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Anti-depressants Flashcards

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1
Q

What are the 5 R’s of antidepressant efficacy?

A
  1. Response– 50% or better reduction in symptoms from baseline
  2. Remission– symptom free
  3. Recovery– 2-6 months of remission (no symptoms)
  4. Relapse–return of symptoms after remission but before recovery
  5. Recurrence–return of symptoms after recovery
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2
Q

What are the symptoms of withdrawal from antidepressants?

A 
F- flu like symptoms
I- insomnia
N- nausea
I- imbalance
S- sensory disturbances
H- hyperarousal
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3
Q

Which antidepressant can also be used for nicotine withdrawal?

A

bupropion

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4
Q

Which antidepressant can be used for enuresis

A

imipramine

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5
Q

Which antidepressant can be used for diabetic peripheral neuropathy, fibromyalgia, and chronic msk pain?

A

duloxetine

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6
Q

Which antidepressant can be used for stress incontinence?

A

duloxetine

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7
Q

Which SSRI is only used for OCD?

A

fluvoxamine

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8
Q

MOA SSRI

A

selectively inhibit the pre-synaptic reuptake of serotonin, via the SERT channel

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9
Q

SSRIs

A

Citalopram
escitalopram
fluoxetine
paroxetine
vortioxetine–also partial agonist at 5-HT1b & full agonist at 5-HT1a, full antagonist at 5-HT1d3,7
sertaline
vilazodone–also partial agonist at 5-HT1a

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10
Q

SE of SSRIs

A

sedation or insomnia/agitation/nervousness
sexual dysfunction
weight gain
acute withdrawal reactions

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11
Q

Rare SE of SSRIs, dose dependent

A

QT prolongation
hyponatremia
serotonin syndrome
suicidality

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12
Q

Symptoms of serotonin syndrome

A

sweating, hyperreflexia, akathisia/myoclonus, shivering/termors

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13
Q

What are the distinguishing features of serotonin syndrome vs neuroleptic malignant syndrome?

A

neuroleptic malignant syndrome is caused by dopaminergic agents (antipsychotics)

will have hyporeflexia vs hyper & clonus
will have normal pupils vs dilated
will have normal or decreased bowel sounds vs increased activity

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14
Q

Which SSRI has the most risk of drug-drug interaction

A

fluoxetine

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15
Q

Which SSRIs has the least risk of drug-drug interaction

A

vortioxetine & escitalopram

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16
Q

MOA of SNRIs

A

selectively inhibit the pre-synaptic reuptake of serotonin (SERT) & norepinephrine (NET)

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17
Q

what do tertiary amines TCAs inhibit

A

TCAs are part of SNRIs

inhibit both NE/5HT relatively equally

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18
Q

What do secondary amines TCAs inhibit

A

NE>5-HT

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19
Q

list the tertiary amine TCAs

A

amitriptyline
clomipramine
doxepin
imipramine

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20
Q

list the secondary amine TCAs

A

amoxapine
desipramine
nortriptyline

21
Q

list the other SNRIs

A

desvenlafaxine
duloxetine
venlafaxine
levomilnacipran

22
Q

What 3 other receptors do TCAs have an effect on

A

histamine (H1)
muscarinic
a1 adrenergic

23
Q

What are the 3 key TCA side effects

A
  1. cardiovascular (alpha)–tachy, ortho hypotension, dysrhythmias
  2. anticholinergic (muscarinic)–dry mouth, urinary retention/constipation, blurred vision
  3. CNS (histamine)–sedation/fatigue, dizziness/seizures
24
Q

3 Cs of toxic ingestion of TCAs

A

Coma
Cardiotoxicity (conduction abnormalities)
Convulsions

25
Q

SE of non-TCA SNRIs

A

like SSRIs but with less risk of sexual dysfunction

26
Q

MOA of action of SARAs

A

2 agents block SERT but also block post-synaptic a1 receptors on noradrenergic neurons & post-synaptic 5-HT2 receptors
–trazadone & nefazodone

1 agent blocks pre-synaptic a2 receptors on noradrenergic & serotonergic neurons & blocks post-synaptic 5-HT2/3 receptors
–miratazapine

27
Q

SE of SARAs

A 
sedation (most with trazadone/mirtazapine)
ortho hypotension (most with trazadone)
weight gain (most with mirtazapine)
28
Q

MOA of NDRIs

A

selectively inhibits pre-synaptic reuptake of norepinephrine (NET) and dopamine (DAT)

29
Q

Which SNRI also blocks dopamine

A

amoxapine

30
Q

what is the only NDRI called

A

bupropion

31
Q

which 2 drugs mess with dopamine

A

bupropion (NDRI) and amoxapine (SNRI)

32
Q

SE of NDRIs

A

agitation/insomnia

seizures (dose dependent, or those at risk)!!

33
Q

MOA of MAOIs

A

inhibition of MAO (a and b subtypes) increase levels of monoamines in neuronal vesicles & increase amounts of NE, 5-HT, and DA released

–all are nonselective except selegiline (B selective)

34
Q

List the MAOIs

A

isocarboxazidp
phenelzine
selegiline
tranylcypromine

35
Q

SE of MAOIs

A

orthostatic hypotension
sexual dysfunction
weight gain
insomnia/agitation/nervousness

36
Q

Drug interactions of MAOIs

A

any 5-HT/NE affecting drugs–SSRIs/TCAs/SNRIs, amphetamines, anti-hypertensives
—2 wk washout period (whatever that means)
risk of serotonin syndrome
risk of hypertensive crisis

37
Q

Risk of hypertensive crisis in MAOIs increased with

A

increased tyramine in GI tract may induce significant catecholamine release
–least risk with selegiline

tyramine containing foods: 
aged cheeses
soy beans
fermented & pickled meats, fish
processed, pickled or cured meats
tap beer, red wine
over-ripe fruits
soy/fish/shrimp sauces
38
Q

s/s of hypertensive crisis

A 
severe headache
nausea/vomiting
sweating/severe anxiety
nosebleeds
tachycardia
CP
changes in vision
SOB
confusion
39
Q

MOA & administration of esketamine

A

NMDA-receptor (glutamate) antagonist

  • -indicated for treatment resistant depression in conjunction with ongoing antidepressant therapy
  • -nasal admin
  • -pt observed for 2 hours post dose
40
Q

MOA & administration of brexanolone

A

GABAa receptor positive allosteric modulator

  • -indicated for post-partum depression
  • -60 hr IV administration
41
Q

List the anti-seizure agents used as mood stabilizers

A

carbamazepine
lamotrigine
divalproex/valproic acid

42
Q

MOA of lithium

A

neurotransmitter modulation– inhibits dopamine neurotransmission
interferes with both stimulatory & inhibitory G-proteins by keeping them in inactive state
–downregulates NMDA receptor
–increases GABA levels in CSF
–inhibits PKC, MARCKS, GSK-3

43
Q

SE of lithium

A

polyuria–looks like nephrogenic diabetes insipidus
–lithium handled by kidneys similar to Na/K, competes with Na for kidney reabsorption

also, tremor, mental confusion/dizziness/sedations. thyroid goiter, leukocytosis, seizures, serotonin syn

44
Q

Drug interactions of Lithium

A

diuretics (esp. thiazides)
ACEIs
NSAIDs

45
Q

Indications for lithium

A
  • -acute & maintenance tx of mania/bipolar I disorder
  • -augmentation in unipolar depression
  • -Off label: reduced risk of suicide in mood disorders
46
Q

What is valproic acid/divalproex used for

A

acute bipolar I (with & w/o psychotic features)

47
Q

What is lamotrigine used for

A

maintenance of bipolar I & II

48
Q

What is Carbamazepine used for

A

acute & mainenance tx of acute mania & mixed episodes of bipolar I
–CYP450 inducer!

Psych (8 decks)

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