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Neuro III > Antidepressant Treatment > Flashcards

Antidepressant Treatment Flashcards

1
Q

Which is the only class of drugs approved to treat juvenile depression?

A

SSRI

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2
Q

SSRI

MOA

A
  • selectively inhibit the reuptake of 5-HT. Specifically, they block the serotonin transporter
    • increase synaptic 5-HT
    • changes in regulation of 5-HT receptors
  • delayed onset of action
    • neuronal platicity (synaptic changes & neurogenesis)
    • may cause changes in neuronal circuitry
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3
Q

What is the only antidepressant that does not have a delayed onset of action?

A

ketamine

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4
Q

SSRI

AE

Contraindications

A
  • AE
    • sexual dysfunction
    • weight gain
    • nausea
    • suicidal ideation
      • controversial in juvenile depression
      • energy comes back before mood
    • withdrawl
      • fluoxetine is least likely
      • neonatal withdrawl
  • Contraindication
    • w/ MAOI - serotonin syndrome
    • any drug that inhibits SSRI metabolism
      • fluoxetine w/ ritonavir
    • paroxetine during pregnancy
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5
Q

What are the symptoms in serotnin syndrome?

Treatment?

A
  • Symptoms
    • agitation, confusion, disorientation, anxiety, hallucinations & poor concentration, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor & fever
    • death
  • Treatment
    • resolves on discontinuation of the drugs
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6
Q

What SSRI is contraindicated during pregnancy?

A

paroxetine

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7
Q

What SSRI carries the least risk of causing withdrawl up on stopping treatment?

A

fluoxetine

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8
Q

SNRI - name & indication

MOA?

AE?

CI?

A
  • Venlafaxine, Duloxetine, desvenlafaxine, levomilnacipran
    • depression, generalized anxiety disorder, social anxiety disorder
  • MOA
    • inhibit reuptake of 5-HT & NE
    • does NOT block ACh, H, or a1 receptors
  • AE
    • nausea, headache, sexual dysfunction
  • CI
    • w/ MAOI
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9
Q

List the SSRIs & provide the indications

A
  • Drugs
    • Fluoxetine
    • sertraline
    • paroxetine
    • fluvoxamine
    • citalopram
    • escitalopram
  • Indications
    • Depression
    • Juvenile depression
    • Anxiety
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10
Q

List the TCAs & provide the indications

A
  • Drugs
    • Imipramine & Desipramine
  • Indications
    • depression
    • depressive phase of bipolar disorder
    • neuropathic pain
    • ADHD
    • panic disorder
    • obsessive complusive disorder
    • chronic insomnia
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11
Q

TCA

MOA?

AE?

CI?

A
  • MOA
    • block serotonin transported or NE transporter or both (ratios vary)
    • delayed onset of action
      • neuronal plasticity
  • AE
    • Block:
      • Histamine receptors
        • drowsiness
      • Muscarinic receptors
        • dry mouth, blurry vision, constipation, urine retention, recumbent tchycardia & memory impairment
      • alpha1 adrenergic recetors on BV
        • orthostatic hypotension
    • Diaphoresis
    • Cardiac toxicity (decrease vagal influence & act at bundle of His)
    • Seizures (lower t hreshold)
    • Hypomania
  • CI
    • w/ MAOI
      • hypertensive crisis (TCA block NE reuptake & MAOI cause accumulation NE -> excessive adrenergic stimulation)
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12
Q

What are the symptoms in hypertensive crisis?

Treatment?

A
  • Symptoms
    • Tachycardia, palpitations, nausea, vomiting
  • Treatment
    • hypertension treated with IV phentolamine (alpha antagonist)
    • or sublingualnifedipine (Ca2+ channel blocker)
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13
Q

What are the MAOIs & what are the indication for thier use?

A
  • Drugs
    • Tranylcypromine
    • phenelzine
    • isocarboxazid
  • Indication
    • depression, second line
    • patients with atypical depression
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14
Q

MAOI

MOA?

AE?

CI?

A
  • MOA
    • inhibit monoamine oxidase A & B
  • AE
    • hypertensive crisis from dietary tyramine
      • “cheese reaction”
    • combo w/ other drugs
      • TCA, ephedrine, methylphenidate, amphetamine, cocaine, cold remedies
    • CNS stimulation (anxiety, hypomania)
    • Orthostatic hypotension
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15
Q

Buproprion belongs to what class?

Indication?

MOA?

AE?

CI?

A
  • Atypical antidepressant
  • Indication
    • depression
    • counters sexual dysfunction when used wiht SSRI
    • hypoactive sexual disorder in women
  • MOA
    • block DA uptake
  • AE
    • reduces seizure threshold
  • Drug interactions
    • w/ MAOI
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16
Q

Mirtazapine belongs to what class?

Indication?

MOA?

AE?

A
  • Indication
    • depression
      • well tolerated alternative to SSRI
      • may counter sexual dysfunction when used with SSRI
    • hyopacive sexual disorder in women
  • MOA
    • alpha-2 adrenergic antagonist (may act more rapidly)
  • AE
    • blocks Histamine receptors
    • drowsiness & weight gain
17
Q

Vilazodone belongs to what class?

Indication?

MOA?

AE?

A
  • Atypical Antidepressant
  • Indication
    • second line drug - patients that cannot tolerate TCAs
    • combined with another drug for antidepressant induced insomnia
    • sedative, may be used for sleep
  • MOA
    • blocks 5-HT reuptake (transporters)
    • serotonergic antagonist for most 5-HT receptors
    • 5-HT1A partial agonist
  • AE
    • sedation
    • orthostatic hypotension
    • nausea
    • dry mouth
    • priapism
18
Q

Vilazodone belongs to what class?

Indication?

MOA?

A
  • Atypical antidepressant
  • Indication
    • depression
  • MOA
    • blocking serotonin reuptake through serotonin transporter
    • partial agonism of 5-HT1A presynaptic receptors
19
Q

Vortioxetine belongs to what class?

Indication?

MOA?

A
  • atypical antidepresant
  • indication
    • depression - may be helpful for cognitive deficits
  • MOA
    • SSRI
    • 5-HT1A full agonist and 5-HT3 receptor antagonist
20
Q

What are the atypical antipsychotics?

Indication (with relation to depression)

A
  • Drugs
    • Aripiprazole
    • quetiapine
    • olanzapine & fluoxetine
  • Indication
    • adjunct for patients not adequately responding to SSRI
21
Q

Symbyax - combo Olanzapine & Fluoxetine

Indication?

AE?

A
  • Indications
    • antipsychotic adjuncts for treatment resistand depression
  • AE
    • anticholinergic effects
      • olanzapines antagonism M1-5 receptors
    • somnolence
      • olazapines antagonism of H1 receptors
    • orthostatic hyoptension
      • olazapines antagonism of alpha1-adrenergic receptors
22
Q

What is the rapid acting antidepressant?

Indication?

MOA?

AE?

Risks?

A
  • Esketamine nasal spray
  • Indication
    • treatment resistant depression
  • MOA
    • unknown - ketamine is an NMDA receptor antagonist
  • AE
    • sedation, dissociation, BP increase (most within 2 hrs)
  • Risks
    • Risk evaluation & mitigation strategy (REMS)
    • only in setting when can be monitored for 2 hrs
23
Q

What are the indications for Electroconvulsive therapy?

MOA?

AE?

A
  • Indication
    • failed to respond to 2 pharmacotherapies
    • severely depressed suicidal patients who need rapid relief from symptoms
  • MOA
    • unknown - changes neuronal circuitry
  • AE
    • short term memory loss
    • transient impairment of cognitive funcion
    • long term memory seems intact
24
Q

What is the first line treatment for PTSD?

A
  • SSRI
  • adjunct for nightmares - prazosin
  • MOA
    • centrally & peripherally acting a1-adrenergic antagonist
  • AE
    • orthostatic hypotension
25
Q

What are the first line drugs for bipolar disorder?

A
  • Lithium
    • indication - euphoric mania & long term prophylaxis
  • Valproate
    • indication
      • dysphoric mania or true mixed mania
        • rapid cycling
    • MOA
      • sodium channel modulator / blocker
    • AE
      • thrombocytopenia
      • pancreatitis
      • liver failure
26
Q

Second & Third line treatment for Bipolar Disorder?

A
  • Atypical Antipsychotics for manic phase (adjunct or monotherapy)
    • ; olanzapine
  • Antidepressants for depressive phase
    • SSRI, risperidone, atypical antipsychoitics (but buproprion, clozapine, venlafaxine)
27
Q

Which atypical antipsychotics are not indicated in bi-polar disorder?

A

buproprion, clozapine, venlafaxine

28
Q

Which SSRI is the most selective

A

Escitalopram

(will cause the least AE)

Neuro III (14 decks)

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