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NMSK Exam 1 > 1. Pharm: Antidepressants > Flashcards

1. Pharm: Antidepressants Flashcards

1
Q
  1. What is considered a “response” to antidepressants?
A
  1. A > 50% reduction in symptoms from BL.
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2
Q

What is considered a PARTIAL RESPONSE when taking anti-depressants?

A

25 - 50% reduction of symptoms.

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3
Q

Goal in treatment of depression with antidepressants

A

Remission and recovery

  • Remission = symptom free = very low => no sx
  • Recovery = 2-6 months of ongoing remission
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4
Q

Difference between relapse and recurrence of depressive symptoms

A
  1. Relapse = when sx return after remission but before recovery
  2. Recurrence = when sx return after recovery
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5
Q

How long do anti-depressants take to kick in?

What happens if the patient does not respond after ___ weeks?

A
  • 3-8 weeks, depending on the severity of depression, duration and the dose of the drug.
  • If the patient does not respond after ~8 weeks => switch to a drug with a different mechanism.
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6
Q

65-75% of patients will see a _____ ( 50% ↓ in symptoms) with antidepressants in _____ weeks.

A

response

3-4 weeks

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7
Q

What percentage of patients reach remission (sx free => no sx) on anti-depressants?

A

20 - 35%

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8
Q

Test Q: When DQing ALL anti-depressants, what is recommended and why?

A

Slowly titrate down (deprescribe) to to prevent withdrawal syndrome, which causes [FINISH]

  1. Flu-like symptoms
  2. Insomnia
  3. Nausea
  4. Imbalance
  5. Sensory distubances
  6. Hyperarousal
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9
Q

MOA of most anti-depressants

A
  1. Monoamine theory: Most want to ↑ 5HT or NE in the synaptic cleft by blocking pre-synaptic reuptake via SERT, NET or both.
  2. Block or stimulate pre/post synaptic receptors
  3. Affect DA system
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10
Q

Besides depression, anti-depressants are also affective for:

A
  1. Nicotene withdrawal
  2. Enuresis
  3. Diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain
  4. Stress incontinence
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11
Q

Which anti-depressant also treats:

  1. Nicotene withdrawal
  2. Enuresis
  3. Diabetic peripheral neuropathy, fibromyaligia, chronic MSK pain
  4. Stress incontinence
A
  1. Buproprion
  2. Imipramine
  3. Duloxetine
  4. Duloxetine
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12
Q

Which anti-depressant is used off-label for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain, and stress incontinence?

A

Duloxetine

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13
Q

_________ may interact with antidepressants and migraine medicines to cause serotonin syndrome.

A

Opioids

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14
Q

Impact of SSRIs on [Histamine, Muscarinic and Adrenergic Receptors]

A

SSRIs have less SE than TCAs because they do not affect the Histamine, Muscarinic and Adrenergic Receptors.

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15
Q

Which SSRI is the broadest and strongest CYP450 inhibitor, thus, having the MOST drug-drug interactions?

A

Fluoxetine

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16
Q

Which 3 SSRIs are only low/mild CYP450 inhibitors?

A
  1. Citalopram
  2. Sertraline
  3. Vilazodone
17
Q

Which SSRI is the least CYP450 inhibitor, thus, having the LEAST drug-drug interactions?

A
  1. Vortioxetine
  2. Escitalopram
18
Q

AE’s associated with TCA’s antagonizing α1-adrenergic receptors?

A

CV –> Tachycardia + Orthostatic hypotension + Dysrhythmias

19
Q

AE’s associated with TCA’s antagonizing histamine (H1) receptors?

A
    • Sedation/Fatigue
    • Dizziness/Seizures
20
Q

AE’s associated with TCA’s antagonizing muscarinic cholinergic receptors?

A

Anticholinergic => dry mouth + urine retention/constipations + blurry vision/IOP

21
Q

OD on TCA’s causes

A

3 C’s

  1. Coma
  2. Cardiotoxicity (conduction abnormalities), a quinidine-like effect
  3. Convulsions
22
Q

Patient wants an antidepressant that has LESS risk of sexual dysfunction: should he take a SNRI or SSRI?

A

SNRI

23
Q

MAO-I Drug Interactions

A
  • Interacts with drugs that affect 5HT/NE to prevent 5HT syndrome, thus, you should only give after a 2 week washout period (if fluoxetine = 5 weeks)
24
Q

MAO-I SE

A

Hypertensive Crisis:

25
Q

Lithium Indications and Off-Label Use

A
  1. Acute and maintenance tx of mania/bipolar I disorder
  2. Augmentation in unipolar depressive pt’s with inadequate response to antidepressant therapy
  3. Off label: reduced risk of suicide and all-cause mortality in pt’s with mood disorders
26
Q

TEST Q = Which mood stabilizer is a major CYP450 inducer?

A

Carbamazepine

NMSK Exam 1 (22 decks)

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