q
geriatric considerations for duloxetine
A
lower doses
12
Q
labs to monitor with duloxetine
A
BP
LFTs
baseline creatinine
13
Q
pregnancy risk of duloxetine
A
low
14
Q
which SNRIs must be tapered to dc
A
duloxetine
venlafaxine
desvenlafaxine
15
Q
what conditions would cause you to avoid duloxetine
A
angle-closure glaucoma
heavy alcohol use
severe renal/hepatic impairment
16
Q
which SNRI decreases the effectiveness of narcotic pain medications
A
duloxetine
17
Q
interaction between duloxetine and THC
A
THC decreases concentration of duloxetine
18
Q
which SNRIs increase bleeding risk when taken with NSAIDs, ASA, or anticoagulants
A
duloxetine
venlafaxine
19
Q
dosage range for ER venlafaxine
A
37.5-225 qd
20
Q
what considerations are there with dosing IR venlafaxine
A
divided in 2-3 doses
max is 375mg
21
Q
FDA approved uses for venlafaxine
A
depression
GAD
social phobia
panic disorder
22
Q
geriatric considerations with venlafaxine
A
lower doses
caution with cardiovascular disease
23
Q
labs to monitor for venlafaxine
A
baseline creatinine
24
Q
pregnancy risk for venlafaxine
A
low
25
when would you avoid venlafaxine
angle-closure glaucoma
26
venlafaxine dosage with renal/hepatic impairment
decrease by 50%
27
dose related side effects of venlafaxine
increased BP and HR
28
dosage range for desvenlafaxine
50-100mg qd
29
FDA-approved uses for desvenlafaxine
MDD
30
Which geriatric conditions should you be cautious with desvenlafaxine
caution with CV disease, HTN, liver/renal failure, glaucoma
31
labs to monitor for desvenlafaxine
baseline creatinine
32
pregnancy risk of desvenlafaxine
low
33
desvenlafaxine effect on UDS
false positive for PCP and amphetamines
34
contraindications for desvenlafaxine
angle-closure glaucoma
MAOIs
ETOH abuse
CNS depressants
35
desvenlafaxine dosage adjustment for renal impairment
50mg qd for moderate
50mg qod for severe
36
desvenlafaxine dosage adjustment for hepatic impairment
max 100mg qd
37
FDA approved indications for venlafaxine
MDD
GAD
social anxiety
panic disorder
38
FDA approved indications for desvenlafaxine
MDD
39
off-label indications for venlafaxine
OCD
ADHD
panic disorder
depression w/ cocaine addiction
chronic pain
40
most common SE of venlafaxine and desvenlafaxine
nausea
41
do venlafaxine and desvenlafaxine have anticholinergic side effects?
side effects that are suggestive but these medications have no affinity for muscarinic or nicotinic receptors
42
are venlafaxine and desvenlafaxine associated with discontinuation syndrome
yes
43
CYP enzyme that primarily metabolizes venlafaxine and desvenlafaxine
CYP2D6
44
initial dose of venlafaxine
75mg
may begin at 37.5mg x4-7 days to reduce GI side effects
45
how often can you increase venlafaxine and by how much
75mg q4 days
46
upper limit and max dosage of venlafaxine
225mg and 375mg
47
are dosages of venlafaxine typically higher or lower when used for anxiety
lower
48
duloxetine and food
delays max concentration by 6-10 hours and reduces absorption by 10%
49
which hepatic enzymes metabolize duloxetine
CYP2D6
CYP1A2
50
excretion of duloxetine
70% as metabolites in urine
20% in feces
51
duloxetine and blood glucose
risk for DM with long-term use d/t elevated glucose and A1C
52
why should you avoid duloxetine in patients with alcohol abuse
increased risk of hepatic impairment
53
contraindications for duloxetine
hepatic insufficiency
ESRD
uncontrolled narrow-angle glaucoma
54
is duloxetine associated with discontinuation syndrome
yes
55
duloxetine in pregnancy
not recommended
56
recommended therapeutic dose of duloxetine
60mg (also max dose)
57
what is milnacipran approved for in the US
only fibromyalgia
58
FDA approved indications for levomilnacipran
MDD
59
does levomilnacipran have greater potency for norepinephrine or serotonin
norepinephrine
60
6 available MAOIs
phenelzine
isocarboxazid
tranylcypromine
rasagiline
moclobemide
selegiline
61
MAOA primarily metabolizes which neurotransmitters
NE, serotonin, and epinephrine
62
which MAO enzymes metabolize dopamine and tyramine
MAOA and MAOB
63
for which indications are MAOIs more effective than TCAs
-atypical depression
-bipolar depression
64
switching from one MAOI to another
taper and dc 1st drug x14 days before starting new one
65
MAOIs with bipolar
associated with the induction of mania
66
MAOIs with schizophrenia
associated with psychotic decompensation
67
MAOIs in pregnancy
contraindicated as well as during lactation
68
how do MAOIs lead to tyramine induced HTN crisis
MAOI inactivates GI metabolism of dietary tyramine allowing intact tyramine to enter blood stream where it exerts a powerful pressor effect
69
how long do tyramine-containing foods have to be avoided in association w/ MAOIs
for at least 2 weeks after last dose
70
tyramine-containing foods
cheese
fish
cured meats and sausage
alcohol
sauerkraut
bananas
avocados
71
which medications can cause HTN crisis when administered with MAOIs
sympathomimetic amines:
ephedrine
pseudoephedrine
dextromethorphan
72
what else can precipitate HN crisis in those treated with MAOIs
bee stings
73
other sx requiring immediate clinical intervention when taking MAOIs
headache
stiff neck
diaphoresis
N/V
74
discontinuation of MAOIs
taper slowly over several weeks to avoid discontinuation syndrome
75
s/s MAOI OD
agitation that can progress to coma
hyperthermia
HTN
dilated pupils
hyperactive deep tendon reflexes
76
drugs that have fatal interaction with MAOIs
demerol
fentanyl
77
which thyroid hormones can be used to tx depression or rapid cycling
levothyroxine
liothyronine
78
thyroid hormones and food
absorption increased if taken on empty stomach
79
main uses of thyroid hormones as adjunctive tx
convert nonresponders to responders
lithium-induced hypothyroidism
80
contraindications to thyroid hormone use
cardiac disease
angine
HTN
adrenal insufficiency
acute MI
81
thyroid hormones and pregnancy
safe
minimally excreted in breast milk
82
medications that are contraindicated w/ thyroid hormones d/t risk of cardiac decompensation
sympathomimetics
ketamine
maprotiline
83
how long is an adequate trial of liothyronine
2-3 weeks
84
ketamine medication class
NMDA receptor antagonist
85
time frame of therapeutic effects of ketamine
relief within 4 hours and lasts several weeks but then depression will relapse w/o further intervention
86
approved ketamine enantiomer
esketamine
87
administration of esketamine
in clinical setting w/ observation for 2 hours post administration
88
medication class of brexanolone
neurosteroid
89
allosteric modulation of brexanolone
-positively modulates GABAA receptors
-negatively modulates nicotinic acetylcholine receptors
90
timeframe for response to brexanolone
within 2-3 days
91
schedule and availability of brexanolone
schedule 4
available only through national registry
92
administration of brexanolone
IV x60 hours in clinical setting
93
General contraindications for SNRIs
Renal/hepatic impairment
Glaucoma
Heavy alcohol use
CNS depressants
94
what distinguishes SNRIs from TCAs
SNRIs have a relative lack for of affinity for muscarinic, histaminergic, and a- and b-adrenergic receptors
95
What enzyme primarily metabolizes venlafaxine and desvenlafaxine
2D6
96
initial dose of duloxetine
20-30mg
97
which MAOI is a reversible inhibitor
moclobemide
98
which enzyme primarily metabolizes norepinephrine, serotonin, and epinephrine
MAOA
99
which enzymes primarily metabolize dopamine and tyramine
MAOA and MAOB
100
what is used to tx HTN crisis with MAOIs
a-adrenergic antagonists
(pentolamine or chlorpromazine)
101
