Antidepressants Flashcards

(69 cards)

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
what is cyproheptadine
a 5HT2 ANTagonist has antihisaminergic and adrenolytic properties may help with AD induced sexual dysfunction
26
how might you prescribe buproprion if being used to help address AD related sexual dysfunction
can add buproprion SR 150mg PRN prior to sexual activity or as a daily adjunct
27
in the most recent YoDA-C study, was there benefit in adding fluoxetine to CBT in kids and teens with depression
did NOT find benefit for this *thus recommendation is that meds should never be first line treatment for C&A depression
28
what is the mechanism of action generally of SSRIs
blocks reuptake of serotonin, increasing levels in the space between neurons
29
ALL SSRIs are first line for which disorders
ALL are first line for MDD and panic disorder
30
which 4 SSRIs are first line for SAD
escitalopram fluvoxamine paroxetine sertraline
31
list the 3 SSRIs that are first line for GAD
escitalopram paroxetine sertraline
32
which SSRIs are first line for OCD
all EXCEPT for citalopram
33
which SSRIs are first line for PTSD
fluoxetine paroxetine sertraline
34
which two SSRIs are recommended in situations of MDD + heart disease
sertraline citalopram
35
in what type of dementia are SSRIs first line and why
ALL are first line for fronto-temporal dementia--> treats impulsivity
36
other than depressive and anxiety disorders, fluoxetine is also studied in what other conditions?
IED (effective) bulimia cataplexy
37
name two SSRIs that are approved in pregnancy and breastfeeding
sertraline citalopram
38
name the ONLY SSRI recommended for bipolar II depression
sertraline
39
name an SSRI that has shown efficacy in treating BPSD
citalopram (CitAD trial)
40
venlafaxine is first line for what disorders
MDD GAD SAD PTSD panic (2nd line for OCD and bipolar II depression)
41
name the only first line med for perimenopausal depression
desvenlafaxine
42
venlafaxine has noradrenergic activity above what dose
above 225mg per day
43
venlafaxine should be avoided in what medical condition
glaucoma
44
duloxetine should be avoided in what medical conditions (health canada warning)
renal and hepatic impairment
45
duloxetine is first line for which conditions
MDD and GAD
46
which is the most noradrenergic of the SNRIs
levomilnacipran
47
why should buproprion be reconsidered in those with a seizure history
lowers seizure threshold
48
above what dose does buproprion start to lower seizure threshold
above 400mg per day
49
what antipsychotics does buproprion interact with
risperidone, abilify due to CYP 2D6 inhibition
50
buproprion is contraindicated in which patients
eating disorder patients
51
is there a risk of GI bleed with buproprion
no--> also only minimal risk of SIADH and QTc prolongation
52
list possible side effects of buproprion
prominent headache irritability restlessness insomnia dry mouth nausea tremor rare psychosis seizures
53
can buproprion be used for ADHD
third line
54
buproprion can be used to help treat what often comorbid condition (especially in those with schizophrenia)
smoking cessation
55
is buspirone recommended for panic disorder
no
56
what is the mechanism of action of agomelatine
melatonin receptor agonist
57
agomelatine is first line for which conditions
MDD and GAD
58
what AD has the most GI side effects
vilazodone
59
TCAs are indicated for what types of illnesses (other than depression)
funcitional illnesses (i.e IBS, fibromyalgia, functional dyspepsia)
60
should you use TCAs fro bipolar depression
no--risk of manic switch
61
why are all TCAs second line in MDD
side effects
62
what is the least anticholinergic and best tolerated if the TCAs
nortriptyline (amitriptyline is the most anicholinergic)
63
clomipramine is first line for what condition
OCD
64
name a TCA that can be used to treat childhood enuresis
imipramine
65
list the MAOis
moclobemide phenelzine selegiline
66
name the only antidepressant included in the sleep guidelines (for insomnia)
doxepin
67
name two tyramine rich foods to be avoided when taking MAOis
aged cheese wine
68
list some side effects associated with MAOIs
hypotension dizziness dry mouth GI upset urinary hesitancy headache sexual side effects weight gain myoclonic jerks edema psychosis
69
why must you be careful is co-prescribing fluoxetine and risperidone
can increase plasma concentration of risperidone by 2-3 fold through CYP2D6 inhibition