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Mood/Psych > Antidepressant Medications > Flashcards

Antidepressant Medications Flashcards

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1
Q

What is the first-line class of antidepressants? How effective are they?

A

SSRI’s - Selective Serotonin Reuptake Inhibitors

70% effective

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2
Q

What are potential risks of SSSRI’s?

A

CYP450 liver enzyme elevations that could lead to liver injury:
- Rare (affects only about 10% of patients taking SSRI’s)
- More common among those with comorbidities

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3
Q

Name the older/earlier generation and less safe SSRI antidepressants and their respective traits.

A

Fluoxetine (Prozac):
- most stimulating

Paroxetine (Paxil):
- sedating

Fluvoxamine (Luvox):
- most sedating
- greatest weight loss
- GI side effects

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4
Q

Name the newer/later generation and safer SSRI antidepressants and their respective traits.

A

Sertraline (Zoloft):
- stimulating

Citalopram (Celexa)

Escitalopram (Lexapro)

***All have lower risk of CYP450 liver enzyme effects

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5
Q

What are the safest or highest risk antidepressants in pregnancy and breastfeeding?

A

Pregnancy -

  • Escitalopram (Lexapro): safest
  • Sertraline (Zoloft): next safest
  • High Risk:
    - Fluoxetine (Prozac)
    - Paroxetine (Paxil)

Breastfeeding -

  • There are generally low levels in breast milk
  • Highest Risk:
    - Citalopram (Celexa)
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6
Q

What are the most common side effects of SSRI antidepressants?

A
  • Diarrhea
  • Nausea and vomiting
  • Sexual dysfunction
  • Somnolence
  • Weight gain
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7
Q

How can side effects from SSRI antidepressants be minimized?

A

Start low, go slow (start with low dose, make increases slowly)
- especially with elderly patients!!

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8
Q

In what timeframes should patients expect to see improvement and relief from depression signs and symptoms when taking SSRI’s? Specify by age groups of young-middle adults and older adults.

A

Young -middle adults:
- Improvement in 2 - 4 weeks
- Relief in 6 - 12 weeks

Older adults:
- Improvement in 4 - 6 weeks
- Relief in 12 - 16 weeks

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9
Q

Describe response rates to initial depression treatment with SSRI’s.

A
  • 70% respond to first line SSRI’s
  • 25% respond to a second medication
  • There is no difference in switching:
    - between drugs in the same class
    - to a different class
  • Consider psych referral if no response
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10
Q

Name the signs and symptoms of abrupt SSRI withdrawal.

A
  • Anxiety
  • Dizziness
  • Insomnia
  • Flu-like symptoms
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11
Q

When are risks of withdrawal from any/all psych meds more likely?

A
  • Med has been taken for >6 weeks
  • Med has been stopped abruptly
  • Dose has been rapidly reduced
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12
Q

What are important factors in the consideration of antidepressant discontinuation?

A
  • Timeframe: about 6 - 9 months after recovery
  • Patient history and preference
  • Consider psych referral for the discontinuation process
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13
Q

What SSRI has the highest risk of withdrawal symptoms? The lowest risk?

A

Highest: Paroxetine (Paxil)
- 21 hour half-life
- 7% rate of withdrawal symptoms

Lowest: Fluoxetine (Prozac)
- 6 day half-life

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14
Q

What is the cause of serotonin syndrome?

A

Excess serotonin:
- from 1+ medications
- most common culprits:
- SSRI’s
- SNRI’s

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15
Q

Describe the non-emergent signs and symptoms of serotonin syndrome.

A
  • BP changes - Restlessness
  • Increased HR - Agitation
  • Tremors - Nausea and vomiting
  • Confusion - Temperature changes
  • Headaches - Shivering

*Hint: BITCH RANTS

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16
Q

What are the severe symptoms of serotonin syndrome that require referral to ER/911?

A
  • High fever
  • Irregular HR
  • Seizures
  • Syncope

*Hint: HISS

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17
Q

How should serotonin syndrome be managed?

A
  • Stop the SSRI/SNRI (or other med)
  • Consider cyproheptadine (Periactin) to block serotonin production
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18
Q

Name the dual-action antidepressant classes.

A

SNRI’s: Serotonin-Norepinephrine Reuptake Inhibitors

NDRI’s: Norepinephrine-Dopamine Reuptake Inhibitors

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19
Q

Name the SNRI antidepressants.

A
  • Duloxetine (Cymbalta): ***Doesn’t raise BP!!!
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq): also for hot flashes per FDA
  • Milnacipran (Savella)
  • Levomilnacipran (Fetzima)
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20
Q

What are the indications for use of an SNRI antidepressant?

A
  • Depression unresponsive to SSRI’s
  • Anxiety disorders
  • Chronic pain, especially neuropathic pain
  • Menopausal vasomotor symptoms (hot flashes) ===> Desvenlafaxine (Pristiq) only
  • Fibromyalgia
  • OCD
  • PTSD
21
Q

What requires monitoring with the use of SNRI antidepressants?

A

Blood pressure*

*except with Duloxetine (Cymbalta)

22
Q

Name the NDRI antidepressants and their main uses.

A

Bupropion:

- Wellbutrin: depression and ADHD
- Zyban: smoking cessation
- Contravene: weight loss
23
Q

What are the pro’s and con’s of NDRI antidepressants?

A

Pro’s (vs other antidepressants):
- No sexual side effects
- No weight gain

Con’s:
- Contraindications: Seizures and HTN
- Requires BP monitoring

24
Q

Give the generic/brand name of the following drug: Prozac

A

Fluoxetine

25
Q

Give the generic/brand name of the following drug: Pristiq

A

Desvenlafaxine

26
Q

Give the generic/brand name of the following drug: Escitalopram

A

Lexapro

27
Q

Give the generic/brand name of the following drug: Bupropion

A

Wellbutrin
Zyban
Contrave

28
Q

Give the generic/brand name of the following drug: Duloxetine

A

Cymbalta

29
Q

Give the generic/brand name of the following drug: Effexor

A

Venlafaxine

30
Q

Give the generic/brand name of the following drug: Celexa

A

Citalopram

31
Q

Give the generic/brand name of the following drug: Sertraline

A

Zoloft

32
Q

Give the generic/brand name of the following drug: Paroxetine

A

Paxil

33
Q

Give the generic/brand name of the following drug: Luvox

A

Fluvoxamine

34
Q

Give the generic/brand name of the following drug: Milnacipran

A

Savella

35
Q

Give the generic/brand name of the following drug: Fetzima

A

Levomilnacipran

36
Q

Give the generic/brand name of the following drug: Wellbutrin

A

Bupropion

37
Q

Give the generic/brand name of the following drug: Fluoxetine

A

Prozac

38
Q

Give the generic/brand name of the following drug: Citalopram

A

Celexa

39
Q

Give the generic/brand name of the following drug: Venlafaxine

A

Effexor

40
Q

Give the generic/brand name of the following drug: Cymbalta

A

Duloxetine

41
Q

Give the generic/brand name of the following drug: Paxil

A

Paroxetine

42
Q

Give the generic/brand name of the following drug: Lexapro

A

Escitalopram

43
Q

Give the generic/brand name of the following drug: Levomilnacipran

A

Fetzima

44
Q

Give the generic/brand name of the following drug: Zoloft

A

Sertraline

45
Q

Give the generic/brand name of the following drug: Zyban

A

Bupropion

46
Q

Give the generic/brand name of the following drug: Fluvoxamine

A

Luvox

47
Q

Give the generic/brand name of the following drug: Contrave

A

Bupropion

48
Q

Give the generic/brand name of the following drug: Desvenlafaxine

A

Pristiq

49
Q

Give the generic/brand name of the following drug: Savella

A

Milnacipran

Mood/Psych (10 decks)

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