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69:252 Psychopharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Major Depressive Disorder
Depression with Psychotic Features
Depression NOS
Depression with Seasonal Pattern
Dysthymia
Obsessive Compulsive Disorder
Panic Disorder
Social Anxiety Disorder/Social Phobia
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder
Bulimia Nervosa
Smoking Cessation
Insomnia
Fibromyalgia
Pain Management
Migraine Headaches

A

Antidepressant Indications:

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2
Q

Also known as the Biogenic Amine Theory of Depression
Depression is thought to be caused be a deficiency of norepinephrine (NE) and/or serotonin (5HT)

A

Monoamine Neurotransmitter Dysfunction

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3
Q

Biogenic amines or mono amines -are Norepinephrine, dopamine and serotonin
Deficiencies in __ and ____ may be a result of:
1. Enzyme breakdown of NE and 5 HT - Monoamine oxidase breaks NE/5HT down to be recycled or restored within the neuron
2. Rapid fire of neurons - Rapid fire of the neurons may lead to NE/5HT depletion
3. Upregulation - The # or sensitivity of postsynaptic receptors may increase therefore depleting the NE/5HT levels. (also called upregulation)

A

NE; 5 HT

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4
Q

is the enzymes that catalyzes the breakdown of monoamines such as serotonin, dopamine, and norepinephrine

A

Monoamine oxidase

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5
Q

Tricyclic Antidepressants (TCA’s)
Monoamine Oxidase Inhibitors (MAOI’s)

A

FIRST GENERATION

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6
Q

Selective Serotonin Reuptake Inhibitors
Serotonin and Norepinephrine Reuptake Inhibitors
Atypical Antidepressants

A

SECOND GENERATION

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7
Q

TCA’s all reduce the reuptake of 5HT and NE into nerves
This leads to an accumulation of NE and 5HT in the presynaptic cleft
This also leads to increased stimulation of the postsynaptic receptors
TCAs also block dopamine, acetylcholine (cholinergic) and histamine receptors

A

Tricyclic Antidepressants (TCA’s)

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8
Q

Non-selective
TCA’s all reduce the uptake of 5HT and NE into nerves
This leads to an accumulation of NE and 5 HT in the presynaptic cleft
This also leads to increased stimulation of the postsynaptic receptors
TCAs also block dopamine, acetylcholine (cholinergic) and histamine receptors

A

Tricyclic Antidepressants (TCA)

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9
Q

Inhibit Monoamine oxidase (MAO)
Allows accumulation of NE, 5 HT and dopamine in the synaptic cleft and the neuronal storage vesicles of the presynaptic neuron

A

Monoamine Oxidase Inhibitors

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10
Q

Specifically block 5HT with little to no effect on NE
Increase the levels of 5HT in the synaptic cleft
Less adverse effects than TCAs and MAOIs
Prototype: fluoxetine (Prozac)

A

Selective Serotonin Reuptake Inhibitors

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11
Q

Prevent the reuptake of 5HT and NE
Also, weakly inhibit Dopamine reuptake
This leads to accumulation of 5HT, NE and Dopamine in the Synaptic Cleft

A

Selective Serotonin Norepinephrine
Reuptake Inhibitors (SSNRI/SNRI)

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12
Q

used as a sleep aid – ______

A

trazadone

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13
Q

ABSORPTION
GI Tract
DISTRIBUTION
Widely distributed through the body
METABOLISM
Liver
EXCRETION
Kidneys
Cross Placenta and enter breast milk

A

Antidepressants ADME

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14
Q

*MAOIs are not trialed until two other chemical classes have failed
*First drug is tapered off while second one is started in most cases
*MAOI and RIMA need a 2 week wash out period

A

Considerations in Dosing for Antidepressants

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14
Q

*Sexual side effects

A

SSRI

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15
Q

*Sexual side effects
*Hyponatremia (SIADH)
*Palpitations
*Increased blood pressure

A

SSNRI

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16
Q

*Drowsiness, dizziness, headache, sedation
*Constipation, dry mouth, sweating
*GI upset
*Serotonin Syndrome
*Antidepressant Discontinuation Syndrome (except fluoxetine)

A

ALL ANTI-DEPRESSANTS

17
Q

If stopped suddenly, the following symptoms can occur:
Flu like symptoms
Emotional lability
Dysesthesia (electric shock sensations)
Vivid dreams/nightmares
Impaired concentration and confusion
Anxiety and agitation
Tremor
Dizziness
Risk of seizure
(not prozac - long half life)

A

Antidepressant Discontinuation Syndrome

18
Q

Cause: excessive serotonin in the synaptic cleft, caused by:
combining medications that increase CNS serotonin levels

Severe cases:
Hyperthermia, seizures, rhabdomyolysis

A

Serotonin Syndrome

19
Q

Risk Factors:
Recent start or increase of medication known to increase serotonin levels
Polypharmacy with more than one drug that increases serotonin (including herbal medication and illicit drugs)

A

Serotonin Syndrome

20
Q

Prevention and Treatment:
1. Provide person-centred education
2. Assess all medications, supplements, foods and recreational drugs
3. Discontinue all substances that may be the causative factors
4. Treat the symptoms either inpatient or outpatient dependent on severity.
- Muscle relaxants and/or medications to control pulse and blood pressure
- Serotonin Blocking Agents (cyproheptadine)
- IV and O2

A

Serotonin Syndrome

21
Q

Signs and Symptoms: Hyperreflexia, tremors, myoclonus, diaphoresis, confusion, agitation
Lab Findings: Non specific
Cause: Increased serotonin
Onset: Minutes to Hours
Fever: Moderate
Hyperreflexia: Moderate
Myoclonus: Moderate
Muscle Rigidity: Moderate

A

Serotonin Syndrome

22
Q

Signs and Symptoms: Severe muscle rigidity, diaphoresis, delirium, fluctuating BP, tachycardia, EPS
Lab Findings: Elevated CPK and leukocytosis (high white blood cell)
Cause: Blockade of dopamine receptors OR abrupt withdrawal of a dopamine agonist
Onset: Days to Weeks
Fever: High
Hyperreflexia: Rare
Myoclonus: Rare
Muscle Rigidity: High

A

Neuroleptic Malignant Syndrome

23
Q

Lethal doses of TCAs are close to accepted dose range
Overdose risk is high
Death may result from: hypotension, uncontrollable seizures and or cardiac arrhythmia
TCAs should NOT be prescribed for any clients at risk of suicide or a history of suicidal ideation

A

TCAs and Suicidal Ideation

24
Q

Sometimes termed Irreversible MAOI
MAOI’s inhibit release of norepinephrine (NE) in the presynaptic cell
NE is a potent vasoconstrictor
If there is a sudden release of NE it can significantly increase blood pressure (Hypertensive crisis)

FIRST symptom OCCIPITAL HEADACHE (severe)
Stiff neck, chest pain, dizziness, incoordination, low energy, sudden changes in mood, constipation, difficulty urinating, fever, diaphoresis, nausea, & vomiting
May cause stroke

A

MAOI and Risk of Hypertension

25
Q

Dried Sausages – Salami, pepperoni, pastrami
Alcoholic Beverages – Beer, unpasteurized beer, micro breweries on tap
Sauerkraut, kimchi, other fermented veggies
Fermented Soy Products – soy sauce, teriyaki, soybean paste, tofu, miso soup
Fava or broad bean pods, banana peel , yeast spreads (Marmite or vegemite), nutritional yeast
All aged and matured cheeses
Any improperly stored meats, fish and poultry

A

MAOI and Tyramine

26
Q

High risk TCA’s, MAOI’s, SSRI’s

A

Suicidal Ideation

27
Q

Hypotension
Cerebral Vascular Disorders
Seizure Disorder
Frequent Headaches

A

Antidepressant - Precautions

28
Q

Known hypersensitivity
Alcohol misuse
Cocaine and amphetamines
Herbal preps and vitamins that increase serotonin
Hepatic and/or renal impairment
QT Prolongation
Mania

A

Antidepressant Contraindications

29
Q

_______ – individuals in an acute confused state (can increase confusion)

A

SNRI/ RIMA

30
Q

_____ – Hx. of myocardial infarction or congestive heart failure

A

TCA

31
Q

______ – Hx. congestive heart failure, Anyone scheduled for elective surgery (anesthesia), certain foods and beverages

A

MAOI

32
Q

_______ use disorder associated w depression
This is more of a caution – requires education
No prescription medication says “take with alcohol” but that shouldn’t mean if they have alcohol use disorder that they can’t be prescribed an antidepressant – just means that we need to provide education about the safety

A

Alcohol

33
Q

_____ Contraindications
Hx. congestive heart failure
Anyone scheduled for elective surgery (due to anesthesia)
Food and beverages high in tyramine

A

MAOI

34
Q

_____ – Interact with the majority of medications available
1-2 week wash out period is needed with all antidepressants before starting MAOI
Except Fluoxetine – it needs a 5 – 8 week wash out period
Severe caution needs to be used with prescribing
Client psychoeducation around MAOIs is required

A

MAOIs

35
Q

Drug of choice because less sedative, anticholinergic, cardiotoxic and psychomotor effects than other antidepressant

A

SSRIs

36
Q

First Line Treatment – should include: sleep hygiene, exercise, regular dietary patterns, consistent parenting and practical problem solving regarding school and life.

A

Children and Youth

37
Q

Combining ____ with antidepressants is the best outcome
Children and youth need to be closely monitored for suicidal ideation and adverse effects

A

CBT

38
Q

_____ - are contraindicated in adolescents and children with a history of suicide
-Imipramine is sometimes used for enuresis in children

A

TCAs

39
Q

MAOIs should be avoided because of the dietary restrictions.

A

Children and Youth

40
Q

_____ - Fluoxetine (Prozac) and citalopram (Celexa)– are considered first line antidepressants for children and youth with the best benefit-risk ratio

A

SSRIs

69:252 Psychopharmacology (14 decks)

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