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PSYC475 psychopharm > antidepressants > Flashcards

antidepressants Flashcards

1
Q

gepirone (trade name) is….

drug class?

A

Exxua

serotonin modulators?

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2
Q

escitalopram (trade name) is….

drug class?

A

Lexapro

SSRI

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3
Q

paroxetine (trade name) is….

drug class?

A

Paxil

SSRI

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4
Q

esketamine (trade name) is….

drug class?

A

Spravato

NMDA receptor antagonists

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5
Q

monoamine theory of depression

A

depression is due to monoamine deficiency

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6
Q

NTs involved in depression

A

DA, 5HT, NE, E

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7
Q

DA, 5HT, NE, E are all …

A

monoamines

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8
Q

second messanger systems in depression

A
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9
Q

types of antidepressants

A
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10
Q

MAOIs

A

Reduce enzymatic deactivation of monoamines

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11
Q

tricyclics

A

imipramine (Tofranil)
desipramine (Norpramin; active metabolite of Imipramine)
trimipramine (Surmontil)
protriptyline (Vivactil)
amitriptyline (Elavil)
nortriptyline (Pamelor, Aventil; active metabolite of amitriptyline)
doxepin (Adapin, Sinequan)
clomipramine (Anafranil)

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12
Q

how do TCAs work?

A

Block reuptake of 5-HT, NE

Block post-synaptic H, AChM, NE

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13
Q

what does blockage of H do?

A

Blockade of H = drowsiness, sedation

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14
Q

what does blockage of AChM do?

A
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15
Q

SE profiles for TCAs

A

Blockade of H = drowsiness, sedation

– Blockade of AChM = confusion, memory & cognitive impairment (hippocampus), dry mouth, blurred vision, tachycardia, urinary retention (ANS)

– Blockade of NE receptors = orthostatic hypotension (PNS)

  • Side effect profiles vary, depending on affinity for H, AChM,
    NE
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16
Q

issues with TCAs

A

Cardiotoxic in large doses
Risk of OD

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17
Q

what drugs are good for pts w depression and chronic pain? why?

A

TCAs; analgesic properties

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18
Q

TCAs absorption

A
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19
Q

MAOIs inhibit ______?

A

MAOa; Most bind irreversibly to MAOA

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20
Q

issues with MAOIs

A

Consumption of foods containing high levels of tyramine is problematic
Product of fermentation
“Wine and Cheese Effect”
Increases blood pressure
Adherence to a strict diet eliminates danger

Low TI, so OD is possible

Side Effects

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21
Q

MAOI SE profile?

A

Sedation
Orthostatic hypotension
Dry mouth
Nervousness
Muscle ache
Paresthesia (pricking or tingling sensation)—usually in extremities
may be from the MAOI’s interference with vitamin B6 metabolism
100 mg of vitamin B6 daily may reduce or eliminate these symptoms
Insomnia
Weight gain
Sexual dysfunction
Anorgasmia (inability to achieve orgasm)
Impotency
Urinary difficulty

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22
Q

selegiline is a _____; it is different than others because _____

A

MAOI; it is transdermally applied so no issues w GI tract

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23
Q

SSRIs
(common ones and their trade names)

A

Fluoxetine (Prozac)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)

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24
Q

how do SSRIs work?

A

Do not bind to 5-HT receptors, rather make 5-HT more available to
bind with receptors

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25
Q

side effects of SSRIs

A

withdrawal syndrome

sexual dysfunction

serotonin syndrome

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26
Q

what is serotonin syndrome? what causes it ?

A

High doses, combination of SSRI with another 5-HT agonist
Cognitive disturbances, agitation, ANS dysfunction (like high fevers) motor problems, hallucinations

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27
Q

acronym for SSRI withdrawal syndrome

A

FINISH: Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, Hyperarousal (FINISH)

28
Q

fluoxetine trade name

A

Prozac

29
Q

what was the first SSRI

A

prozac

30
Q

sertraline (trade name)

A

zoloft

31
Q

issue w zoloft

A

Higher risk of serotonin syndrome and withdrawal syndrome

32
Q

fluvoxamine (trade name)

A

Luvox

33
Q

what drug has the shortest half life of all SSRIs?

A

fluvoxamine (Luvox)

34
Q

what is Luvox best used for? why?

A

High affinity for NE α1, which produces anxiolytic effects
Often used to treat anxiety disorders

35
Q

SNRIs

A

Highly selective for NT and 5-HT, with little binding to other receptors
Fewer side effects, particularly ones related to increased serotonergic tone
Analgesic

36
Q

issues of nefazodone

A

Increased risk for severe liver damage

37
Q

nefazodone (trade name)

A

Serzone

38
Q

what 2 SNRIs are approved for tmt of fibromyalgia

A

milnacipran (Savella)
duloxetine (Cymbalta)

39
Q

milnacipran (trade name)

class of drug

A

Savella

SNRI

not approved for depression

40
Q

issues w duloxetine (Cymbalta)

A

Not recommended for bipolar pxts; may induce mania

41
Q

duloxetine (trade name)

drug class?

A

cymbalta

SNRI

42
Q

venlafaxine (Effexor) is used off label for

A

cocaine dependence

43
Q

issues w venlafaxine (Effexor)

A

inc liability for suicide

44
Q

tetracyclics (common ones, how do they work?)

used for?

A

mirtazepine (Remeron)

Does not block reuptake transporters

Increases release of 5-HT and NE

45
Q

pros of mirtazepine (Remeron)?

A

Increased appetite/weight gain
Good for txting pxts with eating or wasting disorders, and elderly pxts

Very few sexual side effects

46
Q

STARD study? conclusions?

A

Sequenced Treatment Alternatives to Relieve Depression

~2/3 pxts achieved remission
Substantial participation withdrawal after each phase:
21% phase 1, 30% phase 2, 42% phase 3
Before giving up on antidepressants
Try 2 or 3
Give them at least 12 weeks (3 months)
It may be that antidepressant therapy works better in more severely depressed pxts (HAM-D >25)

47
Q

why is gepirone special?

A
48
Q

The neurogenic theory of depression stems from recent findings that in the mature brain

A

Neurons are capable of being repaired and produced

49
Q

First-generation tricyclic antidepressants are defined by a commonality in basic

A

Molecular structure

50
Q

Which statement below best describes the pharmacodynamics of Escitalopram

It primarily effects ____ systems with minimal effects on ___, ___ , & ___ systems

A

It primarily effects 5-HT systems with minimal effects on NE/DA/ACh systems

51
Q

Orthostatic hypotension is a common side effect of

A

TCAs and MAOIs

52
Q

What is the pharmacodynamic mechanism of bupropion?

(trade name of buproprion?)

A

it blocks DA & NE reuptake

wellbutrin

53
Q

An SNRI would be a good treatment choice for someone

A

with MDD and pain

54
Q

The tricyclic antidepressants differ from Prozac and Zoloft in that they also have major effects on ________________.

A

norepinephrine

55
Q

maprotiline (trade name, class of drug?)

A

(Ludiomil)
– Modified TCA

56
Q

amoxapine (trade name, class of drug?)

A

(Ascendin)
– NET antagonist

57
Q

trazodone (trade name, class of drug?)

A

(Desyrel)
– Weak NET, SERT antagonist
– Blocks 5-HT2A

58
Q

clomipramine (trade name, class of drug?)

A

(Anafranil)
– NET, SERT antagonist, with higher affinity for SERT

59
Q

issues with maprotiline (Ludiomil)?

A

epileptogenic (can cause seizures)

60
Q

issues w amoxapine (Ascendin) ; why?

A

Blocks DA receptors – can induce Parkinsonian-like EPS

61
Q

________ is better than TCAs at relieving anxiety and behavioral agitation

A

amoxapine (Ascendin)

62
Q

trazodone (Desryl) has heavy _______ effects, therefore it is primarily used as a _______

A

sedative ; hypnotic

63
Q

clomipramine (Anafranil) is used to treat ________ , _________, & _________. Particularly _______ & ______

A

Used to treat anxiety and pain as well as depression, particularly OCD and Panic Disorder

64
Q

how does clomipramine (Anafranil) work?

A

NET, SERT antagonist, with higher affinity for SERT

65
Q

SSRIs are recommended to be dosed at ________? why?

A

nighttime; they can be sedating

66
Q

SSRIs are more _________ than TCAs; why?

A

safe ; no cardiac effects

67
Q

Luvox (fluvoxatine) has a high affinity for ______, which makes it helpful for tmt of ________

A

NE a1 ; anxiety

PSYC475 psychopharm (14 decks)

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