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Pharm 2 > anti-depressants > Flashcards

anti-depressants Flashcards

1
Q

TCAs are nonselective ___ reuptake inhibitors

A

NE, 5-HT

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2
Q

which antidepressant has NO P450 interactions

A

venlafaxine

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3
Q

class: Selegiline
o Isocarboxazid
o Tranylcypromine
o Phenelzine (off the market)
* LINEZOLID (abx)

A

non-selective MAOIs

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4
Q

MAOI washout period

A

2 weeks for most (before starting another antidepressant class). fluoxetine is 6 wks

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5
Q

AEs:
o Orthostatic hypotension, dizziness
o HA
o Insomnia
o Weight gain (phenelzine)
o Sexual side effects (lower w/ selegiline)

A

MAOIs

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6
Q

MOA: inhibit NE and 5-HT reuptake into presynaptic nerve terminals, block NE/5-HT transporter sites
o Increase monoamine levels rapidly
o Also antihistamine, anti-alpha adrenergic, anticholinergic, anti-cardiac Na/K channel effects

A

TCAs

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7
Q

which has more SEs: secondary or tertiary amines

A

tertiary

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8
Q

class: Nortriptyline, Desipramine

A

secondary amine TCAs

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9
Q

AEs:
o H1 receptor blockade = drowsiness, sedation, impaired mental function, weight gain
o A1 receptor blockade = orthostatic hypotension, reflex tachycardia
o Anticholinergic AEs
o Glaucoma
o Elevated NE = tachycardia, seizures, hyperthermia
o Na/K: QT prolongation, TdP, seizures
o Most likely to see overdose with this class
§ Especially tertiary amines
o BBW: suicidality

A

TCAs

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10
Q

TCA DIs

A

MAOIs = cardiotoxicity
§ Anticholinergics = enhanced anticholinergic side effects
§ CNS Depressants = enhanced sedation

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11
Q

TCAs as monotherapy for depression?

A

no

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12
Q

MOA: selectively blocks 5-HT reuptake by inhibiting transporter on pre-synaptic neurons
o Increases amount of active and available serotonin in synaptic cleft
o No therapeutic action at NE reuptake transporter or other receptor sites
o Increases monoamine levels fairly rapidly

A

SSRIs

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13
Q

AEs:
o Common: drowsiness, HA, nausea, sexual dysfunction, insomnia, dizziness, agitation, weight
gain (paroxetine worst)
o Serious:
§ Serotonin syndrome, suicidality, glaucoma, seizures
§ QT prolongation, TdP (citalopram/escitalopram)

A

SSRIs

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14
Q

worst SSRI for weight gain

A

paroxetine

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15
Q

least problematic SSRI for weight gain

A

fluoxetine

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16
Q

SSRI cautions

A

Other medications that elevate serotonin: Most other antidepressants, St. John’s Wort, sumatriptan
o Avoid abrupt withdrawal
o Pts <25 y/o, elderly (need to monitor Na), pregnant
avoid alcohol
poss increased risk for bleeding
can cause manic episode in bipolar

17
Q

SSRI w/ the most CYP2D6 activity

A

fluoxetine

18
Q

serotonin syndrome antidote

A

cyproheptadine

19
Q

cymbalta CI

A

hepatic and renal dysfunction

20
Q

cymbalta caution

A

Moderate CYP2D6 inhibitor - this can diminish response to opioids

21
Q

AEs:
o Common: NAUSEA, HA, sexual dysfunction, insomnia, dizziness, agitation, weight loss
§ Can ­HR and BP
o GI intolerance w/ duloxetine
o Serotonin syndrome, suicidality, glaucoma, seizures
moderately common: decreased libido, ED, delayed ejaculation, anorgasmia
rare: bleeding, hyponatremia, bone resorption
some anticholinergic effects w/ Effexor

A

SNRIs

22
Q

SNRIs cautions

A

CIs/Cautions
o Other meds elevating 5HT/NE
o Avoid abrupt withdrawal
o CV dz or seizure hx
o Patients <25 y/o, elderly, pregnant

23
Q

MOA: Weak DA and NE reuptake inhibitor, greater effect on dopamine, weak antagonism of nicotinic receptors

A

bupropion

24
Q

AEs:
§ Restlessness, tremors, insomnia, lowers seizure threshold, , dry mouth (in 21%), increased anxiety, nausea, agitation, dyspepsia

A

bupropion

25
Q

bupropion CIs

A

CIs:
§ Seizure hx, bulimia, recent MAOI use, abrupt alcohol or BZ discontinuation

26
Q

MOA: Antagonizes 5-HT2, 5-HT3 receptors, high affinity for H1 receptors causing sedation

A

mirtazapine

27
Q

AEs:
§ Sedation
§ Weight gain (increased appetite), xerostomia

A

mirtazapine

28
Q

MOA: 5-HT antagonist, weak inhibition of SERT, a2/H2 antagonists

A

trazodone

29
Q

AEs:
§ SOMNOLENCE, HA, xerostomia, dizziness
§ Orthostatic hypotension
§ Syncope
§ Sexual dysfunction
§ Priapism
§ Suicidality
§ Serotonin syndrome, QT prolongation, TdP

A

trazodone

30
Q

trazodone CI

A

§ Cardiovascular dz history
§ <25, elderly, pregnant

31
Q

class: Nefazodone, Vilazodone, Vortioxetine

A

atypical antidepressants

Pharm 2 (29 decks)

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