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Pharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

How do antidepressants work?

A
  • Increase the amount of neurotransmitter in the synaptic cleft
    • Inhibition of reuptake
    • Enzymatic degredation
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2
Q

Which antidepressant increases synaptic serotonin and norepinephrine?

A

Tricyclics

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3
Q

Which antidepressant increases synaptic norepinephrine?

A

Tetracyclics

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4
Q

Which antidepressant blocks the degredation of norepinephrine, dopamine and serotonin?

A

MAOIs

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5
Q

Which antidepressant increases synaptic serotonin?

A

SSRIs

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6
Q

What is an example of a dopamine-reuptake inhibitor?

A

bupropion (Wellbutrin, Zyban)

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7
Q

What are the characteristics of bupropion (Wellbutrin, Zyban)?

A
  • Increased risk for seizures
  • Risk for emergent hypertension with concurrent nicotine patch use
  • Take BP on patients using this drug
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8
Q

What does monoamine oxidase do?

A

It’s responsible for metabolism of norepinephrine, serotonin, and dopamine - MAOI’s inhibit them

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9
Q

What types of depression are MAOI’s used for?

A
  • Atypical, non-endogenous, neurotic depression
  • Depression associated with Parkinson’s
  • PTSD
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10
Q

What do you do as a dentist when your patient is on MAOIs?

A
  • Take blood pressure before anesthesia
  • Caution with epinephrine
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11
Q

What are the MAOIs?

A
  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Atapryl, Eldepryl, Selpak)
  • tranylcypromine (Parnate)
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12
Q

What are the adverse events with MAOIs?

A
  • Causes release of endogenous catecholamines
  • Results in hyperadrenergic crisis
    • Severe hypertension, fever, arrhythmias
  • Avoid tyramine containing foods
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13
Q

What are the popular SSRIs?

A
  • fluoxetine (Prozac, Sarafem)
  • proxetine (Paxil)
  • sertraline (Zoloft)
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14
Q

Which SSRI’s are the biggest market sellers?

A

Paxil and Zoloft

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15
Q

What is the only SSRI approved for use in children with OCD?

A

Zoloft

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16
Q

What has been mandated to be put on the boxes of SSRIs?

A
  • Antidepressants increase risk of suicidal thinking and behavior in children with depression and pyschiatric disorders
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17
Q

What antidepressant is not FDA approved for use in children?

A

Escitalopram

18
Q

What are the known side effects of SSRIs?

A
  • Agitation
  • Anxiety
  • Hostility
  • Aggression
19
Q

When taking SSRI’s for depression, when it the highest risk for suicidal attempt?

A

Within 6 weeks of initiating drug therapy

20
Q

What are popular Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?

A
  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)
  • milnacipran (Savella)
  • venlafaxine (Effexor XR)
21
Q

Which SNRI is used solely to treat fibromyalgia?

A

milnacipran (Savella)

22
Q

What are some oral complications or side effects of venlafaxine (Effexor XR)?

A
  • Xerostomia
  • Stomatitis
  • Loss of taste
  • Taste alteration
  • Tongue discoloration
23
Q

What’s an example of a tetracyclic and what’s it used for?

A

maprotiline (Ludiomil)

Depression, anxiety with depression, dsythymic disorder

24
Q

What’s unique about Tricyclics?

A

Adjunctive therapy for chronic pain – exhibits analgesic properties

25
Q

How are tricyclic antidepressants adverse effects determined?

A

By their blockade on cholinergic, adrenergic and histamine transmission.

26
Q

What are some of the side effects of TCA’s?

A
  • Anticholinergic effects - blurred vision, xerostomia, constipation
  • Sympatholytic effects - postural hypotension, dizziness
  • Histamine antagonism - sedation
27
Q

What are the tricylics that are blockers of both norepinephrine and serotonin?

A
  • amitryptyline (Elavil)
  • imipramine (Tofranil)
28
Q

What are the tricyclics that are selective norepinephrine reuptake blockers?

A
  • desipramine (Norpramin)
  • nortriptyline (Pamelor)
29
Q

What is St. John’s Wort?

A

A weed-like plant that has been used as an antidepressant, and you cannot take with prescription antidepressants

30
Q

What are the major active constituents in St Johns wort?

A
  • hyperforin and hypericin
  • flavonoids and tannis
31
Q

Is St. Johns wort effective in treating depression?

A

Meta-analysis then a Cochrane Review shows it to be more efficacious than placebo.

32
Q

Within St. John’s wort there is hypericin - what effect does this have and what cautions do you take?

A
  • Induces some cytochrome P450 liver enzymes
  • Reduces anticoagulant effect on warfarin (increases clotting) and lowers the INR
33
Q

What’s bad about St. John’s wort?

A

Many drug interactions

34
Q

Do you discontinue herbs before surgery?

A

Yes - discontinue all drugs 14 days before surgery

35
Q

What are the common adverse effects of antidepressants?

A
  • Orthostatic hypotension - watch for falling in older adults
  • Sedation
  • Dizziness
  • Light-headedness
36
Q

What is the drug of choice for bipolar disorder?

A

Lithium (Eskalith, Lithobid)

37
Q

How does Lithium work?

A
  • Prevents release of neurotransmitters
  • Increases uptake of serotonin precursor tryptophan
  • Decreases rate of serotonin synthesis
  • Inhibits serotonergic and adrenergic receptor-mediated activation of cAMP and second messenger cascades
38
Q

What are some general characteristics of Lithium?

A
  • Peaks in blood within 2 hours
  • Improvement in condition occurs over several weeks of treatment
  • Very low therapeutic index - monitored weekly
39
Q

What are the side effects of Lithium?

A
  • Nausea, vomiting, diarrhea
  • Weakness, hand tremors
  • Polyuria, renal damage
  • Hypothyroidism
  • Sexual dysfunction
40
Q

What are the drug interactions with Lithium and what do they do?

A
  • These increase the levels of Lithium in blood creating toxicity
    • Diurectics
    • NSAIDS (COX-2 especially)
    • Anticonvulsants
    • Antihypertensives
41
Q

What is contraindicated with lithium?

A

NSAIDS - they inhibit renal excretion of lithium,

use acetaminophen as analgesic instead

Pharmacology (25 decks)

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