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Psychiatry > Anti-Depressants > Flashcards

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
Q

Benefits of bupropion (Wellbutrin)?

A

lack of sexual side effects vs SSRIs

some efficacy in adult ADHD

26
Q

Side effects and contraindications of bupropion (Wellbutrin)?

A

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
Q

Trazodone (Desyrel) mechanism?

A

Serotonin receptor antagonist and serotonin reuptake inhibitor

28
Q

Trazodone (Desyrel) is used for…

A

refractory major depression, major depression with anxiety, insomnia (secondary to its sedative effects)

do not have the sexual side effects of SSRIs

29
Q

Trazodone (Desyrel) specific side effects?

A

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
Q

Mirtazapine (Remeron) is more useful for what population with depression?

A

elderly (helps with sleep and appetite)

refractory major depression (especially those who need to gain weight)

31
Q

Mirtazapine (Remeron) side effects?

A

sedation, WEIGHT GAIN, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis

32
Q

TCAs mechanism?

A

inhibit reuptake of NE and serotonin

33
Q

Why are TCAs rarely used as first-line?

A

higher incidence of side effects, inc monitoring of dosing, can be lethal in overdose

34
Q

What is the difference between tertiary amines and secondary amines among the TCAs?

A

tertiary amines are highly anticholinergic–>more sedating, greater lethality in overdose

35
Q

Amitriptyline (Elavil), Imipramine (Tofranil), Clomipramine (Anafranil), Doxepin (Sinequan) are tertiary or secondary amine TCAs?

A

tertiary

36
Q

Nortriptyline (Pamelor, Aventyl) and Desipramine (Norpramin) are tertiary or secondary amine TCAs?

A

secondary

37
Q

Amitriptyline (Elavil) are used for depression as well as…

A

chronic pain, migraines, insomnia

38
Q

Imipramine (Tofranil) is used for depression as well as…

A

enuresis and panic disorder

also has a injectable IM form

39
Q

Clomipramine (Anafranil) is used for depression as well as…

A

OCD

40
Q

Doxepin (Sinequan) is used for depression as well as…

A

chronic pain, potentially as a sleep aid in low doses

41
Q

Nortriptyline (Pamelor, Aventyl) is used for depression as well as…

A

chronic pain

42
Q

Which TCA is least likely to cause orthostatic hypotension?

A

Nortriptyline

43
Q

Which TCA is least anticholinergic?

A

Desipramine (Norpramin)–>more activating, least sedating

44
Q

How much of a TCA can be lethal in overdose?

A

1 week supply (1-2 g)

45
Q

What is the treatment for TCA overdose?

A

IV sodium bicarbonate

46
Q

Amoxapine (Asendin) and Maprotiline (Ludiomil) are what type of antidepressants?

A

tetracyclic antidepressants

47
Q

Amoxapine (Asendin) specific side effects?

A

metabolite of antipsychotic loxapine

may cause EPS and has similar side effect profile to typical antipsychotics

48
Q

Maprotiline (Ludiomil) specific side effects?

A

higher rates of seizure, arrhythmia, and fatality on overdose

49
Q

Why do TCAs have many drug interactions?

A

highly protein bound and lipid soluble

50
Q

TCAs 3Cs in major complications?

A

Cardiotoxicity
Convulsions
Coma

51
Q

List TCA side effects:

A
  • 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
Q

Symptoms of TCA overdose?

A

agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures, coma

53
Q

MAOIs mechanism?

A

prevent inactivation of amines such as NE, serotonin, dopamine, and tyramine (intermediate from tyrosine–>NE) by irreversibly inhibiting enzymes MAO-A and -B

54
Q

MAO-A affects what amines? MAO-B?

A

MAO-A serotonin
MAO-B NE/E

both dopamine and tyramine

55
Q

When are MAOIs most effective?

A

refractory depression/atypical depression (hypersomnia, inc appetite, inc sensitivity to interpersonal rejection)

also refractory panic/anxiety disorder

56
Q

Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan) are what group of antidepressants?

Selegiline (Deprenyl), Rasagiline (Azilect)?

A

all are MAOIs

Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan) are non-selective

Selegiline (Deprenyl), Rasagiline (Azilect) are MAO-B inhibitors

57
Q

What two medical emergencies does one worry about with MAOIs?

A

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
Q

List side effects seen with MAOIs

A
  • 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
Q

Which MAOI does not require following the dietary restrictions?

A

Selegiline when used in low doses

must still avoid decongestants, opiates (Demerol) and serotonergic drugs

Psychiatry (7 decks)

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