Antidepressants 2 Flashcards
Names of SSRIs
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Lithium, TCAs, warfarin alprazolam, theophylline cause Increased blood levels
PK and drug interactions of which drug?
SSRIs
What toxicity is associated with SSRIs?
sexual dysfunction
Doses greater than 40 mg/day not recommended due to QT prolongation
maximum daily dosage = 20mg for CYP2C19 poor metabolizers
which drug?
Citalopram
What ADR is common to all antidepressants and what must you monitor for due to this?
ADR: suicidality
Monitor: behavioral changes, mental status
What is the black box warning on all antidepressants?
caregivers should be alerted to monitor for acute changes in behavior (especially early in treatment)
Which additional ADRs are common to all SSRIs?
Anxiety or nervousness
Insomnia
Nausea
Serotonin syndrome
Sexual dysfunction
Which SSRI may be more activating (keeping you awake)?
Fluoxetine
Which SSRIs may be more sedating?
fluvoxamine
paroexetine
What is the main ADR of citalopram?
OT interval prolongation
What is the main ADR of fluoxetine?
anorexia
What is the main ADR of fluvoxamine?
somnolence
What is the main ADR of paroxetine?
anticholinergic effects
Indications of SNRIs?
MDD
GAD
Pain disorders: neuropathies and fibromyalgia
Stress urinary incontinence
Vasomotor symptoms of menopause
What are the 4 SNRIs?
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
What is the toxicity of venlafaxine?
HTN
What is the main ADR common to all SNRIs?
CV changesL inc. BP; hearr rate
What is the main ADR to Desvenlafaxine?
dose-related hyperlipidemia
What is the main ADR to venlafaxine?
dose-related HTN
Indications for 5-HT2 receptor antagonists?
MDD
hypnotic
Combo SSRI & 5-HT1A
which drug?
Vilazodone
Inhibits 5-HT, a 5-HT1A agonist and a 5-HT3 receptor antagonist
which drug?
Vortioxetine
What mixed 5-HT would you use for depressed pts with anxiety?
Vilazodone
Which mixed 5-HT should you use with pt with depression & cognitive difficulties?
Vortioexetine
Bupropion is an _____.
Bupropion is an NDRI (norepinephrine and dopamine reuptake inhibitor)
Mirtazapine is a ___________
serotonin and alpha 2 receptor antagonist
What are the 4 heterocyclics?
amoxapine
bupropion
maprotiline
mirtazepine
What heterocyclic can you use for smoking cessation?
bupropion
PK of heterocyclics
hepatic metabolism
Which 2 heterocyclics lower seizure threshold (toxicity)?
amoxapine, bupropion
WHich heterocyclic causes sedation & weight gain?
mirtazepine
ADR of Nefazodone
Liver toxicity
Clitoral priapism (case report)
ADRs of trazodone
orthostatic hypotension
priapism in males
ADRs of Vilazodone
serotonin syndrome
male decreasd libido
ADR of vortioxetine
GI & sexual dysfunction
What 9 things should you keep in mind when choosing an antidepressant?
Indication
Cost
Availability
Adverse effects
Potential drug interactions
Patient’s history of response or lack
Patient preference
Age and gender
Medical status
T/F: When medication and psychotherapy are not effective in treating severe depression or depression with psychosis, ECT can be highly effective.
True
T/F: ECT involves transmitting short electrical impulses into the brain.
True
T/F: ECT does cause some side effects, including some memory loss, but it is much safer than methods used in the past.
True
a type of brain stimulation that uses a magnet instead of an electrical current to activate the brain
It is a relatively new treatment for people whose depression has not responded to medication or psychotherapy
What treatment is this?
Repetitive Transcranial Magnetic Stimulation (rTMS)
T/F: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids cannot be used as augmentation in the treatment of MDD.
False
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids can be used as augmentation in the treatment of MDD.
T/F: EPA alone or the combination of EPA/DHA is likely more effective than DHA alone
True
Lack of consensus regarding use in the treatment of MDD
Induces hepatic metabolic enzymes and is associated with significant drug interactions
APA Task Force conservatively states that this may be reasonable for some individuals with mild to moderate MDD
Which herb?
St. Johns Wort
The use of this has received a favorable review by the APA Task Force
However, the final consensus was that more rigorous studies need to confirm the efficacy of this for treating MDD
What supplement?
SAMe
What are the 3 components in folate?
folic acid
folinic acid
5-MTHF
What does the task force state about folate?
The task force states that augmentation with these compounds is reasonable, but more work is needed to clarify which subgroup of patients may achieve the greatest response.
