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Behavioral Medicine > Anti-depressants 2 > Flashcards

Anti-depressants 2 Flashcards

1
Q

SNRIs do NOT have affect upon

A

Alpha-1 adrenergic, cholinergic, dopaminergic, or histaminergic receptors

(less side effects, but unique side effects)

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2
Q

Unique side effects of SNRI

A

Pseudocholinergic effects by stimulating NE or receptors in the SNS

(decrease parasympathetic tone)

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3
Q

Duloxetine inhibits _____ (enzyme)

A

CYP2D6

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4
Q

SNRI adverse effects (class effects) (5)

A
  1. Nausea, dizziness, diaphoresis
  2. Blood pressure increase
  3. Headaches
  4. Sexual dysfunction
  5. Hyponatremia
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5
Q

In addition to treating depression Duloxetine also treats _____(4)

A
  1. Generalized anxiety disorder
  2. Diabetic peripheral neuropathic pain
  3. Fibromyalgia
  4. Chronic musculoskeletal pain
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6
Q

In addition to treating depression, Milnacipran also treats ______

A

Fibromyalgia

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7
Q

Venlafaxine side effects

A

sexual dysfunction

(Most likely SNRI to cause this)

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8
Q

Two types of Tricyclic antidepressants

A

Tertiary or secondary amines

(tertiary has the methyl group)

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9
Q

Tertiary amines effects (2)

A
  1. Highly anticholinergic
  2. Strong serotonin and norepinephrine reuptake inhibitor

(if this becomes too much, try the secondary Amine TCA)

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10
Q

Secondary amine effects (3)

A
  1. less anticholinergic
  2. More potent
  3. More selective norepinephrine reuptake inhibitor
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11
Q

Tricyclic antidepressant MOA

A

Serotonin and norepinephrine reuptake inhibitor

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12
Q

TCAs block: (4)

A
  1. Blockade of muscarinic M1, H1, alpha-adrenergic 1 receptors
  2. fast Na Channel in cardiac cells

(they bind to everyhing!)

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13
Q

Which Tri cyclic antidepressants have the best overall tolerability (2)?

A
  1. Notriptlyin
  2. Desipramine
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14
Q

All cyclic antidepressants are potentially _____ toxic

A

cardio

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15
Q

________ may treat childhood enuresis (bed-wetting)

A

Imipramine

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16
Q

What are the three C’s of Tri cyclic antidepressants poisoning

A
  1. Convulsion
  2. Cardiac arrest
  3. Coma
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17
Q

Two types of monoamine oxidase inhibitors

A
  1. Hydrazine
  2. Non hydrazine
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18
Q

Monoamine oxidase is responsible for _____(2)

A

Breakdown of Serotonin and norepinephrine

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19
Q

The blockade of monoamine oxidase a in the gastrointestinal tract is responsible for the ______ reaction associated w/MOAIs

A

“cheese reaction” = hypertensive crisis

(A patient taking MOAIs and just foods containing the sympathomimetics tyramine)

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20
Q

MOAIs are metabolized by ______ (process).

A

acetylation

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21
Q

MOAIs can also be effective in treating ______.

A

resistant depression

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22
Q

MOAIs have potent ____ effects

A

hypotensive (leading to dizziness)→risk in treating elderly

(also causes urinary hesitancy, headache and myoclonic jerks)

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23
Q

What is the only antidepressant that is available in a patch?

A

MAOIs

(Also available sublingually)

24
Q

Indication of nefazodone

A

depression

25
Q

Nefazodone MOA

A

Antagonize and down regulates postsynaptic serotonin 5-HT2A

26
Q

Trazodone pharmacokinetics

A

The table is by CYPT3A4

27
Q

Trazodone adverse effects

A
  1. priapism
  2. sedation

(dizziness, dry mouth, nausea)

28
Q

Vilazodone MOA

A
  1. Serotonin reuptake inhibitor
  2. Partial Agonist of 5-HT1A receptor

(side effects: diarrhea, sexual dysfunction)

29
Q

Vilazodone is metabolized by

A

CYP3A4

30
Q

Vilazodone adverse effects

A

sexual dysfunction

(diarrhea, N/V)

31
Q

Vortioxetine indications (2)

A
  1. Treatment for major depression
  2. Cognitive dysfunction associated with depression

(metabolized by CYP2D6)

32
Q

Ketamine MOA

A

NMDA noncompetitve antagonist → releases BDNF

33
Q

Ketamine indication

A

Suicide prevention (when the patient is on the brink; must be given at the doctor’s office); not for regular depression tx

(rapid effect)

34
Q

Brexanolone indication

A

Postpartum depression → due to the drop in alopregnenalone

(effect lasts for 30 days, no dissociateive symptoms or risk of abuse)

35
Q

Brexanalone

A
  1. Sedation / somnolence
  2. Dry mouth
  3. Loss of consciousness
36
Q

Duloxetine should be prescribed with caution to patients with the following conditions (4).

A
  1. Severe kidney impairment
  2. Hepatic impairment
  3. Angle closure glaucoma
  4. Alcohol abuse
37
Q

Levomilnacipran side effects

A
  1. Not recommended for patients with kidney disease
  2. Caution with angle closure glaucoma, hypertension or cardiovascular conditions

(at low dose blocks reuptake of NE 2xs more potently than 5-HT)

38
Q

Milnacipran should be avoided in patients with the following conditions

A
  1. End stage kidney disease
  2. Angle closure glaucoma
  3. Chronic liver disease
  4. Alcohol abuse
39
Q

Venlafaxine should be avoided in patients with the following conditions

A
  1. angle closure glaucoma
  2. patients at risk for bleeding (anticoagulants)
40
Q

TCA Metabolism & elimination occurs largely in the liver by which enzymes (4)?

A
  1. 1A2
  2. 1C19
  3. 2D6
  4. 3A4
41
Q

Many of the TCA metabolites have _____a ctivity. Desipramine is the active (demethylated) metabolite of _____, and nortriptyline is the active (demethylated) metabolite of ______.

A
  • antidepressant
  • imipramine
  • amitriptyline
42
Q

Trazadone use other than antidepressant:

A
  • dyspepsia
  • hypnotic
43
Q

Nefazodone adverse effects is mainly ________.

A

Acute liver failure

Patients receiving the drug should be monitored for signs and symptoms of liver failure (nausea, abdominal pain, jaundice, impaired synthetic function, coagulopathy, and delirium)

44
Q

TCA: adverse effects (5)

A
  1. Prolonged QT interval
  2. Tremor
  3. Bone fracture
  4. Neuroleptic malignant syndrome (amoxapine)
  5. Tardive dyskinesia (amoxapine)
45
Q

Tricyclic antidepressant poisoning: treatment of hypotension

A

Isotonic crystalloid (vasopressor if necessary, i.e. neosynephrine or norepinephrine are preferred)

46
Q

Tricyclic antidepressant poisoning: treatment of conduction disturbances

A
  1. Challenge with intravenous sodium bicarbonate
  2. If QRS Narrows, begin continuous infusion (150 mEq of sodium bicarbonate in 1 liter of D5W to run at 250 mL/hour in adults or twice the maintenance fluid rate in children)
47
Q

Tricyclic antidepressant poisoning: treatment of gastrointestinal issues

A

Administer activated charcoal if patient presents within 2 hours of ingestion (1 g/kg. maximum dose 50 g)

48
Q

Tricyclic antidepressant poisoning: treatment of seizures

A

Benzodiazepine

(do not treat with phenytoin)

49
Q

Tranylcypromine predominantly an irreversible inhibitor of _____, but also irreversibly inhibits ____to a degree; It also appears to block reuptake of ______ (2).

A
  • MAO A
  • MAO B
  • erotonin and catecholamines
50
Q

Tranylcypromine: drug interactions (2)

A
  1. interact with sympathomimetics → hypertensive crisis
  2. interact with serotonin syndrome medications → serotonin syndrome
51
Q

Phenelzine irreversibly inhibits _____(2).

A
  1. MAO A
  2. MAO B
52
Q

Phenelzine side effects (3)

A
  1. Weight gain
  2. Sedation
  3. Sexual dysfunction

(rarely hepatotoxicity, all MAO-Is cause sexual dysfunction, except for selegiline)

53
Q

All MAO-Is cause sexual dysfunction, except for ______.

A

Selegiline

54
Q

Selegiline mechanism of action

A

Selective MAO B inhibitor; non-selective at higher doses

55
Q

EMSAM is FDSA approved for use in the treatment of depression. Also available in ______

A

sublingual forms that bypass both gut and liver metabolism

(this is a form of selegeline; which also comes as a transdermal patch)

Behavioral Medicine (35 decks)

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