Test 1 Flashcards
(77 cards)
1
Q
Deprescribing Anti-Depressives
A
"Titration" Helps Avoid Withdrawal like Symptoms -Flu like Symptoms -Insomnia -Nausea -Poor Balance -Sensory Disturbance -Hyperarousal
2
Q
Bupropion
A
Treats Nicotine Withdrawal
NDRI
3
Q
Imipramine
A
Treats Enuresis
4
Q
Duloxetine
A
Treats: Diabetic Neuropathy, Fibromyalgia, MSK pain, stress incontinence
-SNRI
5
Q
What is an anti-depressant that treats stress incontinence?
A
Duloxetine
6
Q
Fluvoxamine
A
SSRI only for OCD
7
Q
Amoxapine
A
SSNRI+ Dopamine Antagonis
8
Q
SARAs (Sertonin Adrenergic Receptor Antagonist)
A
Nefazodone
Trazodone
Mirtazapine
9
Q
MAOI
A
Isoscarboxazid
Phenelzine
Segeline
Trancyclopromine
10
Q
NDRI (Nadi/DA reuptake inhibitor)
A
Bupropion
enhanced pre-synaptic release of NE and DA via VMAT
selectively inhibits pre-synaptic reuptake of NE via NET and DA via DAT
11
Q
SSRIs
A
Citalopram Escitalopram Sertiline Fluoxetine Paroxetine Valazodone Vortioxetine
less impact on histamine/ muscarinic/ adrinergic receptors
12
Q
SNRIs
A
TCAs Desvenlafaxine Duloxtine Venalfaxine Lenomilnacipran
13
Q
SSRI MOA
A
inhibit presynaptic re-uptake of serotonin via SERT
14
Q
SSRI Side effects
A
sexual dysfunction CNS sedation/insomnia withdrawal rxns QT Prolongation Hyponatremia (esp in old people) Sertonin Syndrome Suicidality esp in young adults
15
Q
Why should you be very cautious giving SSRIs to old people?
A
Risk of hyponatremia
16
Q
Serotonin Syndrome
A
Sweating, Hyperreflexia***, Myoclonus, Tremors, Dilated pupils, hyperactive bowel sounds
-HTN, Tachycardia, Tachypnea, Hyperthermia
17
Q
Neuroepileptic Malignant Syndrome
A
-HTN, Tachycardia, Tachypnea, Hyperthermia
hyporeflexia***, normal pupils, normal bowel sounds
18
Q
Why should you be cautious with using opioids and antidepressants?
A
Increased risk of serotonin syndrome
19
Q
Fluoxetine
A
broad and strong inhibitor of CYP (most powerful)
20
Q
Least CYP inhibition form SSRI
A
Vortioxetine
Escitalopram
21
Q
secondary amines
A
amoxapine
desipramine
nortriptyline
inhibit NE>5HT
22
Q
Tertiary amines
A
Amytriptyline
Clomipramine
Doxepin
Imipramine
generally inhibit NE and 5HT equally except clomipramine and amytriptyiline
23
Q
What is unique about Amitriptyline and Clomipramine?
A
Tertiary amines that inhibit 5HT more than NE
24
Q
TCAs
A
amitriptline clomipramine doxepine imipramine amoxapine desipramine Nortriptyline
**Blocks other receptors (histamine, muscarinic, adrinergic)
25
Side effects of TCAs
```
Tachycardia
Orthostatic hypotension
Dysrythmia
Dry mouth
Urinary Retention
Blurred Vision
Sedation/Fatigue
```
26
TCA overdose
coma, cardiotoxicity, convulsions
27
TCA effects in cardio cells
slows conductions
changes QRS
blocks sodium channels
(quinedien like)
28
Non-TCA SNRI
Desvenlafaxine,
Duloxetine
Venlafaxine
Levomilnacipran
*less risk of sexual dysfunction
29
Mirtazapine
Blocks alpha 2 receptors on NE and 5-HT presynaptically and blocks post-synaptic 5-HT 2/3
- No SERT/NET actvity
* *H1 blockade (Sedation)
****weight gain
30
Nefazodone & Trazodone
**H1 blockade (sedation)
block post-synaptic alpha one receptor and post synaptic 5-HT2
Orthostatic Hypotension
31
NDRI side effects
```
Stimulating
Agitation/Insomnia
HTN, Tachycardia
Weight loss
Seizures
```
32
MAOI MOA
Increase level of monoamines in neuronal vesicles to increase serotonin, 5-HT, and DA released
-Oral--->irreversible
(non-selective except segeline)
33
Segeline
MAOI
transdermal patch
selective at low doses
non-selective MAOa in GI inhibits Tyramine metabolism
34
MAOI Side Effects
```
Orthostatic hypotension
Sexual dysfunction
Insomnia/Agitation
Drug interactions (SSRIS, TCA)--->2 week washout
**Risk of HTN crisis
risk of serotonin syndrome
```
35
What is the major concern with MAOI?
Hypertensive Crisis due to increased tyramine
36
Why is Tyramine of Concern?
causes a HTN crisis
levels increased with MAOA (when inhibited by MAOI)
age cheese, soy, beer
37
Esketamine
NMDA (glutamate) antagonist
treatment resistant depression
Nasal Spray
--must watch for 2 hours post
38
Brexanolone
GABA allosteric modulator (endogenous to allopregnenalone)
indicated for post partum depression
60 hour IV infusion
39
Mood Stabilizers (Anti-seizure meds)
Carbamazepine
Lamotrigine
Valporic Acid
40
Lithium
```
Mood stabilizer
-neuroprotective
-neuroproliferative
Inhibits dopamine neurotransmission
downregulates NMDA
**increases GABA levels in CSF
handled by kidneys like sodium
**narrow therapeutic index
```
41
Lithium Side Effects
Polyuria like Diabetes Insipidus
tremor
goiters
serotonin syndrome
42
Lithium Drug Interactions
Diuretics
ACE inhibitors
NSAIDS
43
Lithium Therapeutic Index
Narrow
| 0.6-1.2 mEq/L
44
Indications for Lithium
- acute& maintance of bipolar 1/ mania
- reduced risk of suicide
- augment unipolar depressive treatment with poor response
45
Carbamazpiene
major CYP inducer
| acute and maintance of Bipolar 1
46
Lamotrigine
maintance of bipolar 1 and 2
| antiseizures
47
Valporic Acid
acute bipolar 1
48
Flumazenil
Benzodiazapene antagonist esp if benzo overdose
| associated with seizures
49
Long Acting Barbiturates
Phenobarbital
50
Short Acting Barbiturates
Secobarbital
51
Ultra-Short Acting Barbiturate
Thiopental
52
Sedatives
Drug that decreases CNS activity, moderates excitement, and calms recipient
-Anxiolytic
53
Hypnotic
Drug that produces drowsiness and facilitates onset and maintenance of sleep
-More pronounced CNS depression
54
Benzodiazapines
acts on Gaba A receptor enhances Gaba activity
---hyperpolarization with CL- influx
(sedation and hypnotic effects, relaxation, anxiolytic, anticonvulsant)
-wide distribution throughout body: breast milk
-dependence and tolerance
-"LAMS and "PAMS"
-high therapeautic index
-cumulative toxicity
55
Barbiturates
acts on GabaA receptor
widely distributed throughout the body (placenta/breastmilk)
-mild sedation and anesthsia
-treats seizures, insomnia, tension HA with acetominophen and caffeine
can counteract the effects of stimulants
induces CYP450
56
Contraindications to Diazepam
Myasthenia Gravis
Respiratory Insuffiency
Hepatic 3 Insufficiency
Sleep Apnea Syndrome
**don't use with alcohol or other CNS depressant
57
Alprazolam
```
CYP3A
-management of anxiety disorders
-panic disorder
CI: acute narrow angle glaucoma, ketoconazole, itraconazole
Dependence & withdrawal: seizures
```
58
Midazolam
given IM or IV
pre-op anxiolytic/ sedation/ amnesia
given before other anesthesia
BBW: respiratory depression
59
Diazepam
anxiolytic, sedative, muscle relaxant, anticonvulsant
prolonged half life: 48 hours (increased in cirrhosis)
active metabolite
-rapid rate of oral onset
--management of anxiety disorders
--treat for acute alcohol withdrawal syndrome
60
Triazolam
short term treatment of insomnia
| BBW: profound sedation, respiratory depression, coma, death
61
Chlordiazepoxide
BENZODIAZEPINE
- pre-op apprehension/anxiety
- short relief of anxiety
- withdrawal symptom of alcoholism
BBW: sedation, respiratory depression, coma, death esp with opiods
62
Lorazepam
Treatment of seizure disorder**
| pre-op anxiety
63
Flurazepam
long acting hypnotic for insomnia treatment
64
Thiopental
ultrashort acting barbiturate
* IV only
- used for brief procedures
- first anesthesia given before "big anesthesia"
- controls anesthesia induced convulsions
- decreases intracranial pressure
AE: cardiac arrythmias, laryngospasm, bronchospasm
65
Secobarbital
preanesthetic
| **short term treatment for insomnia (loss of effect after 2 weeks)
66
Secobarbital Contraindications
```
latent porphyria
impaired liver functions test
respiratory disease (obstruction/dyspnea)
```
67
Phenobarbital Cautions
depressed patients with/without suicidal ideations
68
Phenobarbital
used as sedative/hypnotic
| Induces liver enzymes******
69
Phenobarbital Contraindications
latent porphyria
70
Good insomnia drugs
```
Zolpidem (sustained sleep maintenance)
Zalpelon
Ezopicalone
-CYP3A4
-Short half life
-binds alpha 1 subunit of GABAa subunit
```
71
Zolpidem (ambien)
barbituate
| sustained sleep
72
Rameleton
MT1 and MT2 agonist
AE: dizziness, somnolence, fatigue, endocrine changes
Avoid coadministration with fluvoxamine (an SSRI)
**treats disorder of sleep onset
73
Buspirone
generalized anxiety disorder
CYP3A4
--no sedation/hypnosis/euphoria
MOA unknown
74
Zaleplon
non benzo hypnontic
short term tx of insomnia
GabaBZ receptor
short term insomnia treatment
75
Chloral Hydrate
short term sedative
treat alcohol withdrawal syndrome
relieves anxiety with other drug withdrawal
76
Meprobramate
short term anxiety relief
| slows activity of brain
77
Ezopicalone
treatment for insomnia
improve sleep maintanence
risk of morning impairment and CNS depression
AE: dry mouth, hallucination, anxiety, infection
