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Anti-Depressants Flashcards

1
Q

SSRI mechanism

A

inhibit presynaptic serotonin pumps –> increase availability of serotonin in synaptic cleft

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2
Q

Which SSRI has the longest half-life?

A

Fluoxetine (Prozac)

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3
Q

Which SSRI can be used in pregnancy and approved for use in children?

A

Fluoxetine (Prozac)

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4
Q

Fluoxetine (Prozac) specific concerns

A
  • more common sleep changes and anxiety

- can elevate levels of neuroleptics, leading to inc side effects

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5
Q

Which SSRI has the highest risk for GI disturbances?

A

Sertraline (Zoloft)

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6
Q

Which SSRI is highly protein bound?

A

Proxetine (Paxil)

  • causes several drug interactions
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7
Q

Paroxetine (Paxil) half-life?

A

Short–>leading to withdrawal phenomena if not taken consistently

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8
Q

Paroxetine (Paxil) specific side effects?

A

more anticholinergic effects (sedation, constipation, weight gain)

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9
Q

Which SSRI is the only one approved for OCD?

A

Fluvoxamine (Luvox)

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10
Q

Fluvoxamine (Luvox) common side effects?

A

Nausea and vomiting

Also has a lot of drug interactions

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11
Q

Which SSRI has the fewest drug-drug interactions?

A

Citalopram (Celexa)

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12
Q

Which SSRI has possibly fewer sexual side effects?

A

Citalopram (Celexa)

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13
Q

Compare escitalopram (Lexapro) and citalopram (Celexa)

A

levo-enantiomer

similar efficacy with possibly fewer side effects
more expensive!

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14
Q

In comparison to TCAs and MAOIs, what are the benefits to using an SSRI?

A
  • serotonin selectivity (do not act on HAM)–>fewer side effects
  • much safer in overdose
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15
Q

List side effects of SSRIs

A
  • sexual dysfunction (dec interest, anorgasmia, delayed ejaculation)
  • GI disturbance (nausea, diarrhea)
  • insomnia, vivid dreams
  • headache
  • anorexia, weight loss
  • restlessness (akathisia-like state at initiation and termination)
  • seizures
  • BLACK BOX WARNING: inc suicidal thinking and behavior especially in children/adolescents
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16
Q

Why should SSRIs not be used for at least 2 weeks prior to or after MAOIs?

A

Serotonin syndrome: fever, diaphoresis, shivering, tachycardia, HTN, delirium, neuromuscular excitability, hyperreflexia, potentially death

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17
Q

What drugs may help the sexual side effects of SSRIs?

A

buproprion, changing to a non-SSRI antidepressant, adding sildenafil for men

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18
Q

How do SSRIs interact with warfarin?

A

can inc levels, so must monitor!

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19
Q

Venlafaxine (Effexor) and Duloxetine (Cymbalta) are what type of antidepressant?

A

SNRIs

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20
Q

Venlafaxine (Effexor) is used for depression as well as…

A

anxiety disorders like GAD, some use in ADHD

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21
Q

Venlafaxine (Effexor) specific side effects?

A

similar to SSRIs

can also inc bp (do not use in patients with untreated or labile bp)

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22
Q

Duloxetine (Cymbalta) is used for depression as well as…

A

neuropathic pain or fibromyalgia

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23
Q

Duloxetine (Cymbalta) specific side effects?

A

similar to SSRIs, but more dry mouth and constipation (NE effects)

may be more liver side effects if have liver disease or heavy alc use

expensive!

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24
Q

Bupropion (Wellbutrin) mechanism?

A

NE-Dopamine reuptake inhibitor

25
Benefits of bupropion (Wellbutrin)?
lack of sexual side effects vs SSRIs | some efficacy in adult ADHD
26
Side effects and contraindications of bupropion (Wellbutrin)?
inc risk of seizures and psychosis at high doses; inc anxiety in some contraindicated in patients with seizure (lower seizure threshold) or active eating disorders or those currently on an MAOI
27
Trazodone (Desyrel) mechanism?
Serotonin receptor antagonist and serotonin reuptake inhibitor
28
Trazodone (Desyrel) is used for...
refractory major depression, major depression with anxiety, insomnia (secondary to its sedative effects) do not have the sexual side effects of SSRIs
29
Trazodone (Desyrel) specific side effects?
nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation, and priapism (painful erect penis that will not return to flaccid state... aka "trazondone will raise the bone")
30
Mirtazapine (Remeron) is more useful for what population with depression?
elderly (helps with sleep and appetite) | refractory major depression (especially those who need to gain weight)
31
Mirtazapine (Remeron) side effects?
sedation, WEIGHT GAIN, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis
32
TCAs mechanism?
inhibit reuptake of NE and serotonin
33
Why are TCAs rarely used as first-line?
higher incidence of side effects, inc monitoring of dosing, can be lethal in overdose
34
What is the difference between tertiary amines and secondary amines among the TCAs?
tertiary amines are highly anticholinergic-->more sedating, greater lethality in overdose
35
Amitriptyline (Elavil), Imipramine (Tofranil), Clomipramine (Anafranil), Doxepin (Sinequan) are tertiary or secondary amine TCAs?
tertiary
36
Nortriptyline (Pamelor, Aventyl) and Desipramine (Norpramin) are tertiary or secondary amine TCAs?
secondary
37
Amitriptyline (Elavil) are used for depression as well as...
chronic pain, migraines, insomnia
38
Imipramine (Tofranil) is used for depression as well as...
enuresis and panic disorder also has a injectable IM form
39
Clomipramine (Anafranil) is used for depression as well as...
OCD
40
Doxepin (Sinequan) is used for depression as well as...
chronic pain, potentially as a sleep aid in low doses
41
Nortriptyline (Pamelor, Aventyl) is used for depression as well as...
chronic pain
42
Which TCA is least likely to cause orthostatic hypotension?
Nortriptyline
43
Which TCA is least anticholinergic?
Desipramine (Norpramin)-->more activating, least sedating
44
How much of a TCA can be lethal in overdose?
1 week supply (1-2 g)
45
What is the treatment for TCA overdose?
IV sodium bicarbonate
46
Amoxapine (Asendin) and Maprotiline (Ludiomil) are what type of antidepressants?
tetracyclic antidepressants
47
Amoxapine (Asendin) specific side effects?
metabolite of antipsychotic loxapine may cause EPS and has similar side effect profile to typical antipsychotics
48
Maprotiline (Ludiomil) specific side effects?
higher rates of seizure, arrhythmia, and fatality on overdose
49
Why do TCAs have many drug interactions?
highly protein bound and lipid soluble
50
TCAs 3Cs in major complications?
Cardiotoxicity Convulsions Coma
51
List TCA side effects:
- HAM (antihistamine- sedation; antiadrenergic- cardiovascular such as orthostatic hypotension, dizziness, reflex tachy, arrhythmias, widening QRS/OT/PR; antimuscarinic/anticholinergic: dry mouth, constipation, urinary retention, blurred vision, tacky, exacerbation of narrow angle glaucoma) - weight gain - seizures - serotonergic effects (erectile/ejaculatory dysfunc, anorgasmia)
52
Symptoms of TCA overdose?
agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures, coma
53
MAOIs mechanism?
prevent inactivation of amines such as NE, serotonin, dopamine, and tyramine (intermediate from tyrosine-->NE) by irreversibly inhibiting enzymes MAO-A and -B
54
MAO-A affects what amines? MAO-B?
MAO-A serotonin MAO-B NE/E both dopamine and tyramine
55
When are MAOIs most effective?
refractory depression/atypical depression (hypersomnia, inc appetite, inc sensitivity to interpersonal rejection) also refractory panic/anxiety disorder
56
Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan) are what group of antidepressants? Selegiline (Deprenyl), Rasagiline (Azilect)?
all are MAOIs Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan) are non-selective Selegiline (Deprenyl), Rasagiline (Azilect) are MAO-B inhibitors
57
What two medical emergencies does one worry about with MAOIs?
Serotonin syndrome *wait 2 weeks before switching from SSRI to MAOI and at least 5-6 weeks with fluoxetine* Hypertensive crisis, when taken with tyramine-rich foods or sympathomimetics
58
List side effects seen with MAOIs
- orthostatic hypotension - drowsiness - weight gain - sexual dysfunc - dry mouth - sleep dysfunc - if have pyridoxine deficiency-->paresthesias (treat with B6) - rarely, liver toxicity, seizures, coma
59
Which MAOI does not require following the dietary restrictions?
Selegiline when used in low doses | must still avoid decongestants, opiates (Demerol) and serotonergic drugs

Psychiatry (7 decks)

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