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NMSP Exam 3 > Antidepressant Drugs > Flashcards

Antidepressant Drugs Flashcards

1
Q

5 R’s of antidepressant efficacy

A
  1. Response = ≥50% reduction in sx
  2. Remission = sx free
  3. Recovery = 6-12 months of ongoing remission
  4. Relapse = return of symptoms after remission but before recovery
  5. Recurrence = return of symptoms after recovery
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2
Q

average response time to antidepressants

A

8 weeks

if no response after this time, may switch to another antidepressant with a different MOA

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3
Q

describe the withdrawal sx of antidepressants

A 
FINISH:
flu like sx
insomnia
nausea
imbalance
sensory disturbances
hyperarousal
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4
Q

SSRI MOA

A

selective seratonin reuptake inhibitors

via SERT

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5
Q

what are the SSRIs?

A 
citalopram
escitalopram
fluoxetine
paroxetine
sertraline ** ya girl's med 
vilazodone
vortioxetine
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6
Q

which SSRI is also a partial 5HT1a agonist?

A

vilazodone

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7
Q

which SSRI is also a partial 5HT1b agonist, full 5HT1b agonist and full 5HT1d antagonist?

A

vortioxetine

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8
Q

why are SSRI’s preferred over TCAs?

A

much less impact on histamine, muscarinic and adrenergic receptors

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9
Q

SSRI common side effects

A

sedation
sexual dysfunction
weight gain
acute withdrawal reactions

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10
Q

SSRI rare side effects

A

QT prolongation
hyponatremia
serotonin syndrome
suicidality

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11
Q

sx of serotonin syndrome

A

sweating
hyperreflexia
akathisia/myoclonus
shivering/tremors

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12
Q

which SSRI is most likely to cause drug interactions?

A

fluoxetine – strong CYP450 inhibitor

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13
Q

SNRI MOA

A

selective serotonin and norepinephrine pre-synpatic reuptake inhibitors

serotonin via SERT
norepi via NET

5HT > NE

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14
Q

3˚-amide TCA MOA

A

inhibit both NE/5HT equally

*exception = clomipramine/amtriptyline 5HT > NE

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15
Q

2˚-amide TCA MOA

A

inhibit NE > 5HT

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16
Q

what are the SNRIs?

A 
All TCAs
Desvenlafaxine
Duloxetine
Venlafaxine
Levomilnacipran
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17
Q

what are the 3˚-amide TCAs?

A 
"ACID"
Amitriptyline 
Clomipramine
Imipramine
Doxepin
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18
Q

what are the 2˚-amide TCAs?

A

Amoxapine
Desipramine
Nortryptyline

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19
Q

which receptors are also affected by TCAs?

A

histamine
muscarinic
adrenergic

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20
Q

TCA activation of adrenergic receptors causes which side effects?

A

tachycardia
orthostatic hypotension
dysrhythmias

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21
Q

TCA activation of muscarinic receptors causes which side effects?

A

dry mouth
urinary retention
constipation
blurred vision

22
Q

TCA activation of histamine receptors causes which side effects?

A

sedation/fatigue
dizziness
seizures

23
Q

3 C’s of TCA overdose

A

Coma
Cardiotoxicity (Conduction abnormalities)
Convulsions

24
Q

SNRI side effects

A

relatively similar to SSRI’s but less risk of sexual dysfunction

25
Q

Trazadone and Nefazodone MOA

A

SSRI + block post-synaptic a1 receptors on NE and 5HT receptors

26
Q

Mirtazapine MOA

A

blocks pre-synaptic a2 receptors on NE and 5HT neurons + blocks post-synaptic 5HT receptors

*no SERT/NET activity

27
Q

side effects of SARAs

A

sedation
orthostatic hypotension
weight gain

28
Q

NDRI MOA

A

selectively inhibits pre-synaptic reuptake of NE and DA via NET and DAT

also evidence of an enhanced pre-synaptic release of NE and DA via VMAT2

29
Q

what is the NDRI?

A

bupropion

30
Q

bupropion side effects

A 
agitation
insomnia
HTN
tachy
tremors
weight loss
seizures
31
Q

MAOIs MOA

A

inhibition of monoamine oxidase which increases monoamines in neuronal vesicles and increases amounts of NE, 5HT and DA

32
Q

which MAOI is the only non-selective agent

A

selegiline (patch)

33
Q

what are the MAOI?

A

isocarboxazid
phenelzine
selegiline
tranylcypromine

34
Q

MAOI side effects

A

orthostatic hypotension
sexual dysfunction
weight gain
insomnia/agitation

35
Q

what is the primary concern of patients taking MAOIs?

A

hypertensive crisis

*MAOIs inhibit tyramine metabolism –> causes catecholamine release

36
Q

which MAOI has the lowest risk of a hypertensive crisis?

A

selegiline

37
Q

misc antidepressants

A

esketamine - NMDA antagonist

brexanolone - GABAa agonist

38
Q

indications for giving eskatmine

A

NMDA-ant: treatment-resistant depression in conjunction with ongoing antidepressant therapy

*nasal administration

39
Q

indications for giving brexanolone

A

post-partum depression - identical to endogenous allopregnanolone

*60 hr IV administration

40
Q

what are the mood stabilizers?

A

carbamazepine
lamotrigine
valproic acid
lithium

41
Q

why are anti-seizure meds used as mood stabilizers?

A

exact MOA unclear

the just fuckin work ok?????

42
Q

lithium MOA

A
  1. alters brain structures
  2. neurotransmitter modulation
  3. intracellular changes
43
Q

which brain structures are affected by lithium?

A

anterior cingulate cortex
superior temporal gyrus
ventral prefrontal cortex
hippocampus

44
Q

how does lithium modulate neurotransmitters?

A

inhibits DA
downregulates NMDA receptor
increases GABA levels

45
Q

what are the intracellular effects of lithium?

A

inhibits IPPase and IMPase
inhibits PKC, MARCKS and GSK3
activates CREB transcription factor (neuroprotective)

46
Q

describe the renal effects of lithium

A

lithium enters principal cells of collecting duct via Na channels

lithium accumulation interferes with ADH-mediated effects

can lead to resistance to ADH resulting in polyuria and polydipsia

47
Q

lithium renal toxicity can be confused with what other condition?

A

nephrogenic diabetes insipidus

48
Q

what drugs interact with lithium?

A

diuretics
ACEIs
NSAIDs

49
Q

lithium side effects

A 
tremor
mental confusion
dizziness
sedation
thyroid goiter
leukocytosis
seizures
serotonin syndrome
50
Q

lithium indications

A

mania/bipolar 1
augmentation in unipolar depressive patients

off label: reduced risk of suicide

51
Q

indications for anti-seizure mood stablizers

A

Bipolar 1 and 2

  • lamotrigine for 1 or 2
  • valproic acid and carba for 1 only

NMSP Exam 3 (18 decks)

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