Antidepressant Meds Flashcards
Name the different classes of Antidepressants
- Tricyclic Antidepressants (TCAs)
- Monoamine-oxydase Inhibitors (MAOIs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
The Biogenic Amine Hypothesis states that depression is caused by a deficiency of _________, particularly ___________ and ________
monoamines, noradrenaline and serotonin
Parts of the brain affected by depression
Amygdala
Cerebral Cortex
Hippocampus
Thalamus
People who suffer from recurrent depression have a significantly smaller __________, the brain region associated with forming new memories
hippocamps
___________ is when drug elimination is proportional to its concentration or a percentage of the drug is eliminated each hour. (ex: antibiotics)
First order biotransformation
___________ drug metabolized at a specific rate regardless of the concentration or elimination. (ex: alcohol)
Zero order biotransformation
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.
50%, 25%, 12%
___ half lives must pass before a single dose of a chemical is eliminated
5
Facts about TCAs
- 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)
TCAs effects
- Appetite returns after 5-7 days
- Insomnia improves after 3-4 days
- Takes 10-14 days to act
- Full effect may take 6 weeks
Two major mistakes in prescribing TCAs
- Inadequate dose
- Inadequate time allowed for functioning
Name the meds that are safe to prescribe for depression in elderly
SSRIs & buproprion, mirtazapine, moclobemide, &venlafaxine. Advantage is lower anticholinergic effects & are thus well tolerated by patients with cardiovascular disease
Side effects of TCAs
- Anticholinergic effects
- Cardiac arrhythmia
- Orthostatic hypertension
- Hypertension
- Sedation
Name the Tricyclic Antidepressants (TCAs)
Amitriptyline - Elavil Desipramine - Norpramin Doxepin - Sinequan Imipramine - Tofranil Nortripyline - Aventyl, Pamelor Protriptyline - Vivactil Trimipramine - Surmontil
Facts about MAOIs
Interferes with MAO-A & MAO-B
Superior to TCAs in atypical depression
MAOIs successfully treat 55-70% of depression
Which MAOI does not appear to have a high risk for inducing mania?
Tranylcypromine (Parnate)
Name the MAOIs
Phenelzine - Nardil
Tranylcypromine - Parnate
Isocarboxazid - Marplan
Selegiline - Emsam
A serotonergic crisis occurs when you combine a _____ with a _____
MAOI and SSRI
How does the body respond to a serotonergic crisis?
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
A noradrenergic crisis emerges from combining _____ with ______, tyramine containing foods, stimulants such as ephedrine, pseudoephedrine, phenylephrine, phenylpropanolamine
MAOIs with TCAs
Side effects of noradrenergic crisis
Hypertension
Occipital headache
Stiff or sore neck
Flushing or sweating
Cold clammy skin
tachycardia
If noradrenergic crisis is severe, you may see
Sudden unexplained nosebleeds
Dilated pupils, visual disturbance
Photophobia
Chest pain
Stroke/coma/death
_______ (SSRI) appears to cause the most sedation
paroxetine
______ (SSRI) causes the most GI upset
fluvoxamine
_________ (SSRI) causes the most short-term weight loss and activation (e.g., anxiety and agitation)
fluoxetine
Name SSRIs and dosage range
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
______ (SSRI) helps overweight client, has a long half life, may causes immediate worsening of depression
Fluoxetine (Prozac)
What does Prozac treat?
- 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
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
Sertraline (Zoloft)
FDA approves zoloft for:
- MDD
- OCD
- Panic disorder
PTSD - Premenstrual dysphoric disorder in adulta (PMDD) (newest indicatin)
- social anxiety disorder
FDA approves Paroxetine (paxil) for:
OCD Depression Panic disorder Generalized anxiety disorder PTSD Social phobia
_______ (SSRI) is not well tolerated by clients with severe anxiety symptoms
Citalopram (Celexa)
Citalopram (Celexa) is approved for:
MDD
Depression
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?
Escitaloram oxalate (Lexapro)
FDA approves Escitalopram (Lexapro) for:
MDD
GAD
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
Vilazodone hydrochloride (Viibryd)
_______ (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.
Vortioxetine - Brintellix
Name the SNRIs (5):
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
What was the first SNRI to be marketed in the US and was approved by the FDA in 1993?
Venlafaxine (Effexor)
Venlafaxine (Effexor) is effective in treating what?
Geriatric and melancholic depression
_________ 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
Duloxetine (Cymbalta)
______ should NOT be taken with thioridazine (Mellaril) or a MAOI
Duloxetine - Cymbalta
____ was the 3rd SNRI approved by the FDA in Feb 2008
Pristiq
The recommended dose for Pristiq is _____ once daily.
50 mg
__________ was approved by the FDA in 2013 for MDD
Fetzima
______ is NOT approved for use in children under 18
Pristiq
Name the atypical antidepressants:
Bupropion (Wellbutrin) Nefazadone (Serzone) Clomipramine (Anafranil) Trazadon (Desyrel) Mirtazapine (Remeron) Brexipiprazole - Rexulti
______ is specifically for OCD and is used with panic & phobias
Clomipramine - Anafranil
_______ is used commonly for persons with insomnia and may be prescribed for withdrawal from cocaine
Trazadon-Desyrel
_______ major drawback is that it is associated with increased hunger and weigh gain, but less likely to cause nausea, vomiting or sexual dysfunction
Mirtazapine - Remeron
_______ has side effects like abnormal dreams, abnormal thinking
Remeron
________ 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.
Ketamine. Sometimes called Special K, Kit Kat, Super Acid, Purple
________ is a fast-acting antidepressant that relieves depressive symptoms in hours instead of weeks. FDA granted approval for nasal spray in 2019.
Esketamine
__________ 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
Esketamine
