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Pharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Monoamine Oxidase Inhibitors (names)

A

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline

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2
Q

MAOI MOA

A

Blocks the inhibitory effects of MAO so that there will be more 5HT, NE & DA in the synaptic cleft

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3
Q

MAOI site of action

A

Mitochondria

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4
Q

Hydrazine derivative MAOI

A

Phenelzine

Isocarboxazid

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5
Q

Non-hydrazine derivative MAOI

A

Tranylcypromine

Selegiline

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6
Q

Preference of MAO-A & MAO-B

A 
MAO-A = NE & 5HT
MAO-B = DA & Tyramine
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7
Q

MAOI AEs (9)

A 
Drowsiness
Insomnia
Nausea
O. Hypotension
Weight gain
Muscle pain
Sexual dysfunction
Serotonin syndrome
Cheese reaction
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8
Q

What drugs causes Serotonin syndrome?

How does this happen?

A

MAOI + any Serotonergic agent

Overstimulation of 5HT1A & 5HT2 receptors

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9
Q

Symptoms of Serotonin Syndrome

A

Muscle rigidity
Hyperthermia
Myoclonus

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10
Q

Serotonin syndrome management

A

“4S”

  • Serotonergic agent discontinuation
  • Supportive care
  • Sedation w/ Benzos
  • Serotonin antagonist = Cyproheptadine
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11
Q

Cyproheptadine + Benzo is used for?

A

Serotonin syndrome management

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12
Q

Cause of Cheese Reaction?

A

Excess tyramine buildup (MAO degrade tyramine in cheese, wine, etc)

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13
Q

Symptoms of Cheese reaction

A
  • Tachycardia
  • Hypertension
  • Arrhythmias
  • Seizures
  • Stroke
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14
Q

MAOI Contraindications “2Ps”

A

“2Ps”

OTC cold preparations:

  • pseudoephedrine
  • phenylpropanolamine
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15
Q

Cheese Reaction (Tyramine-induced HTN) Management

A

“2Ps”

  • Phentolamine
  • Prazosin
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16
Q

Tricyclic Antidepressants (names)

A

“Pramine” & “Triptyline”

  • Amitriptyline
  • Clomipramine
  • Desipramine
  • Imipramine
  • Nortriptyline
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17
Q

TCAs MOA

A

Blocks SERT & NET (Inc. 5HT & NE in cleft)

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18
Q

Selectivity of TCAs for SERT & NET

A

SERT: Clomipramine
NET: Desipramine & Nortriptyline

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19
Q

TCAs Overdose Management

A

Sodium bicarbonate to reverse the conduction block

20
Q

Why are TCAs avoided in elderly?

A

Can cause:

  • Orthostatic hypotension
  • Reflex tachycardia
21
Q

Selective Serotonin Reuptake Inhibitors (SSRI) (names)

A
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
22
Q

DOC for treating depression

A

SSRI

23
Q

SSRI MOA

A

Blocks SERT = No serotonin reuptake

24
Q

SSRI AEs

A 
Gut = nausea, GI upset & diarrhea
Dec sexual function & interest
Weight gain
Serotonin syndrome when used w/ MAOI
Overdose = Seizures
25
Q

what are the best anti-depressants to start the pt. on?

A

Citalopram, setraline or Escitalopram

Low potential for interactions

26
Q

Serotonin & Norepinephrine Reuptake Inhibitors (SNRI) (names)

A
  • Venlafaxine

- Duloxetine

27
Q

What drug should you switch the pt to if SSRIs provide no relief?

A

SNRIS - Venlafaxine & Duloxetine

28
Q

Norepinephrine & Dopamine Reuptake Inhibitors (NDRI) (names)

A
  • Bupropion
29
Q

Overdose of Bupropion causes?

A

-Seizures (so contraindicated in pts. w/ seizure disorders)

30
Q

Noradrenergic & Specific Serotonergic Antidepressants (NASSA) (names)

A
  • Mirtazapine
31
Q

NASSA (Mirtazapine) MOA

A
  • Central presynaptic A2 antagonist - Inc NE & 5HT release
  • 5HT2 & 5HT3 Antagonist
  • H1 antagonist
32
Q

NASSA (Mirtazapine) AE

A
  • Sedation & weight gain (H1)
33
Q

Antidepressant Discontinuation Syndrome symptoms

A
  • Anxiety, irritability & tearfulness
  • Dizziness
  • Headache
  • Lethargy
  • Flu-like symptoms
  • Electric-shock sensations
  • Insomnia
  • Nausea, vomiting & diarrhea
34
Q

Drugs most likely to cause Antidepressant Discontinuation Syndrome

A
  • Paroxetine
  • Venlafaxine
    Due to short half life
35
Q

Drug least likely to cause Antidepressant Discontinuation Syndrome

A
  • Fluoxetine

Due to long half life

36
Q

Clinical uses of SSRIs

A
  • Depression (DOC)
  • Anxiety (DOC) - GAD, SAD, PTSD, PD & OCD
  • Eating disorders - Bulimia
  • Premenstrual Dysphoric Disorder
37
Q

Clinical uses of Bupropion

A
  • Depression

- Smoking cessation

38
Q

Clinical uses of TCAs & SNRIs

A
  • Depression

- Chronic pain (neuropathic, etc.)

39
Q

DOC for Bipolar Disorder

A
  • Lithium

NB: AD may worsen the symptoms of Bipolar so always rule out the disorder before using AD

40
Q

Lithium MOA

A

Inhibits Inositol polyphosphatase & monophosphatase –> No Inositol regeneration

41
Q

Adverse effects of Lithium

A
  • Tremor, ataxia & aphasia
  • Sedation & seizures
  • Weight gain
  • Hypothyroidism
  • Nephrogenic DI
  • Edema
  • Dermatitis
  • Alopecia
  • Leukocytosis
42
Q

Management of Lithium-induced Nephrogenic DI

A
  • Discontinue OR
  • Add Amiloride
  • Thiazides & NSAIDs
43
Q

Contraindications of Lithium

A
  • Nursing mothers

- Cat D in pregnancy - Congenital cardiac anomalies

44
Q

Monitoring the bodily effects of Lithium

A
  • Serum lithium conc.
  • Thyroid function
  • Renal function
45
Q

Drugs that reduce the Renal clearance of lithium

A
  • Thiazides
  • NSAIDs
  • ACEI
  • ARBs
46
Q

Alternatives to Lithium

A

Antiepileptics - Valproate, Carbamazepine & Lamotrigine

Atypical AP - Olanzapine, Aripiprazole, Quetiapine & Risperidone

47
Q

Monitoring of Lithium-alternatives

A
  • Valproate - Liver function & CBC

- Carbamazepine - CBC

Pharmacology (16 decks)

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