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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
SSRI with 2D6 interactions
fluvoxamine fluoxetine sertraline citalopram
26
SSRI drug interactions
``` clozapine fentanyl hydrocodone methadone tamoxifen tramadol ```
27
SSRI ADR
``` NVD anorexia delayed ejaculation anorgasmia insomina/sedation temp increase in anxiety headache ```
28
SSRI major drug interactions
MAOI
29
serotonin syndrome
``` too high serotonin from combo of drugs that increase serotonin autonomic instability rigidity fever stupor death ```
30
treatment of serotonin syndrome
``` stop SSRI benzodiazepines short acting drugs for BP control non depolarizing neuromuscular blocker intubation ```
31
SNRI MAO
SERT and NET inhibition
32
SNRI drugs
venlafaxine desvenlafaxine duloxetine milnacipran
33
venlafaxine dose info
``` SNRI prodrug- active form desvenlafaxine dose dependent effects low dose- SERT inhibition mid dose- NET inhibition high dose- DA reuptake inhibition ```
34
ADR venlafaxine
HTN | sweating
35
duloxetine dose
SNRI | low dose- SERT and NET inhibition
36
duloxetine use
SNRI diabetic peripheral neuropathy fibromyalgia pain
37
milnacipran use
SNRI | prodrug for fibromyalgia
38
venlafaxine
SNRI prodrug
39
duloxetine
SNRI
40
milnacipram
SNRI prodrug
41
milnacipran use
fibromyalgia
42
levomilnacipran
SNRI | active form of milnacipran
43
levomilnacipran use
antidepressant
44
MAOI drugs
phenelzine tranylcypramine selegiline
45
phenelzine selectivity
MAO nonselective
46
tranylcypramine selectivity
MAO nonselective
47
selegiline selectivity
MAO B
48
selegiline use
low dose transdermal for parkinson's
49
MAOI ADR
tyramine effect serotonin syndrome orthostatic hypotension
50
tyramine effect
increased circulating tyramine increases NE levels which leads to HTN crisis
51
symptoms of tyramine effect
``` bad headache neck pain sweating HTN intracerebral hemorrhage ```
52
MAOI drug interactions
linezolid- antibiotic | anything that increases serotonin/NE
53
TCA
tricyclic antidepressants
54
TCA MOA
SERT and NET inhibition
55
other receptors affected by TCA
histamine H1 alpha muscarinic
56
effects of TCA via histamine receptor
sedation weight gain hypotension
57
effects of TCA alpha receptor
orthostatic hypotension dizziness reflex tachycardia
58
effects of TCA muscarinic
``` dry mouth blurry vision constipation urinary retention dizziness delirum ```
59
effects of TCA overdose
respiratory depression | arrhythmia
60
TCA secondary amines
desipramine | nortriptyline
61
desipramine
TCA secondary amines
62
nortriptyline
TCA secondary amine
63
TCA tertiary amines
amitriptyline imipramine clomipramine
64
amitryptyline
TCA tertiary amine
65
imipraminne
TCA tertiary amine
66
clomipramine
TCA tertiary amine
67
SARI
serotonin antagonist and reuptake inhibitor
68
SARI drugs
trazodone | nefazodone
69
trazodone receptors
5HT2a* 5HT2c alpha1
70
high dose trazodone
5HT2a + SERT for depression
71
low dose trazodone
5HT2a for insomnia, PTDS
72
benefits of trazodone
avoids: sexual dysfunction sedation anxiety
73
ADR of trazodone
sedation dizziness rare priapism
74
nefazodone receptors
5HT2a, 5HT1a, alpha1, NET inhibition
75
ADR nefazodone
hepatotoxic | cyp inhibitor
76
vilazodone MOA
SERT inhibition | 5HT1a partial agoinst
77
bupropion MOA
DA and NE reuptake inhibitor | AChN antagoinst
78
bupropion use
with SSRI for sexual dysfunction | smoking cessation
79
hydroxybupropion
active metabolite of bupropion similar to amphetamine
80
effects of bupropion
agitation anxiety restlessnes
81
use of bupropion
psychomotive retarded depression hypersomina if concerned about weight gain
82
bupropion ADR
insomnia constipation dry mouth seizures
83
contraindications bupropion
eating disorders | epilepsy
84
NaSSA
noradrenergic and specific serotonergic antidepressant
85
mirtazapine
NaSSA
86
mirtazapine MOa
alpha2 antagoinst- increase 5HT and NE release 5HT2/3 antagoinst- blocks DA and NE release in reward area H1 antagonist=- sedation, weight gain
87
drugs with minimal interactions
sertraline escitalopram venlafaxine mirtazapine

Block 6 (24 decks)

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