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8. Psychopharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

when was fluoxetine first introduced

A

1980s

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2
Q

why did the introduction of SSRIs revolutionize the treatment of depression

A

had wider therapeutic index and fewer side effects than MAOIs and TCAs which were the only meds previously available

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3
Q

is any one class of antidepressant more effective than any other

A

no–> shown in STAR*D trial

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4
Q

why is paroxetine generally not recommended first line

A

very potent

most severe withdrawal symptoms if stopped abruptly

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5
Q

what side effect are we trying to prevent with the diet restriction required with MAOIs

A

hypertensive crisis

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6
Q

why is the max dose of escitalopram 20mg

A

risk of QTc prolongation at higher doses

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7
Q

antidepressants with more serotonergic action may help more with which symptoms of depression

A

cognitive symptoms such as rumination

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8
Q

antidepressants with more norepinephrine reuptake action may help more with which symptoms of depression

A

more of the behavioural symptoms like anhedonia and low mood

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9
Q

list common side effects of antidepressants

A

nausea
headache
GI issues

most will self resolve within 1-2 weeks

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10
Q

is excessive sweating common in those on SSRI/SNRIs?

A

can be

mechanism not understood–> likely related to 5HT receptors or NE reuptake inhibition

severe cases have been reported

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11
Q

what medication can you add if someone is having excessive sweating on ADs

A

benztropine, clonidine or terazosin may be helpful

can try switching to another SSRI

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12
Q

on which AD is sweating most likely to occur? least likely?

A

sweating is most likely to occur with paroxetine and least likely to occur with escitalopram

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13
Q

in the elderly, falls are more common in which ADs? less likely?

A

more likely to fall if on SNRIs or TCAs

less likely on SSRIs

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14
Q

what blood monitoring is particularly important in elderly people on ADs

A

monitoring of sodium levels–> risk of hyponatremia

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15
Q

what effect do ADs have on sleep efficiency

A

almost all DECREASE sleep efficiency

will also increase number of awakenings, worsen PLMS and RLS, can worsen parasomnias and increase stage 1 sleep

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16
Q

what effect do ADs have on REM sleep

A

almost all will:

increase REM latency

suppress REM

delay REM onset

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17
Q

what placebo response is generally seen in studies of ADs

A

strong placebo response up to 30-40% in MDD (but this does not explain all of the efficacy of SSRIs/SNSRIs)

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18
Q

is paroxetine safe for kids and teens

A

no

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19
Q

have any antidepressants been approved for kids and teens in canada

A

no

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20
Q

which aspects of sexual function are most commonly affected by SSRIs

A

libido and sexual interest–occasionally

ejaculation and orgasm–frequently

erection(potency) in males–rarely affected

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21
Q

agonism at what receptors are thought to cause sexual dysfunction with SSRIs

A

5HT2A and 5HT2C agonism

specifically spinal cord 5HT2A receptor agonism

*serotonergic nerve terminals also target dopamine and norepinephrine pathways in the brain and inhibit their activity and these pathways are involved in desire and arousal phases of the sexual response cycle

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22
Q

name two ADs that are MORE likely to cause sexual dysfunction

A

escitalopram and paroxetine

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23
Q

list 5 ADs that are LESS likely to cause sexual dysfunction

A

buproprion

agomelatine

mirtazapine

vilazodone

vortioxetine

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24
Q

list 5 medication that can be added to an existing AD regimen to address issues related to sexual dysfunction

A

buproprion

bupsirone

cyproheptadine

mirtazapine

sildenafil

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25
Q

what is cyproheptadine

A

a 5HT2 ANTagonist

has antihisaminergic and adrenolytic properties

may help with AD induced sexual dysfunction

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26
Q

how might you prescribe buproprion if being used to help address AD related sexual dysfunction

A

can add buproprion SR 150mg PRN prior to sexual activity or as a daily adjunct

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27
Q

in the most recent YoDA-C study, was there benefit in adding fluoxetine to CBT in kids and teens with depression

A

did NOT find benefit for this

*thus recommendation is that meds should never be first line treatment for C&A depression

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28
Q

what is the mechanism of action generally of SSRIs

A

blocks reuptake of serotonin, increasing levels in the space between neurons

29
Q

ALL SSRIs are first line for which disorders

A

ALL are first line for MDD and panic disorder

30
Q

which 4 SSRIs are first line for SAD

A

escitalopram

fluvoxamine

paroxetine

sertraline

31
Q

list the 3 SSRIs that are first line for GAD

A

escitalopram

paroxetine

sertraline

32
Q

which SSRIs are first line for OCD

A

all EXCEPT for citalopram

33
Q

which SSRIs are first line for PTSD

A

fluoxetine

paroxetine

sertraline

34
Q

which two SSRIs are recommended in situations of MDD + heart disease

A

sertraline

citalopram

35
Q

in what type of dementia are SSRIs first line and why

A

ALL are first line for fronto-temporal dementia–> treats impulsivity

36
Q

other than depressive and anxiety disorders, fluoxetine is also studied in what other conditions?

A

IED (effective)

bulimia

cataplexy

37
Q

name two SSRIs that are approved in pregnancy and breastfeeding

A

sertraline

citalopram

38
Q

name the ONLY SSRI recommended for bipolar II depression

A

sertraline

39
Q

name an SSRI that has shown efficacy in treating BPSD

A

citalopram

(CitAD trial)

40
Q

venlafaxine is first line for what disorders

A

MDD

GAD

SAD

PTSD

panic

(2nd line for OCD and bipolar II depression)

41
Q

name the only first line med for perimenopausal depression

A

desvenlafaxine

42
Q

venlafaxine has noradrenergic activity above what dose

A

above 225mg per day

43
Q

venlafaxine should be avoided in what medical condition

A

glaucoma

44
Q

duloxetine should be avoided in what medical conditions (health canada warning)

A

renal and hepatic impairment

45
Q

duloxetine is first line for which conditions

A

MDD and GAD

46
Q

which is the most noradrenergic of the SNRIs

A

levomilnacipran

47
Q

why should buproprion be reconsidered in those with a seizure history

A

lowers seizure threshold

48
Q

above what dose does buproprion start to lower seizure threshold

A

above 400mg per day

49
Q

what antipsychotics does buproprion interact with

A

risperidone, abilify

due to CYP 2D6 inhibition

50
Q

buproprion is contraindicated in which patients

A

eating disorder patients

51
Q

is there a risk of GI bleed with buproprion

A

no–> also only minimal risk of SIADH and QTc prolongation

52
Q

list possible side effects of buproprion

A

prominent headache

irritability

restlessness

insomnia

dry mouth

nausea

tremor

rare psychosis

seizures

53
Q

can buproprion be used for ADHD

A

third line

54
Q

buproprion can be used to help treat what often comorbid condition (especially in those with schizophrenia)

A

smoking cessation

55
Q

is buspirone recommended for panic disorder

A

no

56
Q

what is the mechanism of action of agomelatine

A

melatonin receptor agonist

57
Q

agomelatine is first line for which conditions

A

MDD and GAD

58
Q

what AD has the most GI side effects

A

vilazodone

59
Q

TCAs are indicated for what types of illnesses (other than depression)

A

funcitional illnesses (i.e IBS, fibromyalgia, functional dyspepsia)

60
Q

should you use TCAs fro bipolar depression

A

no–risk of manic switch

61
Q

why are all TCAs second line in MDD

A

side effects

62
Q

what is the least anticholinergic and best tolerated if the TCAs

A

nortriptyline

(amitriptyline is the most anicholinergic)

63
Q

clomipramine is first line for what condition

A

OCD

64
Q

name a TCA that can be used to treat childhood enuresis

A

imipramine

65
Q

list the MAOis

A

moclobemide

phenelzine

selegiline

66
Q

name the only antidepressant included in the sleep guidelines (for insomnia)

A

doxepin

67
Q

name two tyramine rich foods to be avoided when taking MAOis

A

aged cheese

wine

68
Q

list some side effects associated with MAOIs

A

hypotension

dizziness

dry mouth

GI upset

urinary hesitancy

headache

sexual side effects

weight gain

myoclonic jerks

edema

psychosis

69
Q

why must you be careful is co-prescribing fluoxetine and risperidone

A

can increase plasma concentration of risperidone by 2-3 fold through CYP2D6 inhibition

8. Psychopharmacology (21 decks)

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