Unit 8: OVERVIEW (Depression, Anxiety, Psychosis, Bipolar, etc.)

Question 1

Drug Classes used to treat Depression

Answer 1

SSRIs (Selective Serotonin Reuptake Inhibitors)
TCAs (Trycyclic Antidepressants)
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
SARIs (5-HT2 Antagonists)
Tetracyclic and Unicyclic Antidepressants
MAOIs

Question 2

Advantages to SSRIs

Answer 2

very affordable (many on $4 list)

Question 3

MOA of SSRIs

Answer 3

increase serotonin by blocking reuptake

Question 4

SSRIs interact with MAOIs and can cause what major issue?

Answer 4

SEROTONIN SYNDROME

Question 5

Important dosing note for SSRIs

Answer 5

DO NOT STOP abruptly; taper minimum of 2 weeks

Question 6

What happens if SSRIs are abruptly stopped?

Answer 6

withdrawal syndrome

Question 7

Side effects can happen with SSRIs; what do you need to tell patients?

Answer 7

hang in there; many side effects tend to go away

Question 8

Name 7 SSRIs

Answer 8

fluoxetine (Prozac)
paroxetine
sertraline (Zoloft)
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine
vilazodone

Question 9

How do the SNRIs work to treat depression?

Answer 9

block reuptake of serotonin & norepinephrine

Question 10

Name 4 SNRIs used to treat depression

Answer 10

venlafaxine
desvenlafaxine
duloxetine
milnacipran

Question 11

How do the TCAs work to treat depression?

Answer 11

block reuptake of biogenic amines, including serotonin and norepinephrine

Question 12

Name 5 tertiary amine TCAs used to treat depression

Answer 12

amitriptyline
clomipramine
doxepin
imipramine
trimipramine

Question 13

Name 3 secondary amine TCAs used to treat depression

Answer 13

despiramine
nortriptyline
protriptyline

Question 14

What antidepressant class can be fatal in overdoses, and why?

Answer 14

TCAs

due to arrhythmias or seizures

Question 15

What happens with many TCAs and other drugs?

Answer 15

many drug-drug interactions increase the TCA concentration

Question 16

Name the 1st, 2nd and 3rd line classes used to treat depression

Answer 16

1. SSRIs
2. SNRIs
3. TCAs

Question 17

Name 2 SARIs used to treat depression

Answer 17

trazodone (Desyrel)

nefazodone

Question 18

How do the SARIs (5-HT2 Antagonists) work?

Answer 18

block of serotonin @ 5-HT2A receptors –>
antianxiety
antipsychotic
antidepressant

Question 19

Name 2 tetracyclic and unicyclic antidepressants

Answer 19

bupropion

mirtazapine

Question 20

Name 4 MAOIs used to treat depression

Answer 20

isocarboxazid
phenelzine
tranylcypromine
selegiline

Question 21

MAOIs can interact with what drugs to cause a hypertensive crisis?

Answer 21

antidepressants
carbamazepine
levodopa

Question 22

MAOIs can interact with what drugs to cause serotonin syndrome?

Answer 22

dextromethorphan

antidepressants

Question 23

Why can MAOIs be fatal?

Answer 23

slow elimination

interaction with SSRI or tyramine-containing foods can cause a fatal hypertensive crisis

Question 24

What does tyramine do?

Answer 24

releases norepinephrine which increases BP and can cause arrhythmias

Question 25

What drug classes are used to treat insomnia and acute anxiety?

Answer 25

``` barbitruates benzodiazepines benzodiazepine antagonists hypnotics 5-HT Receptor Antagonists ```

Question 26

Define tolerance

Answer 26

reduced effect with repeated use of a drug; need higher doses for same effect

Question 27

Define cross-tolerance

Answer 27

person tolerant to 1 drug also tolerant to drugs in the same class

Question 28

Define dependance

Answer 28

s/sx of withdrawal when drug levels fall

Question 29

For what are barbiturates used?

Answer 29

anesthesia insomnia seizure disorders

Question 30

What barbiturate works within minutes and is used for anesthesia?

Answer 30

thiopental

Question 31

What barbiturates have a duration of action for hours?

Answer 31

pentobarbital secobarbital amobarbital

Question 32

What barbiturate has a duration of action for days?

Answer 32

phenobarbital

Question 33

Which benzodiazepines are more difficult to discontinue?

Answer 33

shorter-acting agents

Question 34

Name 2 short-acting benzodiazepines

Answer 34

midazolam | triazolam

Question 35

Name 2 intermediate-acting benzodiazepines

Answer 35

alprazolam (Xanax) | lorazepam (Ativan)

Question 36

Name 2 long-acting benzodiazepines

Answer 36

clonazepam (Klonipin) | diazepam (Valium)

Question 37

Name a 5-HT Receptor Antagonist used to treat anxiety

Answer 37

buspirone (Buspar)

Question 38

Name 3 hypnotics

Answer 38

zolpidem (Ambien) zalepon ezopiclone (Lunesta)

Question 39

What is the risk of using hypnotics in elderly patients?

Answer 39

delirium

Question 40

Name a benzodiazepine antagonist used for benzodiazepine overdose

Answer 40

flumazenil

Question 41

Of what should you be aware if you give flumazenil for a benzodiazepine overdose?

Answer 41

withdrawal symptoms in patients who are dependent on benzodiazepines

Question 42

Goal of Schizophrenia treatment

Answer 42

most drugs bind to dopamine receptors | want to keep dopamine available in the synapse so patients feel more euphoric/up

Question 43

Classes used to treat Schizophrenia

Answer 43

antipsychotic drugs antischizophrenics tranquilizers

Question 44

Typical antipsychotics can cause what irreversible side effect?

Answer 44

tardive dyskinesia

Question 45

Name some 1st generation typical antipsychotics

Answer 45

``` chlorpromazine fluphenazine haloperidol perphenazine thoridazine thiothixene trifluoperazine ```

Question 46

Name some 2nd generation atypical antipsychotics

Answer 46

``` ariprazole (Abilify) clozapine (Clozaril) olanzapine (Zyprexa) quetiapine (Seroquel) risperidone (Risperdal) ziprasidone (Geodon) ```

Question 47

What atypical antispsychotic has a huge risk fo agranulocytosis and requires WEEKLY BLOODWORK and patients to be on a registry?

Answer 47

clozapine (Clozaril)

Question 48

Serious side effects of typical antipsychotics

Answer 48

QT prolongation neuroepileptic malignant syndrome extrapyramidal effects

Question 49

Which antipsychotics can cause QT prolongation?

Answer 49

ziprasidone (Geodon) | quetiapine (Seroquel)

Question 50

Which antipsychotics increase the risk of stroke?

Answer 50

risperidone | olanzapine

Question 51

What do you need to remember for all antipsychotics?

Answer 51

1 year to life | can cause withdrawal because they work on neurotransmitters --> taper on/off