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Behavioral Medicine > Anti-Depressants Wolters > Flashcards

Anti-Depressants Wolters Flashcards

1
Q

What is the monoamine hypothesis, what are monoamines, and what drug helped make this conclusion?

A

The monoamine hypothesis is that psychological disorders such as depression are due to a deficit of monoamines such as serotonin, norepinephrine, and dopamine. The drug that helps determine this is RESERPINE which depleted monoamine storage in WWII.

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2
Q

What receptors do serotonin, norepinephrine and dopamine go to?

A

Serotonin: sert –> 5-HT
Norepinephrine –> A1 & B1
Dopamine: DAT –> DA

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3
Q

Where are serotonin receptors found in the body what are the effects of said monoamine??

A

90% - GI Tract
CNS - mood and sexual behavior

Cardiovascular- released by platelets for hemostasis

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4
Q

Where are dopamine receptors found in the body what are the effects of said monoamine?

A

CNS: emotion, cognition, memory, reward

Endocrine: regulate prolactin

Cardiovascular: vasoconstriction & dilation

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5
Q

What patterns are found in Parkinson’s and schizophrenia regarding dopamine?

A

decreased levels in Parkinson’s and increased levels in schizophrenia

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6
Q

Where are norepinephrine receptors found in the body and what are the effects of said monoamine?

A

Cardio: a1- vasoconstriction b1- increases heart rate

Fight or flight - less diarrhea

CNS: concentration and alertness

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7
Q

What monoamine is best in treating septic shock?

A

norepinephrine

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8
Q

What 2 general classes should be used as initial therapy in treating depression and what 6 specific antidpresseion should also first be useD?

A

SSRIs
SNRIs

bupropion
mirtazapine
vortioxetine
trazodone
vilazodone
nefazodone
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9
Q

in what time frame should a patient expect for their anti-depressant to start working?

What other important details might you want to discuss with a patient regarding using anti-depressants?

A

4-8 wks
only 60-70% of patients achieve remission

Med-changes such as beta-blockers will make you feel crappy and depressed

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10
Q

What are the 6 SSRI’s you need to know?

A 
Fluoxetine - Prozac 
Sertraline - Zoloft 
Paroxetine - Paxil 
Citalopram - Celexa 
Excitalopram - Lexapro
Fluvoxamine - Luvox
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11
Q

What 3 major side effects are noted with the SSRI paroxetine, commonly known as Paxil?

A

Sedation, anticholinergic, hyponatremia

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12
Q

What SSRI is an S-Isomer of citalopram and has less side effects and better efficacy?

A

Escitalopram - Lexapro

SSRI

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13
Q

What drug class can help perimenopausal women?

A

SSRIs

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14
Q

What SLUDGE-M characteristics make up cholinergic drugs?

A 
Salivation
Lacrimation
Urination
Diarrhea
GI cramping
Emesis
Miosis
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15
Q

What SLUDGE-M characteristics make up anti-cholinergic drugs?

A 
Dry Mouth 
Dry Eyes
Retention
Constipation
Mydriasis
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16
Q

What 2 drugs are significant is causing QT prolongation and what are the red flags and things to note about QT prolongation?

A

citalipram/escitalipram

hypokalemia and magnesia can cause this

and QTc >500msec is cause for concern

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17
Q

What antibiotic has potential to cause serotonin syndrome in patients taking SSRIs

A

Linezolid which covers MRSA

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18
Q

What is the drug interaction between fluoxetine and clopidogrel?

A

Fluoxetine inhibits clopidorel ??

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19
Q

What are the 2 main SNRIs we need to know?

A

Venlafaxine - Effexor

Duloxetine - Cymbalta

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20
Q

What class of anti-depressants has a significant side effects of increasing blood pressure?

A

SNRIs

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21
Q

What is a CYP1A2 inhibitor that interacts with Ciprofloxacin?

A

Duloxetine

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22
Q

What SNRI is mostly used for chronic muscle pain?

A

duloxetine

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23
Q

Buproprion

MOA
use when….
Side effects

Do Not Use With!!!

A

Wellbutrin

Has action at Dopamine and norepinephrine REUPTAKE

used after SSRIs fail

increased risk of seizures
Weight Loss
Improves sexual dysfunction

Use in smoking cessation

Do not use with MAOIs - hypertensive crisis

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24
Q

What are the 5 other SNRI antidepressants we need to know?

A 
Mirtazapine
Vortioxetine 
Trazadone 
Nefazodone
Vilazodone
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25
Q

Mirtazapine

MOA
S/e

A

Increase NE and 5HT in synapse

Acts like SNRI

S/e: Pronounced sedation, weight gain

Great for depressed grandmas who cannot sleep and are too skinny

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26
Q

Vortioxetine

A

Inhibits serotonin reuptake

“Improves cognition”

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27
Q

Trazadone

A

Inhibits serotonin reuptake

Can cause orthostatic hypertension, sedation, used for insomnia and risk for prolonged erection

28
Q

Usual dose for Citalopram and it’s brand name

A

20-40 (40 max because BBW QTc prolongation risk)

Celexa

29
Q

Side effects of SSRI

A

GI N/V dry mouth
Perimebipausal women help with hot flashes

CNS, urogential, anticholingetic, etc

30
Q

QT prolongation risk factors

A

Major: medications (don’t give citalobam or escitalopram if QTc>500), hypokalemia magnesmia

Others: genetic LVH heart disease age> 65 female bradycardia

31
Q

Inhibitors of Tamoxifen

A

Fluoxetine, paroxetine

32
Q

Unique Side effect SNRI

A

Increased blood pressure avoid with uncontrolled HTN

Also Duloxetine has anticholingeric symptoms (anti SLUDGEM)

33
Q

Drug interaction of Duloxetine

A

CYP1A2 inhibitors - Ciprofloxacin/fluvoxamine

CYP2D6 inhibitors (like paroxetine)

34
Q

Bupropion brand name , facts, side effects

A

Wellbutrin (2nd choice - after failure of SSRI), stops norepinephrine and dopamine
SE: increased risk Sz, use in smoking cessation

35
Q

Mirtazapine función

A

Pre-synaptic alpha 2 antagonist (increase NE and 5HT)

Sedation used for insomnia, weight gain

36
Q

Trazodone function

A

Insomnia (use for)

37
Q

Nefazodone BBW MOA

A

Liver toxicity BBW, potent CYP3A4 inhibitor

38
Q

Trycyclic antidepressants side effects

A

Anticholenrgic (esp Amitriptyline)
Narrow therapeutic index (Amitriptyline 4x critical value: 125-250 Crit=500)
GI

39
Q

TCA overdose management

A

Sodium bicarbonate

40
Q

MAOi side effect

A 
Hypertensive crisis 
(Also orthostatic hypotension, CNS, weight gain)
41
Q

Serotonin Syndrome symptoms that differentiate it

A

Agitation, diaphoresis, increased bowel sounds (diarrhea, N/V)

42
Q

Serotonin syndrome management the serotonin antagonist

A

Cyproheptadine: not IV, emergent NG tube

43
Q

Trend of remission rates based on treatment

A

Gradual downward trend as you switch agents

44
Q

Geriatric Beer’s list problems and drugs that cause them

A

Anti-cholinergic: TCA, paroxetine
Chronic seizures: bupropion
SIADH: SSRI (fluoxetine, paroxetine)

Constipation and urinary retention are common side effect

45
Q

Fluoxetine

A

Prozac

46
Q

Special side effect of fluoxetine

A

Hyponatremia

47
Q

What specific drug interaction was indicated with fluoxetine/Prozac?

A

With clopidogrel

Fluoxetine is a cyp2c19 inhibitor and clopidogrel is a prodrug that needs activated so clopidogrel won’t work w lol

48
Q

What to drugs can increase the potential risk of breast cancer relapse?

A

Peroxetine aka Paxil and fluoxetine aka Prozac

49
Q

What second-generation antipsychotics are FDA approved as adjuncts for resistant depression?

A

Aripiprazole brevipiprazol and quetiapine

50
Q

What to second-generation antipsychotics or after he proved for treatment of resistant depression

A

Olanzapine and fluoxetine

51
Q

What antidepressant medications are on the beers list?

A

All anti-cholinergics such as TCAs and paroxetine

Bupropion

SSRIs such as fluoxetine and paroxetine

52
Q

Sertraline

A

Zoloft

53
Q

Paroxetine

A

Paxil

54
Q

What are specific side effects for PAROXETINE?

A

It is an SSRI so they will have complaints possibly of nausea vomiting dry mouth, suicidal ideation

Specifically: sedation , anti-cholinergic side effects, hyponatremia

55
Q

Citalopram

A

Celexa

56
Q

Dosing of citalopram/Celexa?

A

The max dose is 40 mg per day due to the blackbox warning risk of QTC prolongation

57
Q

Escitalopram

A

Lexapro

58
Q

What SSRI is only indicated for OCD?

A

Fluvoxamine/Luvox

59
Q

Luvox them in

A

Luvox

60
Q

What SSRIs need to be monitored for QTC prolongation? 2

A

Citalopram/ceLexa

EsCitalopram/Lexapro

61
Q

Venlafaxine

A

SNR I

Effexor

62
Q

Duloxetine

A

Snri

Cymbalta

63
Q

Which SNR I needs to be monitored for intake ant cholenergic symptoms and liver toxicity?

A

Duloxetine/cymbalta

64
Q

What SNR I is mostly used for chronic musculoskeletal pain?

A

Duloxetine/Cymbalta

65
Q

What SNR I is used of the label for diabetic neuropathy?

A

Venlafaxine

Behavioral Medicine (9 decks)

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