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Block 6 > Antidepressant Drugs > Flashcards

Antidepressant Drugs Flashcards

1
Q

NT involved in MDD

A

serotonin
NE
DA

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2
Q

brain structures involved in MDD and their roles

A

amygdala- higher activity

hippocampus- smaller = issues with long term memory and recollection

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3
Q

effects of antidepressants

A

increase in libido, concentration, energy, mood

decrease in anhedonia, hopelessness

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4
Q

risk of using antidepressants in bipolar disorder

A

cause switch to mania

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5
Q

antidepressants best for bipolar disorder

A

SSRI

bupropion

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6
Q

4 theories of how antidepressants work

A

monoamine hypothesis
permissive hypothesis
dysregulation
post synaptic receptor sensitivity hypothesis

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7
Q

monoamine hypothesis

A

decrease 5HT and DA synaptic concentrations

*doesn’t explain lag in effect

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8
Q

permissive hypothesis

A

5HT- mood expression
NE- mood type
depresssed- low 5HT and NE
mania- low 5HT and high NE

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9
Q

dysregulation

A

NT are out of whack leading to pre/post changes

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10
Q

post synaptic receptor sensitivity hypothesis

A

up regulation of receptors when monoamines are low

down regulation of receptors when monoamines are high/normal

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11
Q

3 ways of achieving balance of NT

A

enzyme inhibition
reuptake inhibition
receptor blockage

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12
Q

class using enzyme inhibition

A

MAOI

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13
Q

class using reuptake inhibition

A 
TCA
SSRI
SNRI
vilazodone
bupropion
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14
Q

class using receptor blockage

A

mirtazapine
trazodone
nefazodone

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15
Q

first line treatment for depression

A

SSRI

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16
Q

Drugs that inhibit SERT

A

SSRI
SNRI
TCA

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17
Q

SSRI advantages

A

few side effects
few interactions
safe
once daily dosing

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18
Q

SSRI in order of decreasing half life

A 
fluoxetine
sertraline
citalopram
escitolpram
paroxetine
fluvoxamine
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19
Q

fluoxetine

A

SSRI
active metabolite- norfluoxetine
VERY long half life (1-3 days)
2D6 inhibitor

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20
Q

sertraline

A

SSRI
active metabolite
2D6 substrate

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21
Q

citalopram

A

SSRI

2D6 substrate

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22
Q

paroxetine

A

SSRI

2D6 inhibitor

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23
Q

escitolpram

A

2D6 inhibitor

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24
Q

fluvosamine

A

SSRI
shortest half life (1d)
cyp inhibitor
used mainly for OCD

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25
Q

SSRI with 2D6 interactions

A

fluvoxamine
fluoxetine
sertraline
citalopram

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26
Q

SSRI drug interactions

A 
clozapine
fentanyl
hydrocodone
methadone
tamoxifen
tramadol
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27
Q

SSRI ADR

A 
NVD
anorexia
delayed ejaculation
anorgasmia
insomina/sedation
temp increase in anxiety
headache
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28
Q

SSRI major drug interactions

A

MAOI

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29
Q

serotonin syndrome

A 
too high serotonin from combo of drugs that increase serotonin
autonomic instability
rigidity
fever
stupor
death
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30
Q

treatment of serotonin syndrome

A 
stop SSRI
benzodiazepines
short acting drugs for BP control
non depolarizing neuromuscular blocker
intubation
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31
Q

SNRI MAO

A

SERT and NET inhibition

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32
Q

SNRI drugs

A

venlafaxine
desvenlafaxine
duloxetine
milnacipran

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33
Q

venlafaxine dose info

A 
SNRI
prodrug- active form desvenlafaxine
dose dependent effects
low dose- SERT inhibition
mid dose- NET inhibition
high dose- DA reuptake inhibition
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34
Q

ADR venlafaxine

A

HTN

sweating

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35
Q

duloxetine dose

A

SNRI

low dose- SERT and NET inhibition

36
Q

duloxetine use

A

SNRI
diabetic peripheral neuropathy
fibromyalgia
pain

37
Q

milnacipran use

A

SNRI

prodrug for fibromyalgia

38
Q

venlafaxine

A

SNRI prodrug

39
Q

duloxetine

A

SNRI

40
Q

milnacipram

A

SNRI prodrug

41
Q

milnacipran use

A

fibromyalgia

42
Q

levomilnacipran

A

SNRI

active form of milnacipran

43
Q

levomilnacipran use

A

antidepressant

44
Q

MAOI drugs

A

phenelzine
tranylcypramine
selegiline

45
Q

phenelzine selectivity

A

MAO nonselective

46
Q

tranylcypramine selectivity

A

MAO nonselective

47
Q

selegiline selectivity

A

MAO B

48
Q

selegiline use

A

low dose transdermal for parkinson’s

49
Q

MAOI ADR

A

tyramine effect
serotonin syndrome
orthostatic hypotension

50
Q

tyramine effect

A

increased circulating tyramine increases NE levels which leads to HTN crisis

51
Q

symptoms of tyramine effect

A 
bad headache
neck pain
sweating
HTN
intracerebral hemorrhage
52
Q

MAOI drug interactions

A

linezolid- antibiotic

anything that increases serotonin/NE

53
Q

TCA

A

tricyclic antidepressants

54
Q

TCA MOA

A

SERT and NET inhibition

55
Q

other receptors affected by TCA

A

histamine H1
alpha
muscarinic

56
Q

effects of TCA via histamine receptor

A

sedation
weight gain
hypotension

57
Q

effects of TCA alpha receptor

A

orthostatic hypotension
dizziness
reflex tachycardia

58
Q

effects of TCA muscarinic

A 
dry mouth
blurry vision
constipation
urinary retention
dizziness
delirum
59
Q

effects of TCA overdose

A

respiratory depression

arrhythmia

60
Q

TCA secondary amines

A

desipramine

nortriptyline

61
Q

desipramine

A

TCA secondary amines

62
Q

nortriptyline

A

TCA secondary amine

63
Q

TCA tertiary amines

A

amitriptyline
imipramine
clomipramine

64
Q

amitryptyline

A

TCA tertiary amine

65
Q

imipraminne

A

TCA tertiary amine

66
Q

clomipramine

A

TCA tertiary amine

67
Q

SARI

A

serotonin antagonist and reuptake inhibitor

68
Q

SARI drugs

A

trazodone

nefazodone

69
Q

trazodone receptors

A

5HT2a*
5HT2c
alpha1

70
Q

high dose trazodone

A

5HT2a + SERT for depression

71
Q

low dose trazodone

A

5HT2a for insomnia, PTDS

72
Q

benefits of trazodone

A

avoids:
sexual dysfunction
sedation
anxiety

73
Q

ADR of trazodone

A

sedation
dizziness
rare priapism

74
Q

nefazodone receptors

A

5HT2a, 5HT1a, alpha1, NET inhibition

75
Q

ADR nefazodone

A

hepatotoxic

cyp inhibitor

76
Q

vilazodone MOA

A

SERT inhibition

5HT1a partial agoinst

77
Q

bupropion MOA

A

DA and NE reuptake inhibitor

AChN antagoinst

78
Q

bupropion use

A

with SSRI for sexual dysfunction

smoking cessation

79
Q

hydroxybupropion

A

active metabolite of bupropion similar to amphetamine

80
Q

effects of bupropion

A

agitation
anxiety
restlessnes

81
Q

use of bupropion

A

psychomotive retarded depression
hypersomina
if concerned about weight gain

82
Q

bupropion ADR

A

insomnia
constipation
dry mouth
seizures

83
Q

contraindications bupropion

A

eating disorders

epilepsy

84
Q

NaSSA

A

noradrenergic and specific serotonergic antidepressant

85
Q

mirtazapine

A

NaSSA

86
Q

mirtazapine MOa

A

alpha2 antagoinst- increase 5HT and NE release
5HT2/3 antagoinst- blocks DA and NE release in reward area
H1 antagonist=- sedation, weight gain

87
Q

drugs with minimal interactions

A

sertraline
escitalopram
venlafaxine
mirtazapine

Block 6 (24 decks)

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