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Pharmacology Exam 3 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

State the duration of therapy for antidepressant therapy?

A

Acute: 8-12 weeks
Maintenance: 6-24 months or longer

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2
Q

What are the monoamines?

A

dopamine, norepinephrine, serotonin

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3
Q

What is the monoamine hypothesis of depression?

A

Depression is caused by a functional insufficiency of monoamine neurotransmitters

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4
Q

How do antidepressants work?

A

Antidepressants works by restoring homeostatic equilibrium of the NT system, by increasing the availability of these NTs - as their names suggest, they target the vesicles and recycler molecules in the synapse, preventing the reabsorption of NT into the axon terminal, which results in more NT in the synaptic cleft for longer, therefore more chances for the NT to bind.

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5
Q

SSRIs MOA

A

block the reuptake of serotonin

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6
Q

SNRIs MOA

A

block the reuptake of serotonin and norepinephrine

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7
Q

NDRIs MOA

A

block the reupatake of norepinephrine and dopamine
also used for smoking cessation

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8
Q

SSRI common drug names

A

Citalopram (Celexa)
Escitalopram (Cipralex)
Sertraline (Zoloft)
Fluoxetine (Prozac)

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9
Q

SNRI common drug names

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

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10
Q

NDRI common drug names

A

Bupropion (Wellbutrin)

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11
Q

SSRI side effects

A

Insomnia (take AM) , sedation (take PM) , headache.
Nausea, vomiting (goes away after you get used to new drug), diarrhea, weight gain
Sexual dysfinction
Hyponatremia
Serotonin syndrome (in combination)

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12
Q

SNRI side effects

A

same as SSRI
PLUS increased BP and increased HR

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13
Q

NDRI side effects

A

Seizure risk (dose related) insomnia,, agitation, headache
Stimulating (not ideal for folks with anxiety)

NO weight gain of sexual dysfunction, or serotonin syndrome

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14
Q

NDRI contraindications

A

Bulimia, anorexia, seizure disorder, abrupt withdrawal from alc or benzos

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15
Q

what is serotonin syndrome?

A

Serotonin syndrome is usually the result of the combination of two or more drugs that enhance the transmission of serotonin, resulting in excessive serotonergic activity in the CNS. It can happen after a single serotonergic drug or an increased dose (and includes OTC and NHPs that increase serotonin) Fast onset

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16
Q

symptoms of serotonin syndrome

A
  • Mental/behavioural: anxiety, agitation, confusion, seizures, coma
  • Muscle tone: tremor, shivering, rigid, hyperreflexia
  • Autonomic: hypertension, fever, tachycardia, vomiting, diaphoresis (excess sweating) diarrhea,
17
Q

risks of antidepressant withdrawal syndrome

A

o Antidepressant use > 5 weeks
o High dose
o Agents with short half lives (paroxetine, venlafaxine) are worse than agents that get removed slowly
o Previous hx of antidepressant withdrawls

18
Q

symptoms of antidepressant withdrawal syndrome

A

FINISH
Flu
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperactivity

19
Q

Why should antidepressants be tapered off of before discontinuation/switching of agents.

A

to avoid withdrawal & the unpleasant and dangerous symptoms

20
Q

What should you monitor the infant for in ALL antidepressants

A

sedation, irritability, poor feeding/weight gain

21
Q

SSRI potential risks in pregnancy

A
  • NAS (neonatal abstinence syndrome)
  • PPHN (Persistent Pulmonary Hypertension of the newborn)
22
Q

what are the potential risks of paroxetine in pregnancy

A

conflicting evidence about potential correlation to cardiac anomalies

23
Q

what is the most commonly used class of anti-depressant in pregnancy

A

SSRI

24
Q

What is PPHN (incl symptoms)

A

Persistent Pulmonary Hypertension of the newborn:
maintained high vascular resistance to the lungs = poor oxygenation -

25
Q

What is NAS

A

Neonatal abstinence syndrome, 30% of infants, resolves in 2 weeks with supportive care (irritability, tachypnea, temp instability) not associated with an increased risk of mortality or neurodevelopmental problems

26
Q

SNRI risks in pregnancy

A

Inconsistent data linking bupropion explore to cardiac anomalies, overall evidence does not suggest an increased rate of congenital malformation with first trimester exposure

27
Q

What have case reports associated with NDRI in bf?

A

2 case reports of seizures, although adverse effects are very rare

28
Q

What clinical tip should you rememeber re: long hospital stays

A

Going through SSRI withdrawal while also in labour during a longer hospital stay is not fun!! remember your meds in your hospital bag

Pharmacology Exam 3 (8 decks)

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