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Psych > Antidepressant Pharm > Flashcards

Antidepressant Pharm Flashcards

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1
Q

Name the SSRIs

A

Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa), Fluvoxamine (Luvox), Escitalopram (Lexapro)

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2
Q

SSRIs that are isomers and have similar SE/metabolism profiles

A

citalopram and escitalopram

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3
Q

Block the presynaptic serotonin reuptake pump. Increases the time that serotonin is available in the synapse. Increases postsynaptic receptor occupancy

A

SSRIs

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4
Q

SSRI that has an active metabolite

A

fluoxetine (Prozac)

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5
Q

General elimination half life range for SSRIs

A

20-30 hours. Except fluoxetine (Prozac)- 4-16 days

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6
Q

Which SSRIs inhibit liver enzymes less than other SSRIs? (ie good when you’re worried about drug-drug interactions)

A

Citalopram and escitalopram

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7
Q

What happens when another drug is introduced that also works at same enzyme sites as first drug?

A

Stays in system longer, more chance of toxicty, overdose, greater side effects

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8
Q

Why are SSRIs contraindicated if taking MAOis within 2 weeks?

A

risk of serotonin syndrome

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9
Q

Top three side effects of SSRIs

A

sexual dysfunction, drowsiness, weight gain

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10
Q

Sx include: dysphoria, dizziness, GI distress, fatigue, chills, myalgias. More common with fluvoxamine and paroxetine

A

serotonin withdrawal syndrome

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11
Q

How long should someone be on SSRI for depression?

A

at least 1 yr after resolution of symptoms otherwise there may be recurrence

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12
Q

Risk associated with citalopram

A

QT prolongation at doses over 40mg or at 20mg for >60yr/hepatic impairment/cimetidine

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13
Q

Advantages of fluoxetine (Prozac)

A

capsule for weekly dosing and least problems with weight gain

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14
Q

SSRIs CI with Tamoxifen

A

fluoxetine (Prozac), paroxetine (Paxil),

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15
Q

SSRI with significant withdrawal symptoms

A

Paroxetine (Paxil)

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16
Q

SSRI more likely to cause diarrhea than others

A

Sertaline (Zoloft)

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17
Q

Name the SNRIs

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)

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18
Q

use for treatment of depression if intolerable side effects or poor response to first line SSRI therapy

A

SNRIs

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19
Q

inhibit the reuptake of norepinephrine and serotonin. leads to increased stimulation of the post-synaptic receptors

A

SNRIs

20
Q

Food decreases the rate of absorption but not the degree of absorption (ie less side effects)

A

SNRIs

21
Q

Most common side effects of SNRIs

A

nausea, dizziness, diaphoresis

22
Q

SNRI that most commonly causes nausea. Monitor for elevation of blood pressure

A

Desvenlafaxine (Pristiq)

23
Q

SNRI that is CI in uncontrolled angle closure glaucoma, severe renal or liver impairment. Indicated for diabetic neuropathy and fibromyalgia

A

Duloxetine (Cymbalta)

24
Q

SNRI with increased risk of upper GI bleed, slow taper off of it to avoid withdrawal symptoms, can cause QT prolongation

A

Venlafaxine (Effexor)

25
Q

Usually avoided in clinical practice for the treatment of depression due to anticholinergic side effects

A

TCAs

26
Q

Highly sedating so are often used for insomnia and for those with night time neuropathic pain or fibromyalgia

A

TCAs

27
Q

Inhibit reuptake of serotonin and norepinephrine. Also block muscarinic, histamine and alpha-adrenergic receptors

A

TCAs

28
Q

Group of medications whose cardiac SE include: Heart block, ventricular arrhythmias, sudden death

A

TCAs

29
Q

what patients do you need to screen for cardiac conduction system disease with an EKG before initiation of TCAs?

A

patients >40yrs

30
Q

Lower the seizure threshold, Increase in bone fractures, dangerous in overdose due to their broad spectrum

A

TCAs

31
Q

Block histamine receptors causing sedation, increased appetite, confusion, delirium

A

TCAs

32
Q

Block acetylcholine receptors causing blurred vision, constipation, dry mouth, urinary retention

A

TCAs

33
Q

Name the MAOi

A

Phenelzine (Nardil). Tranylcypromine (Parnate)

34
Q

Medication group most likely to cause serotonin syndrome. Need to avoid tyramine containing foods

A

MAOi

35
Q

Serotonin antagonist and reuptake inhibitors. Good for sleep at low doses. If tolerated – functions as an antidepressant at higher doses

A

Trazodone (Desyrel)

36
Q

Uses include: Major Depressive disorder, ADHD, Smoking cessation

A

Bupropion (Wellbutrin)

37
Q

Structurally related to amphetamine. Can cause anxiety. Lowers the seizure threshold. Avoid in bulemia

A

Bupropion

38
Q

No withdrawal syndrome upon discontinuation or sexual dsyfxn.

A

Bupropion

39
Q

Mildly stimulating so good for patients with fatigue, hypersomnia, or poor concentration

A

Bupropion

40
Q

Blocks adrenergic receptors leading to an increased release of norepinephrine and serotonin. Blocks serotonergic receptors and increases serotonin mediated neurotransmission

A

Mirtazapine (Remeron)

41
Q

Used off-label for insomnia. Used off-label for appetite stimulant. Good for patients with nausea

A

Mirtazapine

42
Q

classically associated with the simultaneous administration of two serotonergic agents. Majority present within 24 hrs.

A

serotonin syndrome

43
Q

Sx include: hyperthermia, agitation, tremor, clonus, dilated pupils, diaphoresis, DTR hyperreflexia, flushed skin

A

serotonin syndrome

44
Q

What does HARM stand for with serotonin syndrome?

A

hyperthermia, autonomic instability, rigidity, myoclonus

45
Q

Tx for serotonin syndrome

A

DC serotonin agents, sedate using benzos, O2, Fluids, avoid acetaminophen.

46
Q

At what temp of serotonin syndrome do you need to intubate and sedate immediately?

A

> 41.1C (105.98F)

47
Q

If benzos don’t work, what is the antidotes for serotonin syndrome?

A

cyproheptadine

Psych (20 decks)

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