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Psychosocial Rehabilitation > Antidepressant Meds > Flashcards

Antidepressant Meds Flashcards

1
Q

Name the different classes of Antidepressants

A
  • Tricyclic Antidepressants (TCAs)
  • Monoamine-oxydase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
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2
Q

The Biogenic Amine Hypothesis states that depression is caused by a deficiency of _________, particularly ___________ and ________

A

monoamines, noradrenaline and serotonin

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3
Q

Parts of the brain affected by depression

A

Amygdala
Cerebral Cortex
Hippocampus
Thalamus

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4
Q

People who suffer from recurrent depression have a significantly smaller __________, the brain region associated with forming new memories

A

hippocamps

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5
Q

___________ is when drug elimination is proportional to its concentration or a percentage of the drug is eliminated each hour. (ex: antibiotics)

A

First order biotransformation

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6
Q

___________ drug metabolized at a specific rate regardless of the concentration or elimination. (ex: alcohol)

A

Zero order biotransformation

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7
Q

After 1st half life, ___ of drug remains in system. After 2nd half life, ____ drug remains in system. After 3rd half life, ____ drug remains in system.

A

50%, 25%, 12%

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8
Q

___ half lives must pass before a single dose of a chemical is eliminated

A

5

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9
Q

Facts about TCAs

A
  • Inhibit or block active reuptake of norepinephrine
  • Sedative effects are attributed to antihistaminic action (H1) receptors
  • TCAs absorbed from the GI tract
  • Largely metabolized by first pass metabolism
  • Highly lipophilic (concentrated in heart and brain)
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10
Q

TCAs effects

A
  • Appetite returns after 5-7 days
  • Insomnia improves after 3-4 days
  • Takes 10-14 days to act
  • Full effect may take 6 weeks
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11
Q

Two major mistakes in prescribing TCAs

A
  • Inadequate dose

- Inadequate time allowed for functioning

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12
Q

Name the meds that are safe to prescribe for depression in elderly

A

SSRIs & buproprion, mirtazapine, moclobemide, &venlafaxine. Advantage is lower anticholinergic effects & are thus well tolerated by patients with cardiovascular disease

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13
Q

Side effects of TCAs

A
  • Anticholinergic effects
  • Cardiac arrhythmia
  • Orthostatic hypertension
  • Hypertension
  • Sedation
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14
Q

Name the Tricyclic Antidepressants (TCAs)

A 
Amitriptyline - Elavil
Desipramine - Norpramin
Doxepin - Sinequan
Imipramine - Tofranil
Nortripyline - Aventyl, Pamelor
Protriptyline - Vivactil
Trimipramine - Surmontil
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15
Q

Facts about MAOIs

A

Interferes with MAO-A & MAO-B

Superior to TCAs in atypical depression

MAOIs successfully treat 55-70% of depression

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16
Q

Which MAOI does not appear to have a high risk for inducing mania?

A

Tranylcypromine (Parnate)

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17
Q

Name the MAOIs

A

Phenelzine - Nardil
Tranylcypromine - Parnate
Isocarboxazid - Marplan
Selegiline - Emsam

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18
Q

A serotonergic crisis occurs when you combine a _____ with a _____

A

MAOI and SSRI

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19
Q

How does the body respond to a serotonergic crisis?

A

Elevated temp, fever

Abnormal muscle movements, twitches, myclonic jerking muscles

Autonomic dysreflexia - overreaction of the involuntary (autonomic) nervous system to stimulation

Rarely - generalized seizure

Possible effects
- hypotension
- anxiety & agitation
- shivering
- enhanced startle response
- insomnia
confusion & delirium
- Shock
- Death
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20
Q

A noradrenergic crisis emerges from combining _____ with ______, tyramine containing foods, stimulants such as ephedrine, pseudoephedrine, phenylephrine, phenylpropanolamine

A

MAOIs with TCAs

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21
Q

Side effects of noradrenergic crisis

A

Hypertension

Occipital headache

Stiff or sore neck

Flushing or sweating

Cold clammy skin

tachycardia

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22
Q

If noradrenergic crisis is severe, you may see

A

Sudden unexplained nosebleeds

Dilated pupils, visual disturbance

Photophobia

Chest pain

Stroke/coma/death

23
Q

_______ (SSRI) appears to cause the most sedation

A

paroxetine

24
Q

______ (SSRI) causes the most GI upset

A

fluvoxamine

25
Q

_________ (SSRI) causes the most short-term weight loss and activation (e.g., anxiety and agitation)

A

fluoxetine

26
Q

Name SSRIs and dosage range

A

Floxetine - Prozac
20-60 mg
children - 5-10mg

Paroxetine - Paxil
10-60 mg

Sertraline - Zoloft
50-150 mg

Citalopram - Celexa
40-60 mg

Escitalopram oxalate - Lexapro
10-20 mg

Vilazodone hydrochloride -Viibryd
10-40 mg

Vortioexitine - Brintellix
10-40 mg

Fluvoxamine - Luvox
100-300mg

27
Q

______ (SSRI) helps overweight client, has a long half life, may causes immediate worsening of depression

A

Fluoxetine (Prozac)

28
Q

What does Prozac treat?

A
  • MDD
  • OCD
  • Moderate to severe bulimia nervosa
  • panic disorder
  • In Jan 2003, prozac was approved by the FDA for the tx of depression and OCD in children and adolescents who are 7 to 17 years of age
29
Q

Which SSRI is lowest in anorexia, has half life of 26 hrs (so unlikely to build up), low mania induction in bipolar, causes dryer mouth than other SSRIs, can cause somnolence

A

Sertraline (Zoloft)

30
Q

FDA approves zoloft for:

A
  • MDD
  • OCD
  • Panic disorder
    PTSD
  • Premenstrual dysphoric disorder in adulta (PMDD) (newest indicatin)
  • social anxiety disorder
31
Q

FDA approves Paroxetine (paxil) for:

A 
OCD
Depression
Panic disorder
Generalized anxiety disorder
PTSD
Social phobia
32
Q

_______ (SSRI) is not well tolerated by clients with severe anxiety symptoms

A

Citalopram (Celexa)

33
Q

Citalopram (Celexa) is approved for:

A

MDD

Depression

34
Q

Which SSRI may take 4 or more weeks to act, has the active isomer of the antidepressant citalopram, and has a recommended dose of 10mg daily?

A

Escitaloram oxalate (Lexapro)

35
Q

FDA approves Escitalopram (Lexapro) for:

A

MDD

GAD

36
Q

Which SSRI is used to treat MDD, has a recommended INITIAL dose of 40 mg/day, and then treatment should be titrated, starting with an initial dose of 10mg/day for 7 days, followed by 20 mg/day for an additional 7 days, and then an increase to 40 mg/day

A

Vilazodone hydrochloride (Viibryd)

37
Q

_______ (SSR) is a serotonin modulator and simulator, is specificially indicated for MDD, recommended dose is 10 mg, and then should be increased to 20 mg/day.

A

Vortioxetine - Brintellix

38
Q

Name the SNRIs (5):

A 
Venlafaxine - (Effexor) 75 to 225 mg
Venlafaxine (Effexor XR) 
Duloxetine (Cymbalta) 20 to 60 mg
Mirtazapine - (Remeron) 15 to 45 mg
Desvenlafaxine - (Pristiq) 50 to 400 mg
39
Q

What was the first SNRI to be marketed in the US and was approved by the FDA in 1993?

A

Venlafaxine (Effexor)

40
Q

Venlafaxine (Effexor) is effective in treating what?

A

Geriatric and melancholic depression

41
Q

_________ is used to treat MDD and GAD and is also used to treat a chronic pain disorder called fibromyalgia and to treat pain caused by nerve damage in persons with diabetes (neuropathy) and other diseased characterized by neuropathy

A

Duloxetine (Cymbalta)

42
Q

______ should NOT be taken with thioridazine (Mellaril) or a MAOI

A

Duloxetine - Cymbalta

43
Q

____ was the 3rd SNRI approved by the FDA in Feb 2008

A

Pristiq

44
Q

The recommended dose for Pristiq is _____ once daily.

A

50 mg

45
Q

__________ was approved by the FDA in 2013 for MDD

A

Fetzima

46
Q

______ is NOT approved for use in children under 18

A

Pristiq

47
Q

Name the atypical antidepressants:

A 
Bupropion (Wellbutrin)
Nefazadone (Serzone)
Clomipramine (Anafranil)
Trazadon (Desyrel)
Mirtazapine (Remeron)
Brexipiprazole - Rexulti
48
Q

______ is specifically for OCD and is used with panic & phobias

A

Clomipramine - Anafranil

49
Q

_______ is used commonly for persons with insomnia and may be prescribed for withdrawal from cocaine

A

Trazadon-Desyrel

50
Q

_______ major drawback is that it is associated with increased hunger and weigh gain, but less likely to cause nausea, vomiting or sexual dysfunction

A

Mirtazapine - Remeron

51
Q

_______ has side effects like abnormal dreams, abnormal thinking

A

Remeron

52
Q

________ is a parenterally administered, general anesthetic used largely for short term diagnostic & surgical procedures. Limited in use because of psychological side effects includeing vivid hallucinations, agitation & confusion.

A

Ketamine. Sometimes called Special K, Kit Kat, Super Acid, Purple

53
Q

________ is a fast-acting antidepressant that relieves depressive symptoms in hours instead of weeks. FDA granted approval for nasal spray in 2019.

A

Esketamine

54
Q

__________ can be used in conjunction with an oral antidepressant, was approved for depression tx in adults who have tried other antidepressant meds but have not benefitted from them

A

Esketamine

Psychosocial Rehabilitation (3 decks)

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