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NMSP Exam 1 > Anti Depressant Drugs - Segars > Flashcards

Anti Depressant Drugs - Segars Flashcards

1
Q

What are the symptoms of withdrawal syndrome?

A

FINISH

  • flu-like
  • insomnia
  • nausea
  • imbalance
  • sensory disturbance
  • hyperarousal
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2
Q

what is the monoamine theory of depression?

A

agents block 5HT and/or NE re-uptake by pre-synaptic transporters (SERT, NET)

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3
Q

what are the “other” antidepressant indications Segars wants us to know?

A
  • nicotine withdrawal
  • enuresis (can’t control urination)
  • diabetic peripheral neuropathy, fibromyalgia, and chronic MSK pani
  • stress incontinence
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4
Q

what med used for nicotine withdrawal?

A

bupropion

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5
Q

what med used for enuresis?

A

impramine

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6
Q

what med used for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain and stress incontinence?

A

duloxetine

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7
Q
  • citalopram
  • escitalopram
  • fluxotine
  • paroxetine
  • sertraline
  • vilazodone
  • vortioxetine
A

serotonin-selective reuptake inhibitors

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8
Q
  • amitriptyline
  • clomipramine
  • doxepin
  • imipramine
A

tertiary amines

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9
Q
  • amoxapine
  • nortriptyline
  • desipramine
A

secondary amines

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10
Q
  • TCA’s
  • descenlafaxine
  • duloxetine
  • venlafaxine
  • levomilnacipran
A

serotonin-norepinephrine reuptake inhibitors

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11
Q

buproprion MOA?

A

noradrenergic-dopamine reuptake inhibitor

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12
Q
  • mirtazapine
  • nefazodone
  • trazodone
A

serotonin-noradrenergic receptor antagonist

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13
Q
  • isocarboxazid
  • phenelzine
  • selegiline
  • tranylcypromine
A

monoamine oxidase inhibitors

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14
Q

amoxapine MOA?

A

SNRI and dopamine antagonist

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15
Q

what is the first line drug class prescribed for depression?

A

SSRI’s

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16
Q

what is the additional MOA of vilazodone?

A

also a partial agonist of 5HT-1A

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17
Q

what is the additional MOA of vortioxetine?

A
  • partial agonist on 5HT-1B
  • full agonist on 5HT-1A
  • full agonist on 5HT-1D,3,7
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18
Q 
what drug class has much less impact on histamine, muscarinic and adrenergic receptors
- and fewer side effects/risk than TCA's?
A

SSRI’s

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19
Q

what side effect is a concern with all categories of anti depressants?

A

acute withdrawal reactions

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20
Q

what are the most serious side effects of SSRI’s?

A

serotonin syndrome:

  • sweating
  • hyperreflexia
  • akathisia

also suicidal thoughts/tendencies

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21
Q

when is there an increased risk of serotonin syndrome?

A

when SSRI’s are given concurrently with other serotonin-affecting agents

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22
Q

which SSRI has the most CYP450 drug-drug interactions?

A

fluoxetine (broad and strong inhibitor) - KNOW this one

23
Q

which SSRI’s have the least CYP450 drug-drug interactions?

A

vortioxetine, escitalopram

24
Q

which SSRI’s have low/mild CYP450 drug-drug interactions?

A

citalopram, sertraline, vilazodone

25
Q

what is amitriptyline metabolized into?

A

nortriptyline (tertiary -> secondary amine)

26
Q

what is imipramine metabolized into?

A

desipramine (tertiary -> secondary amine)

27
Q

what other receptors do TCA’s block?

A
  1. histamine (H1)
  2. muscarinic (cholinergic)
  3. alpha 1 adrenergic
28
Q

what are the 3 key system-based side effects of TCA’s?

A
  1. cardiovascular (alpha): tachycardia, orthostatic hypotension, dysrhythmias
  2. anticholinergic: dry mouth, urinary retention/constipation, blurred vision
  3. CNS (histamine): sedation/fatigue, dizziness/seizures
29
Q

what are the 3 C’s of a TCA overdose?

A
  • coma
  • cardiotoxicity (conduction abnormalities) -> “quinidine-like” effect
  • convulsions
30
Q

what two SARA’s act like SSRI’s AND selectively block post-synaptic a1 receptors on NE neurons and post-synaptic 5HT receptors?

A
  • trazodone

- nefazodone

31
Q

which SARA blocks pre-synaptic a2 receptors on NE and 5HT neurons AND blocks post-synaptic 5HT-2/3 receptors?

A

mirtazapine

  • no SERT-NE activity
  • also H1 blockage (sedation)
32
Q

what are the side effects of SARA’s?

A
  • CNS sedation (mostly trazodone/mirtazapine)
  • orthostatic hypotension (mostly trazodone)
  • weight gain (mostly mirtazapine)
33
Q

what is the worst/most worrisome side effect of bupropion (NDRI)?

A

seizures

- can also cause insomnia

34
Q

all MAOI’s are non-selective for A/B except for which?

A

selegiline is B selective

35
Q

which is there a 2 week wash-out period for MAOI’s?

A

all oral agents are considered irreversible
- they increase levels of monoamines in neuronal vesicles and increase amounts of NE. 5HT and DA released

NOTE: fluoxetine has a FIVE week washout period!

36
Q

what is the major concern with MAOI’s?

A

risk of hypertensive crisis

  • MAOI’s inhibit MAO-A, which is necessary in GI for tyramine metabolism
  • increased tyramine in diet (fermented foods) can induce significant catecholamine release and HTN crisis
37
Q

what are the sx of hypertensive crisis?

A
  • severe headache
  • nausea/vomiting
  • sweating/severe anxiety
  • nosebleeds
  • tachycardia
  • chest pain
  • changes in vision
  • SOA
  • confusion
38
Q

what is esketamine?

A

a miscellaneous antidepressant

- NMDA-receptor (glutamate) antag

39
Q

when is esketamine indicated?

A

treatment-resistant depression in conjunction with ongoing antidepressant therapy

40
Q

what is brexanolone?

A

a miscellaneous antidepressant
- GABA-A receptor positive allosteric modulator

NOTE: 60 hr IV administration by authorized physician only! but single dose lasts up to 30 days!

41
Q

what are the two classes of mood stabilizers?

A
  • anti-seizure agents

- miscellaneous

42
Q
  • carbamazepine
  • lamotrigine
  • divalproex/valproic acid
A

anti-seizure agents, used as mood stabilizer

- exact MOA unknown

43
Q

litium

A

miscellaneous mood stabilizer

44
Q

what are the actions of lithium?

A

alters brain structure, neurotransmitter modulation, and intracellular changes

45
Q

what is the only mood stabilizer with neuro-protective effects?

A

lithium

NOTE: is a monovalent ion, handled by kidneys similar to Na/K. Li competes with Na for kidney reabsorption

46
Q

what is the MOA of lithium?

A

inhibits DA neurotransmission, by interfering with activity of both stimulatory and inhibitory proteins (Gs and Gi), keeping them inactive
- lithium also increases GABA levels in CSF by promoting neurotransmission (NT)

NOTE: in mania, dopamine NT is increased. in depression, dopamine NT is decreased

47
Q

what are the main side effect of lithium?

A

polyuria/polydipsia

- causes clinical nephrogenic diabetes insipidus

48
Q

what are the drug-drug interactions with lithium?

A
  • diuretics (preferential Na loss and Li reabs)
  • ACEI’s
  • NSAID’s
49
Q

what are the indications for lithium?

A
  • acute and maintenance treatment of mania/bipolar I disorder
  • augmentation in unipolar depressive pts with inadequate response
50
Q

what are the indications for valproic acid/divalproex?

A

acute bipolar I (with or without psychotic features)

51
Q

what is lamotrigine used for?

A

maintenance of bipolar I and II

52
Q

what is carbamazepine used for?

A

acute and maintenance treatment of acute mania and mixed episodes (bipolar I)

53
Q

which mood stabilizer is a major CYP450 inducer?

A

carbamazepine

NMSP Exam 1 (19 decks)

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