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NMSP Week 6/7 > Antidepressant Drugs (Segars) > Flashcards

Antidepressant Drugs (Segars) Flashcards

1
Q

ALL Antidepressants either are known to, or can, be associated with a withdrawal syndrome that is characterized by what symptoms?

A

FINISH:

1) Flu-like symptoms
2) Insomnia
3) Nausea
4) Imbalance
5) Sensory disturbances
6) Hyperarousal

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2
Q

The following list makes up what class of drugs?

1) Citalopram
2) Escitalopram
3) Fluoxetine
4) Paroxetine
5) Sertraline
6) Vilazodone
7) Vortioxetine

A

SSRI’s

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3
Q

What is the MOA of SSRI’s?

A

Selectively inhibit the pre-synaptic reuptake of serotonin via SERT

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4
Q

Which SSRI is also a partial agonist on 5-HT(1A)?

Which SSRI is also a partial agonist on 5-HT(1B), a full agonist on 5-HT(1A), and a full antagonist on 5-HT(1D,3,7)?

A

1) Vilazodone

2) Vortioxetine

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5
Q

What is the most common adverse effect of SSRI’s?

A

Sexual dysfunction

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6
Q

Serious effects of SSRI’s include?

A

1) Serotonin syndrome

2) Suicidality

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7
Q

Serotonin syndrome which causes sweating, hyperreflexia, akathisia/myoclonus, and shivering/tremors has an increased risk when?

A

When multiple serotonin affecting agents are given together

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8
Q

Which SSRI’s has the most CYP450 interactions (broad and strong inhibitor)?

A

Fluoxetine

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9
Q

Which SSRI’s have the least CYP450 interactions?

A

1) Vortioxetine

2) Escitalopram

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10
Q

What are the SSRI’s?

A

1) Citalopram
2) Escitalopram
3) Fluoxetine
4) Paroxetine
5) Sertraline
6) Vilazodone
7) Vortioxetine

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11
Q

The following list makes up what class of drugs?

1) All TCA’s
2) Desvenlafaxine
3) Duloxetine
4) Venlafaxine
5) Levomilnacipran
6) Amoxapine

A

SNRI’s (incl. TCA’s)

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12
Q

What is the MOA of SNRI’s?

A

Selectively Inhibit the pre-synaptic Reuptake of Serotonin (via SERT) and Norepinephrine (via NET)

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13
Q

Which TCA’s inhibit both NE/5-HT relatively-equally?

Which inhibit NE more than 5-HT?

A

1) 3°-amine TCA’s

2) 2°-amine TCA’s

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14
Q

TCA’s have a lot of side effects because they also block other receptors such as?

A

1) Histamine (H1)
2) Muscarinic (cholinergic)
3) α1 (adrenergic)

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15
Q

TCA’s affecting alpha1 receptors causes what side effects?

TCA’s affecting muscarinic receptors causes what side effects?

TCA’s affecting histamine receptors causes what side effects?

A

1) Cardiovascular (tachycardia, orthostatic hypotension)
2) Anticholinergic (dry mouth, urinary retention/constipation)
3) CNS (Sedation, seizures)

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16
Q

What are the three main toxicities noted with over-dose of TCAs?

A

1) Coma
2) Cardiotoxicity (conduction abnormalities)
3) Convulsions

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17
Q

What are the SNRI’s?

A

1) All TCA’s
2) Desvenlafaxine
3) Duloxetine
4) Venlafaxine
5) Levomilnacipran
6) Amoxapine (SNRI + DA)

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18
Q

The following list makes up what class of drugs?

1) Mirtazapine
2) Nefazodone
3) Trazadone

A

SARA’s

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19
Q

What is the MOA of the SARA drugs Trazodone and Nefazodone?

A

Act like SSRI’s and also selectively block post-synaptic α1 receptors on noradrenergic (NE) neurons and post-synaptic 5-HT2 receptors

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20
Q

What is the MOA of the SARA drug Mirtazapine?

A

Blocks pre-synaptic α2 receptors on noradrenergic (NE) and Serotonergic (5HT) neurons and also blocks post-synaptic 5-HT2/3 receptors

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21
Q

Which SARA has no SERT/NET activity?

A

Mirtazapine

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22
Q

Because the SARA drugs also block H1, what can they cause?

A

Sedation

23
Q

What side effect is seen mostly with Trazodone / Mirtazapine?

With just Trazodone?

With just Mirtazapine?

A

1) Sedation
2) Orthostatic hypotension
3) Weight gain

24
Q

What are the SARA drugs?

A

1) Mirtazapine
2) Nefazodone
3) Trazadone

25
Q

Bupropion makes up what drug class?

A

NDRI’s

26
Q

What is the MOA of bupropion?

A

Selectively inhibits pre-synaptic Reuptake of Norepinephrine (via NET) and Dopamine (via DAT)

27
Q

With Bupropion, evidence also suggests enhanced pre-synaptic release of NE and DA via?

A

VMAT2

28
Q

What side effects are seen with Bupropion?

A

1) Seizures

2) Agitation/Insomnia (Stimulating)

29
Q

What drug makes up the NDRI?

A

Bupropion

30
Q

The following list makes up what class of drugs?

1) Isocarboxazid
2) Phenelzine
3) Selegiline
4) Tranylcypromine

A

MAOI’s

31
Q

What is the MOA of MAOI’s?

A

Inhibition of MAO increases levels of monoamines in neuronal vesicles and increases amount of NE, 5-HT, and DA released

32
Q

All oral MAOI agents are considered?

A

Irreversible (averages 14 days for recovery)

33
Q

All MAOI agents are non-selective (MAO A/B), except?

It is selective for?

A

1) Selegiline

2) MAO B

34
Q

The anti-depressant form of selegiline is given in what form?

A

Patch

35
Q

MAOI’s have drug interactions with?

A

5-HT/NE affecting drugs

36
Q

What should be done to avoid MAOI drug interactions?

What is the exception?

A

1) 2 week wash-out period

2) Fluoxetine takes 5 weeks

37
Q

What risk is the major concern of MAOI’s?

A

Hypertensive crisis (Severe headache, Sweating, Nosebleeds, Tachycardia, Confusion, Chest pain)

38
Q

What does MAOI’s increase the levels of which leads to the hypertensive crisis?

A

Tyramine (MAO-A induces its metabolism)

39
Q

Which MAOI has the least amount of risk for hypertensive crisis occuring?

A

Selegiline (because it minimally blocks MAO-A)

40
Q

What are the MAOI’s?

A

1) Isocarboxazid
2) Phenelzine
3) Selegiline
4) Tranylcypromine

41
Q

Esketamine, which is indicated for treatment-resistant depression in conjunction with ongoing antidepressant therapy is what type of antidepressant?

A

NMDA-receptor (glutamate) antagonist

42
Q

Brexanolone, which is indicated for post-partum depression, is what type of antidepressant?

A

GABA(A) receptor positive allosteric modulator

43
Q

What is the MOA of lithium in neurotransmitter modulation?

A

1) Inhibits dopamine neurotransmission
2) Downregulates NMDA receptor
3) Promotes GABAergic neurotransmission

44
Q

Lithium which is a monovalent ion, competes with what ion for kidney reabsorption?

A

Na+

45
Q

Accumulation of Li+ in principal cells of collecting duct can lead to?

This results in?

A

1) ADH resistance

2) Polyuria/polydipsia

46
Q

Lithium therapy is the most common cause of?

A

Nephrogenic diabetes insipidus

47
Q

Lithium has drug interactions with other agents impacting Na+/K+ such as?

A

1) Diuretics
2) ACEIs
3) NSAIDs

48
Q

What was one of the biggest reasons why lithium therapy use decreased?

A

It has a narrow therapeutic window (Therapeutic concentrations = 0.6-1.2 mEq/L)

49
Q

Lithium is indicated for acute and maintenance treatment of?

A

Mania/bipolar I disorder

50
Q

Can lithium be used for unipolar depressive patients?

A

Yes, as an adjunctive therapy if there was inadequate response to other antidepressant therapies

51
Q

What off label use does lithium have?

A

Reduce risk of suicide in patients with mood disorders

52
Q

Valproic acid/Divalproex is a mood stabilizer (anti-seizure) agent that is indicated for acute treatment of?

A

Bipolar I disorder

53
Q

Lamotrigine is a mood stabilizer (anti-seizure) agent that is indicated for maintenance of?

A

Bipolar I and II disorder

54
Q

Carbamazepine is a mood stabilizer (anti-seizure) agent that is indicated acute and maintenance treatment of?

What affect does carbamazepine have on CYP450?

A

1) Mania and mixed episodes (Bipolar I)

2) CYP450 Inducer

NMSP Week 6/7 (18 decks)

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