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Pharmacology > Anti-depressants > Flashcards

Anti-depressants Flashcards

1
Q

depression is defined as having ____ or more of the symptoms in the same ____ week period

A

5 or more symptoms, 2 week period

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2
Q

Gold standard for MDD diagnosis

A

Structured Clinical Interview for DSM-V

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3
Q

interview assessment for depression

A

Hamilton Depression Rating Scale

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4
Q

2 self-administered screening tools

A

Beck Depression Inventory, Edinburgh Postnatal Depression Score

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5
Q

Having a first degree relative with MDD increases risk ____x with _______ onset and recurrence

A

2-4x, earlier onset

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6
Q

5 causes/risk factors for MDD

A

temperament, environment, genetic, gender, cultural

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7
Q

Depression prevalence is higher in which gender

A

females

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8
Q

2 environmental risk factors for MDD

A

adverse childhood experiences, stressful life events

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9
Q

3 health statuses that could cause depression

A

hypothyroidism, cancer, pain disorders

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10
Q

depression can lead to death by

A

suicide

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11
Q

which hypothesis suggests that depression is related to a deficiency in serotonin, NE, and dopamine

A

monoamine hypothesis

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12
Q

the monoamine hypothesis suggests that depression is related to a deficiency in _________, _________, and __________

A

serotonin, norepinephrine, and dopamine

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13
Q

evidence for Monoamine hypothesis: depletion of monoamines by __________ can _________ depression

A

reserpine, induce depression

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14
Q

Reserpine is a _______ inhibitor and can ______ monoamines which _______ depression

A

VMAT2 inhibitor, deplete monoamines, induce depression

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15
Q

dietary ______ (a precursor of _______) is required for effect of SSRIs

A

tryptophan, serotonin precursor

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16
Q

the neurotropic hypothesis suggests that changes in _______ factors (especially _______) appear to play a major role in depression

A

trophic factors, BDNF

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17
Q

BDNF stands for

A

brain derived neurotropic factor

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18
Q

which hypothesis suggests that a decrease in trophic factors leads to depression

A

neurotropic hypothesis

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19
Q

stress and pain are associated with a ______ in BDNF and cause _______ changes in the brain

A

decrease, structure

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20
Q

major depression is associated with _____% loss in hippocampal volume

A

5-10%

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21
Q

chronic administration of antidepressants _______ BDNF —> _______ neurogenesis

A

increase BDNF, increased neurogensis

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22
Q

depressed patients often have _______ glutamate in CSF and cortex

A

elevated

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23
Q

chronic antidepressant use ________ glutamate transmission

A

decreases

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24
Q

stress ________ the release of glutamate in the brain; antidepressants ________ this

A

increases, decrease

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25
Q

Ketamine is a _____ receptor antagonist and has antidepressant effects

A

NMDA (glutamate receptor)

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26
Q

what is the glutamate receptor

A

NMDA

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27
Q

which drug is an NMDA Receptor antagonist

A

Ketamine

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28
Q

MDD is associated with ______ cortisol and altered functioning of _____

A

elevated coristol, HPA axis

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29
Q

5 drug classes

A

MAOi, Tricyclics, SSRI, SNRI, Atypical

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30
Q

3 MAOIs

A

Phenelzine, Tranylcypromine, Selegiline

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31
Q

class of Phenelzine

A

MAOi

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32
Q

class of Tranylcypromine

A

MAOi

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33
Q

class of Selegiline

A

MAOi

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34
Q

which MAOi is also used in Parkinsons and why

A

Selegiline, has higher affinity for MAO-B

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35
Q

2 types of Tricyclics

A

tertiary amines and secondary amines

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36
Q

5 Tricyclic tertiary amines

A

Amitriptyline, Clomipramine, Doxepin, Imipramine, Trimipramine

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37
Q

5 tricyclic secondary amines

A

Amoxapine, Desipramine, Maprotiline, Nortriptyline, Protriptyline

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38
Q

class of Amitriptyline

A

Tricyclic (tertiary)

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39
Q

class of Clomipramine

A

Tricyclic (tertiary)

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40
Q

class of Doxepin

A

Tricyclic (tertiary)

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41
Q

class of Imipramine

A

Tricyclic (tertiary)

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42
Q

class of Trimipramine

A

Tricyclic (tertiary)

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43
Q

class of Amoxapine

A

Tricyclic (secondary)

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44
Q

class of Desipramine

A

Tricyclic (secondary)

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45
Q

class of Maprotiline

A

Tricyclic (secondary)

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46
Q

class of Nortriptyline

A

Tricyclic (secondary)

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47
Q

class of Protriptyline

A

Tricyclic (secondary)

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48
Q

are tertiary or secondary Tricyclics more selective for inhibiting NE reuptake

A

secondary

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49
Q

class of Citalopram

A

SSRI

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50
Q

class of Escitalopram

A

SSRI

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51
Q

class of Fluoxetine

A

SSRI

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52
Q

class of Fluvoxamine

A

SSRI

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53
Q

class of Paroxetine

A

SSRI

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54
Q

class of Sertraline

A

SSRI

55
Q

3 SNRIs

A

Venlafaxine, Atomoxetine, Duloxetine

56
Q

class of Venlafaxine

A

SNRI

57
Q

class of Atomoxetine

A

SNRI

58
Q

class of Duloxetine

A

SNRI

59
Q

active metabolite of Venlafaxine

A

Desvenlafaxine

60
Q

4 atypical antidepressants

A

Bupropion, Mirtazapine, Nefazodone, Trazodone

61
Q

class of Bupropion

A

atypical

62
Q

class of Mirtazapine

A

atypical

63
Q

class of Nefazodone

A

atypical

64
Q

class of Trazodone

A

atypical

65
Q

indication of Bupropion

A

smoking cessation

66
Q

4 non-pharmacological treatments

A

psychotherapy, electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation

67
Q

4 off label indications of antidepressants

A

pain disorders, PMDD, vasomotor symptoms, stress urinary incontinence

68
Q

7 FDA approved indications of antidepressants

A

MDD, panic disorder, GAD, PTSD, OCD, bulimia, smoking cessation

69
Q

enzyme that breaksdown serotonin, 5HT

A

monoamine oxidase

70
Q

MOA of monoamine oxidase inhibitors

A

inhibit MAO —> increase presynaptic NE and 5HT available for relase

71
Q

MOA of SSRIs

A

inhibit presynaptic SERT —> decrease 5HT reuptake —-> increase 5HT in synapse

72
Q

SSRIs: inhibit presynaptic _______, _______ 5HT reuptake, _______ 5HT in synapse

A

SERT, decrease reuptake, increase 5HT

73
Q

MOA of tricyclics and SNRIs

A

inhibit presynaptic NET —> decrease reuptake —-> increase amount in synapse

74
Q

tricyclics and SNRIs inhibit presynaptic ______

A

NET

75
Q

Tricyclics also block _____ which decreases _____ signaling and increases _____ signaling

A

alpha1 receptors, decreases IP3, increases NE

76
Q

serotonin syndrome can be caused by an overdose of

A

antidepressants

Using more than 1 at the same time, Not properly weaning from one before starting another

77
Q

most antidepressants should be D/C at least _____ weeks before starting a new one

A

2 weeks

78
Q

long half life serotonergic reuptake inhibiting agents (ex: ________) should be D/C at least ____ weeks before MAOI is initiated

A

Fluoxetine, 4-5 weeks

79
Q

do secondary or tertiary amines have more side effects

A

tertiary

80
Q

which class has the best side effect profile

A

SSRIs

81
Q

route of administration is almost always ______

A

oral

82
Q

SSRIs are generally ______ and _______ absorbed and survive first pass effect

A

rapidly and well absorbed

83
Q

SSRIs have a ______ bioavailability (____% for sertraline to ____% for Fluvoxamine)

A

high, 45% - 90%

84
Q

peak plasma conc ____ hours after administration

A

4-6 hours

85
Q

most antidepressants are _______ protein bound, which _______ distribution

A

highly, decreases

86
Q

SSRIs are ________ which _______ distribution. (______ volume of distribution)

A

lipophilic, increases, large VOD

87
Q

______ is the primary metabolic enzyme for most antidepressants

A

CYP2D6

88
Q

Exceptions to metabolism: _________ and __________ which are metabolized by CYP____ and _____

A

Citalopram and Escitalopram, CYP3A4 and 2C19

89
Q

_________ and _________ have active metabolites

A

Fluoxetine and Sertraline

90
Q

antidepressants are excreted _______

A

renally (adjust dose in renal failure)

91
Q

antidepressants have a ______ half life. makes _______ dosing appropriate

A

long half life, once daily dosing

92
Q

food-drug interactions: MAOIs + _______ containing foods

A

tyramine

93
Q

what types of food contain tyramine

A

fermented, cured, aged, spoiled

94
Q

Tyramine is metabolized by _____

A

MAO

95
Q

MAOIs ________ tyramine metabolism —> _______ systemic tyramine absorption —> tyramine taken up into adrenergic nerve endings —> release of ________ into blood vessels —> vessel _______ —> ______ blood pressure —> __________ crisis

A

decreases metabolism, increase absorption, catecholamines, vessel constriction, increase BP, hypertensive

96
Q

3 CYP2D6 inhibitors

A

Fluoxetine, Paroxetine, Duloxetine

97
Q

4 CYP3A4 inhibitors

A

Fluvoxamine, Nefazodone, Sertraline, Fluoxetine

98
Q

what 3 things are CYP3A4 substrates

A

Citalopram, Escitalopram, TCAs

99
Q

Substrates of CYP2D6

A

TCAs, Trazodone, Paroxetine, Duloxetine, Venlafaxine, Bupropion, Mirtazapine

100
Q

4 patient factors

A

sex, age, race/culture, sexual orientation

101
Q

antidepressants are wrongfully thought of as _________ in many cultures

A

Addictive

102
Q

BBW for antidepressants

A

increased risk of suicidal thinking in children, adolescents, and young adults

103
Q

__________ is contraindicated in pregnancy due to __________ malformation in fetus

A

Paroxetine, cardiac malformation

104
Q

best course of treatment for antidepressants during pregnancy

A

continue antidepressant therapy

105
Q

_________ circulating glucocorticoids can cause _____ birth weight

A

increased, low birth weight

106
Q

indication of atomoxetine

A

ADHD

107
Q

which tertiary tricyclic is LEAST LIKELY to cause seizures

A

Doxepin

108
Q

main risk with MAOIs

A

Serotonin Syndrome

109
Q

a person will develop ________ to MOST side effects of antidepressants

A

tolerant (GI, sedation)

110
Q

2 main side effects of SSRIs

A

GI effects and Sexual effects

111
Q

side effects of tertiary tricyclics

A

seizures, sedation, hypotension, Anti-ACh effects, weight gain, sexual effects, cardiac effects

112
Q

what are ACh side effects

A

dry mouth, pupil dilation, sensitive to light, hot/flushed/dry skin, increased intraocular pressure

113
Q

what side effect is very common amgonst antidepressants

A

sexual (ED, decreased libido)

114
Q

symptoms of Serotonin Syndrome

A

Hyperthermia, muscle rigidity, myoclonus, tremors, autonomic instability, confusion, irritability, agitation

can process to coma/death

115
Q

antidepressant monotherapy should NOT be prescribed for patients with ________

A

bipolar disorder

116
Q

why should antidepressant monotherapy not be prescribed for bipolar pt

A

can induce manic state

117
Q

antidepressants have a delayed effect; can take ______ weeks to take effect

A

4-6 weeks

118
Q

antidepressant can cause physical _______, which leads to withdrawal

A

dependence

NOT ADDICTION!!!

119
Q

be very careful when switching between antidepressant classes to avoid ________

A

serotonin syndrome

120
Q

therapeutic range of citalopram

A

20-40

121
Q

therapeutic range of escitalopram

A

10-20

122
Q

therapeutic range of fluoxetine

A

20-80

123
Q

therapeutic range of fluvoxamine

A

100-200

124
Q

therapeutic range of paroxetine

A

20-40

125
Q

therapeutic range of sertraline

A

100-150

126
Q

therapeutic range of TERTIARY tricyclics

A

100-200

127
Q

therapeutic range of protriptyline

A

15-40

128
Q

therapeutic range of amoxapine

A

200-300

129
Q

therapeutic range of desipramine

A

100-200

130
Q

therapeutic range of maprotiline

A

100-150

131
Q

therapeutic range of nortriptyline

A

75-140

132
Q

therapeutic range of phenelzine

A

30-60

133
Q

therapeutic range of tranylcypromine

A

20-30

134
Q

therapeutic range of selegiline

A

10

Pharmacology (5 decks)

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