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Antidepressants Flashcards

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0
Q

Which class of antidepressants are used for treatment of neuropathic pain and other pain disorders?

A

TCAs

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1
Q

What enzyme degrades tyramine and why is this a problem?

A

MAO - people on MAOIs who eat cheese, soy, or wine can have lethal side effects of excess tyramine - excess catecholamines leading to HTN/stroke

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2
Q

Name the 4 MAOIs

A

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline

Rarely prescribed now

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3
Q

What is the method of action of TCAs?

What are common side effects and why?

A

Block SERT and NET, but also block alpha cholinergic, muscarinic, histamine, and 5-HT

Alpha block: orthostatic hypotension
Anti muscarinic: blurred vision, constipation, dry mouth
H1 block: sedation and weight gain
5-HT block: sexual dysfunction

Increased catecholamines can also cause cardiac overstimulation and can also slow cardiac conduction leading to arrhythmias

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4
Q

Which class of antidepressant drug requires close monitoring of suicidal patients?

A

TCAs

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5
Q

Which class of antidepressant can lead to conduction block and how do you treat it?

A

TCAs

With sodium bicarbonate

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6
Q

Which two TCAs are known to have string anti muscarinic effects?

A

Amitriptyline and imipramine

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7
Q

Which TCA has strong SERT effects but little NET effects?

A

Clomipramine

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8
Q

Which TCA is strongly associated with sexual dysfunction? Why?

A

Clomipramine

Strong SERT effects cause sexual dysfunction

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9
Q

Which TCA has strong NET effects?

A

Nortriptyline

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10
Q

Which TCA is least sedating?

A

Desipramine

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11
Q

What class of drug is the DoC for depression?

A

SSRIs

Selective serotonin reuptake inhibitors

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12
Q

What class of antidepressants is the DoC for treatment of anxiety disorders?

A

SSRIs

Selective serotonin reuptake inhibitors

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13
Q

What disorder can TCAs treat but not SSRIs?

A

Chronic pain

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14
Q

Which class of antidepressants can treat enuresis? What is it? Why aren’t they commonly prescribed for this indication?

A

TCAs

Enuresis: involuntary urine voiding

Too many side effects

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15
Q

What are the effects of overdose of SSRIs?

A

Can cause seizures RARELY fatal

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16
Q

Name the 7 TCAs

A 
Clomipramine
Imipramine
Nortriptyline
Amoxapine
Maprotiline
Amitriptyline
Desipramine
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17
Q

Which SSRI inhibits 3 different CYPs and has a high potential for drug interactions?

A

Fluvoxamine

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18
Q

Which two antidepressants treat PMS/PMDD? What class?

A

Fluoxetine and sertraline

SSRIs

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19
Q

Which antidepressant treats bulimia? What class?

A

Fluoxetine

SSRI

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20
Q

Which SSRI is strongly associated with weight gain?

A

Paroxetine

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21
Q

What is the only SSRI associated with NE blocking effects?

A

Paroxetine

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22
Q

Which three SSRIs have low potential for drug interactions?

A

Citalopram Escitalopram and Sertraline

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23
Q

Blockage of reuptake of what two compounds can be effective in pain management?

A

NE and 5-HT

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24
What is the difference in effect in stimulating 5HT1A and 5HT2 receptors?
(+) 5HT1A: helps depression | (+) 5HT2: causes agitation, anxiety, and sexual dysfunction
25
Which SSRIs inhibit CYP2D6 and have high potential for drug interactions?
Fluoxetine and paroxetine
26
Patient presents with hyperthermia, muscle rigidity, and myoclonus. What is the name of this condition and what causes it?
Serotonin syndrome Occurs when giving a MAOI + any serotonin reuptake inhibitor like SSRI, SNRI, TCA, or meperidine (opioid analgesic)
27
Describe the Monoamine hypothesis of depression
Decreases levels of dopamine, serotonin, or NE can cause depression. MAOIs treat it, but the drugs act immediately but the clinical effects are not seen for weeks (something else is going on)
28
What drugs do you use to treat depression if SSRIs are ineffective? MOA?
SNRIs - serotonin and NE reuptake inhibitors Block SERT and NET (like TCAs but dont affect the other receptors)
29
Which drug treats fibromyalgia? Name and class?
Duloxetine - SNRI
30
Which SNRI blocks both SERT and NET at all doses?
Duloxetine
31
Which SNRI blocks NET only at high doses?
Venlafaxine
32
Name the 6 SSRIs
``` Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline ```
33
Which SNRI has no sedative effects?
Venlafaxine
34
Name the 2 SNRIs
Venlafaxine | Duloxetine
35
What is the advantage of using SNRIs over SSRIs?
SNRIs have fewer CYP interactions
36
Name the 1 NDRI
Bupropion
37
Which antidepressant treats diabetic neoropathy? Name and class
Duloxetine - SNRI
38
Which antidepressant can be used to stop smoking? Name and class. MOA?
Bupropion NDRI - NE and dopamine reuptake inhibitors Block reuptake of NE and dopamine and also increase their release
39
Which class of antidepressant is LEAST effective in treating anxiety?
NDRI
40
Which hormone affected by antidepressants leads to sexual dysfunction? Which class of antidepressants doesn't have this side effect?
Serotonin | NDRIs
41
Which class of antidepressant blocks serotonin reuptake but also prevents agitation, anxiety, and sexual dysfunction? How?
SARIs - 5HT2 antagonist/reuptake inhibitors 5HT blockage treats depression Blockage of 5HT2 prevents the side effects
42
Which SARI is associated with hepatotoxicity and is no longer commonly prescribed?
Nefazodone
43
Overdose of bupropion causes what symptoms?
Seizures
44
Which antidepressant is used to treat insomnia? Drug and class
Trazodone - SARI Used as a hypnotic
45
Name the two SARIs
Nefazodone | Trazodone
46
Wich antidepressant has priapism as an AE? Drug and class?
Trazodone - SARI
47
Which class of antidepressants is NOT a reuptake inhibitor? MOA?
NASSAs - noradrenergic and specific serotonergic antidepressants Antagonist at presynaptic alpha2 receptors (this leads to inc release of NE and 5HT) but also antagonist at 5HT2 and 5HT3 and H1 (sedation and wt gain) receptors
48
Antagonism at H1 receptors is associated with what to side effects?
Sedation and wt gain
49
Name the 1 NASSA - what is special about this drug amongst antidepressants?
Mirtazapine - NOT a reuptake inhibitor
50
DoC for bipolar disorder? MOA?
Lithium Inositol depletion theory: Gq activates PLC which cleaves PIP2 to DAG and IP3. IP3 inactivated to IP2 which is degraded to IP1 to inositol to PI and back to PIP2. Lithium blocks IP2 -> IP1 AND IP1 -> inositol which stops signaling cascade in brain Noncompetitive inhibitor though so only works at active receptors
51
Which drug used to treat bipolar disorder has a narrow therapeutic index and must be titrated?
Lithium - double the dose can cause death
52
Pt with bipolar disorder has tremor. What drug is he on?
Lithium
53
How is lithium delivered and what needs to be monitored?
Rapidly absorbed orally and plasma levels of drug need to be monitored.
54
What two drugs are common substitutes for lithium in treatment of bipolar disorder? What class of drugs are they?
Valproate and carbamazepine Antiepileptics
55
What bipolar medication requires monitoring of liver function tests?
Valproate - antiepileptic
56
Which bipolar drug requires monitoring of CBC?
Carbamazepine - antiepileptic
57
Which bipolar drug can lead to neural tube defects?
Valproate - antiepileptic
58
What two atypical antipsychotics can be used to treat bipolar pts?
Olanzapine and atripiprazole
59
What three atypical antipsychotics can be used to treat acute mania or mixed episodes?
Quetiapine Risperidone Ziprasidone
60
What antiepileptic can be used in maintainence treatment for bipolar pts?
Lamotigine
61
Pt with bipolar disorder develops diabetes insipidus and acneiform skin lesions. What drug is he on?
Lithium
62
Common side effects of lithium?
Confusion, motor impairment, tremor (most people develop this), sedation, ataxia, aphasia
63
Which drug used to treat bipolar patients leads to severe cardiac problems in the child if used during pregnancy?
Lithium
64
- ipramine and - triptyline are common endings of what class of drug?
TCAs

Pharm Final (20 decks)

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