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N P psych part > 032315 antidepressants > Flashcards

032315 antidepressants Flashcards

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1
Q

monoamine theory of depression

A

depression results from deficient monoamine (NE and/or 5HT) transmission in the CNS

the delay in onset of effects fails to support the traditional monoamine hypothesis

restated (new) monoamine hypothesis is that depression is due to bioegnic amine receptor or transmission imbalance

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2
Q

neurons containing NE are located where

A

locus coeruleus

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3
Q

neurons containing serotonin are located where

A

raphe nucleus

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4
Q

TCAs MOA

A

block reuptake of NE and 5HT

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5
Q

SSRI MOA

A

block reuptake of 5HT

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6
Q

mirtazapine MOA

A

atypical antidepressant

blocks serotonin and NE presynaptic alpha2 receptors

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7
Q

MAO inhibitors’ MOA

A

prevents breakdown of NE, 5HT

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8
Q

where is MAO located

A

mitochondria, liver, lung

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9
Q

what percent of pts w major depression respond to anti-depressants

A

67%

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10
Q

tx of major depression–order of use

A 
SSRIs
SNRIs
atypical drugs
TCAs
MAO inhibitors
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11
Q

SSRIs-list them

A 
fluoxetine
sertraline
paroxetine
citalopram
escitalopram
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12
Q

acute toxicity of SSRIs

A

less than TCAs and MAOinhibitors

  • nausea, insomnia, sexual dysfxn
  • suicidal thinking risk increased in children and adolescents
  • SSRI withdrawal: shock-like sensations, dizziness, anxiety, etc
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13
Q

serotonin reaction

A

occurs when SSRIs are given with MAOIs

hyperthermia, muscle rigidity, cardiovascular collapse

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14
Q

neuroleptic malignant syndrome

A

SSRIs and SNRIs, are associated with when given w anti-psychotics

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15
Q

uses for SSRIs

A
  • major depression
  • OCD (drug of choice)
  • panic disorder, social anxiety disorder, PTSD (more effec than anti-anxiety agents)
  • generalized anxiety disorder (drug of choice)
  • PMS
  • hot flashes
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16
Q

side effect profile of SNRI

A

more SSRI-like than TCA-like (TCA can bind to lots of other receptors like those for dopamine, etc, leading to more side effects)

17
Q

use of SNRIs

A

major depression, anxiety, fibromyalgia, etc

18
Q

bupropion MOA

A

weakly blocks NE and dopamine uptake

19
Q

use of bupropion

A

major depression, nicotine withdrawal, seasonal affective disorder

20
Q

side effects of bupropion

A

NO weight gain or sexual dysfxn

21
Q

mirtazapine MOA

A

blocks presynaptic alpha2 receptors

22
Q

side effects of mirtazapine

A

increases appetite (AIDs pts)

23
Q

trazodone MOA

A

weak SSRI-like effect

24
Q

side effects of trazodone

A

priapism, sedating

25
Q

use of trazodone

A

major depression, insomnia

26
Q

vortioxetine MOA

A

SSRI-like action in addition to 5HT1A agonist and 5HT3 antagonist

27
Q

side effects of TCAs

A

decreases REM, increases stage 4 sleep

ANTICHOLINERGIC effects: dry mouth, blurry vision, urinary retention

sedation

orthostatic hypotension

cardiac side effects (due to anticholinergic and increased NE)-palpitations, tachycardia, arrhythmias, longer QRS intervals, EKG changes

28
Q

drug interactions of TCAs

A

guanethidine
sympathomimetic drugs
absoprtion and metabolism of other drugs

29
Q

uses of TCAs

A

MDD
enuresis in childhood
chronic pain
OCD

30
Q

side effects of MAOIs

A

lowers blood pres, orthosatic hypotension

acute toxicity: agitation, hallucinations, hyperpyrexia, convulsions, BP changes

31
Q

tyramine

A

if not broken down, can cause release of NE, resulting in hypertensive crisis

32
Q

foods that can interact w MAOIs

A 
avocados
soybean
figs
smoked meats
fermented sausage
dried fish
cheese
33
Q

uses of MAOIs

A

MDD (not first line)

narcolepsy

34
Q

what if antidepressant drugs alone aren’t effective?

A

add antipsychotic drugs

physiological tx-ECT, transcranial magnetic stimulation, deep brain stimulation

35
Q

St John’s wort

A

MAOI activity

N P psych part (18 decks)

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