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Pharmacology Exam III > Anti-Depressants > Flashcards

Anti-Depressants Flashcards

1
Q

Two Primary Types of Depression Classification

Differentiation?

A

MDD or Unipolar

Bipolar - has manic episodes

Key is MANIC EPISODES

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2
Q

Chemical Anti-Depressant Important Considerations (3)

A

Ineffective in 30% of patient population

Therapeutic response takes weeks to months

Side effects can limit dosing - elderly are more likely to experience adverse effects

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3
Q

Two Hypotheses of Depression

A

Monoamine/Biogenic Amine

Neurotrophic

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4
Q

Monoamine/Biogenic Amine Hypothesis

A

Depression may be related to DEFICIENCY OF 5-HT, NE, and DA

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5
Q

Neurotrophic Hypothesis

A

Loss of NEUROTROPHIC GROWTH FACTORS

BDNF - “brain fertilizer”

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6
Q

MAOI Mechanism of Action

A

block MAO enzyme (MAO a or b)

increases synaptic availability of NE AND 5-HT

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7
Q

MAO-A targets

MAO-B targets

A

A - Tyramine, NE, 5-HT, DA

B - DA

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8
Q

Phenelzine

A

MAO-A and B inhibitor

irreversible

WORSE SIDE EFFECT PROFILE

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9
Q

Tranylcypromine

A

MAO-A and B inhibitor

Irreversible

WORSE SIDE EFFECT PROFILE

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10
Q

Selegiline

Dose dependent uses?

A

MAO-B Inhibitor (low dose)
Non-selective (High dose)

Low dose - Parkinsons

High dose - Antidepressant

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11
Q

MAOI Most common side effects

A

ORTHOSTATIC HYPOTENSION - alpha-1 receptor inhibition in brainstem

WEIGHT GAIN

Irreversible MAOi’s have HIGHEST RATE OF SEXUAL DYSFUNCTION

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12
Q

Food Interactions

A

Tyramine

HYPERTENSIVE CRISIS

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13
Q

Tricyclic Antidepressant Important clinical use

A

CHRONIC PAIN CONDITIONS

tricyclic - three ring structure

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14
Q

Tricyclic Antidepressant MOA

A

block reuptake of 5-HT AND NE

inhibits SERT and NET

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15
Q

Imipramine - drug type? MOA? Important characteristic?

A

inhibits SERT and NET

PROTOTYPE TCA

has some anti-cholinergic effect

Used to treat enuresis

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16
Q

Desipramine - drug type? MOA? Important characteristic?

A

TCA

inhibits SERT and NET

More effective at treating neuropathic pain

17
Q

Amitriptyline - drug type? MOA? Important characteristic?

A

TCA

inhibits SERT and NET

Sedative effects

18
Q

Side Effects of TCA’s

A

Hip breakers in elderly patients - ORTHOSTATIC HYPOTENSIONS

DELIRIUM in elderly more pronounced

CARDIAC TOXICITY

OVERDOSE - convulsions, coma, cardiac arrythmias

19
Q

TCA Drug Interactions

A

Do not use with MAOI’S OR SSRI’S

20
Q

6 Available SSRI’s

A 
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
21
Q

SSRI’s MOA

A

selectively inhibit SERT and block reuptake of 5-HT into presynaptic terminal

22
Q

SSRI’s Side Effects

A

Short term - NAUSEA, GI UPSET, DIARRHEA

Long term - SEXUAL DYSFUNCTION

LOW RISK OF OVERDOSE

23
Q

SSRI’s Drug Interaction

A

SEROTONIN SYNDROME if used with other anti-depressants

24
Q

Serotonin Syndrome

A

Rare side effect d/t LONG HALF LIFE

Need to ALLOW TIME FOR DRUGS TO CLEAR BEFORE MAKING SWITCHES

25
Q

Fluoxetine and Serotonin Syndrome avoidance

A

Discontinued for 4-5 WEEKS prior to using other anti-depressants

(others are 2 weeks)

26
Q

Discontinuation Syndrome

A

discontinuation of SHORT HALF-LIFE SSRI’s

Dizziness, paresthesias, anxiety

only occurs in some patients

27
Q

Venlafaxine - drug type? MOA?

Clinical?

A

SNRI

inhibit BOTH SERT AND NET

severe depression

28
Q

Duloxetine - drug type? MOA?

Clinical?

A

SNRI

inhibits BOTH SERT AND NET

increasing use for CHRONIC PAIN

29
Q

Trazodone - drug type? MOA?

Clinical?

Side effect?

A

Atypical anti-depressant

BLOCKS 5-HT2 AND H1

unlabeled hypnotic

Priapism - prolonged painful erections - peripheral alpha-1 block

30
Q

Bupropion - drug type? MOA?

Clinical?

A

Atypical Antidepressant

BLOCKS NE AND DA REUPTAKE

SMOKING CESSATION

31
Q

Mirtazapine - drug type? MOA?

A

atypical antidepressant

Blocks pre-synaptic alpha-2 - increases 5-HT and NE release

32
Q

Anti-depressant Treatment Considerations

A

2-4 weeks for therapeutic effect

SHOULD NOT COMBINE DIFFERENT CLASSES

33
Q

Pharmacokinetic Considerations

A

most INHIBIT CYP ISOENZYMES - 2D6 and 3A4

Never combine TCA’S AND SSRI’S –> SEROTONIN SYNDROME AND TCA TOXICITY

34
Q

Bipolar Disorder Treatment

Main drug?

Drugs used to treat acute mania?

A

Lithium - mood stabilizing agent - MAINTENANCE

Valproic acid and Carbamazepine - anti-convulsants

35
Q

Lithium Side Effects

A

Tremor

Hypothyroidism

Nephrogenic diabetes insipidus

Skin reactions

36
Q

Lithium Drug Interactions

A

THIAZIDES AND LOOP DIURETICS

diminishes Li clearance - can cause toxicity

Pharmacology Exam III (11 decks)

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