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424 Pharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

SSRis

A

Fluoxetine, olanzapine-fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram

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2
Q

Nonselective norepinephrine-serotonin reuptake inhibitors

Tricyclic:

A

amitriptyline, nortriptyline, imipramine, doxepin, trimipramine maleate, amoxapine, desipramine, protriptyline hydrochloride, clomipramine

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3
Q

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

A

Venlafaxine (Effexor), duloxetine, (Cymbalta), milnacipran (Savella), desvenlafaxine (Pristig)

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4
Q

Tricyclic antidepressants:

amitriptyline pharmacodynamics

A

Act on neurotransmitters, serotonin, and norepinephrine (NE), block reuptake in presynaptic neuron.
and histamine and acetylcholine

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5
Q

Tricyclic antidepressants:

amitriptyline ADRs

A

paradoxical diaphoresis, causing anticholinergic effects (dry mouth), orthostatic hypotension, sedation, drowsiness

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6
Q

Tricyclic antidepressants:

amitriptyline patient education

A

Do not discontinue abruptly; avoid OTC medications that stimulate, insomnia or drowsiness.

Must let provider know if having myocardial infarction, glaucoma . avoid in glaucoma

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7
Q

Tricyclic antidepressants:

amitriptyline caution and contraindications

A

cardiovascular disease

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8
Q

Tricyclic antidepressants:

amitriptyline monitoring

A

Must report any chest pain
Reassess patient after 2 to 4 weeks of starting medications: suicide, ADRs
Baseline electrocardiography (EKG).

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9
Q

SSRI pharmacodynamics

A

All SSRIs have selective inhibitory effects on presynaptic serotonin reuptake and weak effects on NE and dopamine neuronal uptake.

Other wording:
affect the serotonin neurotransporter system in the synaptic cleft by blocking the serotonin transporter from returning remaining serotonin to the presynaptic cell. So through this mechanism, more serotonin is available to bind with the postsynaptic receptors.

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10
Q

SSRI ADRs & BBW

A

CNS, n/v/d, sexual dysfunction
Serotonin syndrome , upper GI bleed, hyponatremia, QTC prolongation, headache

BBW: increased risk of suicidal thinking/behavior in childre, adolescent and young adults.
Major depressive disorder and other psych disorders/

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11
Q

SSRI patient education

A

May take 2-6 weeks to see maximum effects
Pregnancy: evaluate risk v. benefit
Pediatrics: fluoxetine first line
Withdrawal symptoms if abruptly discontinued

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12
Q

SSRI patient monitoring

A

Never give more than 4 weeks on first prescription.

Monitor target symptoms.

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13
Q

SNRI indications:

duloxetine, venlafaxine

A

Major depressive disorder, general anxiety disorder, neuropathy pain, fibromyalgia

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14
Q

SNRI pharmacodynamics

A

Inhibit reuptake of both norepinephrine and serotonin.

boost dopamine in prefontal cortex

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15
Q

SNRI ADRs

A

Headache, somnolence, dizziness, insomnia, fatigue, dry mouth, constipation, orthostatic hypotension, erectile dysfunction, ejaculation failure

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16
Q

SNRI patient education

A

Adherence, suicide ideation, avoidance of OTC medications that stimulate, insomnia or drowsiness, suicide ideation

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17
Q

SNRI monitoring

A

May increase serum transaminase levels: Watch in patients with liver disease.
Monitor suicide risk, activation of hypomanic or manic symptoms

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18
Q

atypical antidepressants:
buproprion (wellbutrin, zyban) and Mirtazapine (remeron)

pharmacodynamics

A

Exact mechanism of action unknown

Mirtazapine is a antagonist of 5-HT2, 5-HT3 and histamine (H1) receptors

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19
Q

buproprion (wellbutrin, zyban) and Mirtazapine (remeron) contraindications

A

seizure disorder

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20
Q

buproprion (wellbutrin, zyban) and Mirtazapine (remeron) ADRs

A

Bupropion may cause insomnia.

Mirtazapine causes drowsiness, greater at 15 mg/ day than at 30 mg/day.

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21
Q

buproprion (wellbutrin, zyban) and Mirtazapine (remeron) monitoring

A

depression and suicide

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22
Q

buproprion (wellbutrin, zyban) and Mirtazapine (remeron) patient education

A

Take mirtazapine before bedtime because it may cause drowsiness
Wellbutrin does not have the sexual dysfunction side effect like SSRIs.

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23
Q

typical antipsychotics

A

Phenothiazine: chlorpromazine (Thorazine), prochlorperazine.

Non Phenothiazines: haloperidol (Haldol)

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24
Q

atypical antipsychotics

A 
Aripiprazole (Abilify)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Olanzapine-fluoxetine: Symbyax
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
25
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol)

pharmacodynamics

A

Block dopamine receptors in the basal ganglia, hypothalamus, limbic system, and medulla

26
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol)
side effects

A

Parkinsonism, prolactin elevation, and extrapyramidal symptoms (EPS); concurrent therapy with anticholinergic

27
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol)
contraindications

A

Narrow-angle glaucoma, bone marrow depression, and severe liver or cardiovascular disease
Black Box: increased mortality in older adult patients

28
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol) ADRs

A

Neuroleptic malignant syndrome (NMS), EPS, sedation, weight gain

29
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol)
patient education

A

drug interactions, avoid sudden withdrawal, sun protection

30
Q

typical antipsychotics
Phenothiazines: chlorpromazine (Thorazine)
Non Phenothiazine: haloperidol (Haldol) monitoring

A

Abnormal Involuntary Movement Scale (AIMS)

31
Q

atypical antipsychotics pharmacodynamics

A

blocks serotonin receptors in the cortex

32
Q

atypical antipsychotics contraindications

A

hepatic and renal disease

33
Q

atypical antipsychotics ADRs

A

seizures, weight gain, diabetes, hyperprolactinemia, dizziness, orthostatic hypotension,
Clozapine: fatal agranulocytosis

34
Q

atypical antipsychotics patient education

A

ADRs, do not stop taking.

35
Q

atypical antipsychotics monitoring

A

symptoms and ADRs

36
Q

SSRI and other 2nd generation antidepressants are

A

more effective in pediatric anxiety but not pediatric depression.

37
Q

fluoxetine is least likely to cause

A

weight gain.
start low and titrate slow.
long half life… meaning they wont feel bad if they miss a dose by accident

38
Q

paroxetine (paxil) quickfacts

A

interacts with a lot of other medications. so try to avoid in the elderly.

has significant withdrawal profile, patients will instantly get side effects.

highest weight gain in all the antidepressants.

can be sedating

39
Q

citalopram (celeza) BBW

A

QTC prolongation

40
Q

ecitalopram (lexapro)

A

eight neutral, neutral side effects.

geat choice for anxiety or depression.

41
Q

venlafaxine / desvenlafaxine monitoring:

A

heart rate and bp.

42
Q

mirtazepine

A

low doses causes sedation..

as you increase the dose, it will decrease the sedative factor

43
Q

bupropion (wellbutrin)

A

lowers seizure threshold. avoid in pts with seizure risk.

avoid this in patients with anxiety because it spikes fight of flight response

44
Q

TCAs quick facts

A 
highly cardiotoxic.
fatal in overdose.
causes serious arrythmias
narrow therapeutic index.
weight gain is common
orthostatic hypotension
45
Q

MAOIs quick facts

A

rarely seen in primary care.
interacts with tyramine.
causes HTN crisis.
dangerous in overdose

46
Q

paroxetine, mirtazapine, amytriptaline

A

highest association of weight gain

47
Q

paroxetine is the most

A

sedating antidepressant

48
Q

fluoxetine is the most

A

energizing antidepressant

49
Q

antidepressants in pregnancy

A

increased episodes of spontaneous abortion.

risk of stopping antidepressants for mother.

50
Q

sertraline

A

ok for lactation

51
Q

fluoxetine

A

ok in pregnancy

52
Q

clinical use for SSRI

A

depressive, anxiety, panic, obsessive-compulsive disorder, body dysmorphic disorder, bulimia, premenstrual dysphoric disorder, post-traumatic stress disorder, and vasomotor symptoms of menopause.

53
Q

what nonpharmacologic substances can contribute to serotonin syndrome?

A

St. John’s wort, grapefruit, ergot, woodrose, SAMe, lithium over the counter

54
Q

fluoxetine and ecitlopram

A

FDA approved for use in pediatrics

55
Q

sertraline and lexapro

A

lowest dose that goes to baby, usually undetected. can be used in lactation

56
Q

SSRI should be tapered how?

A

slowly

57
Q

desvenfalaxine indications

A

used for major depression, vasomotor symptoms, fibromyalgia, generalized anxiety, social anxiety, panic disorders, PTSD, which is Post-Traumatic Stress Disorder, postmenstrual dysphoric disorder.

58
Q

An 8-year-old has been diagnosed with major depression. Which medication is preferred for this patient?

A

fluoxetine

424 Pharmacology (11 decks)

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