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Antidepressants Flashcards

1
Q

Where is the monoamine system located

A

Upper brainstem and limbic system

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2
Q

What are the NT involved in the monoamine system

A

NE,5HT, DA

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3
Q

What is the purpose of NE

A

Study and get things done

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4
Q

What is the purpose of 5HT

A

Everyday life NT- appetite, mood, emotion, sleep

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5
Q

What is the purpose of DA

A

Joy of life, feel good and party, attention

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6
Q

What other receptors are involved in the monoamine system

A

5HT3,2
H1
Alpha 1adrenergic
M- cholinergic

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7
Q

5HT3

A

Agonist- N/V/D

Antagonist- anti emetic

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8
Q

5 HT2

A

Agonist- insomnia, anxiety, akathesia, sexual dysfunction

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9
Q

H1

A

Weight gain and sedation

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10
Q

M cholinergic

A

Antagonist- constipation, dry mouth, drowsiness and confusion

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11
Q

Alpha 1 adrenergic

A

Orthostatic hypotension

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12
Q

Rules for diagnosing depression

A

Must have 5 of the SIGECAPS symptoms (1 of them must be from the interest category), change from normal functioning, and must rule out physical problems- tsh, hgb, b12

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13
Q

SIGECAPS

A

S- sleep- insomnia or hypersomnia
I- interest- depressed mood or adhedonia
G- guilt- feelings of worthlessness
E- energy- decreased energy
C-concentration- inability to make decisions or focus
A-appetite- wit changes or loss of enjoyment of food
S-suicidie- recurring thoughts of suicide

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14
Q

Who is most successful at suicide

A

Older men

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15
Q

What questions should you ask about suicide and when should you’ve concerned?

A

Always be concerned

Be especially concerned and make sure to ask if they have a plan

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16
Q

Etiologic hypothesis of depression

A

Stress diathesis- threshold for depression, environment determines if we exceed it
Biological hypothesis- aided by fact that drugs help
Catecholamine hypothesis- body runs out of NE AND 5HT
Dsregulation hypothesis- imbalance between NE and 5HT

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17
Q

Role of psychotherapy and CBT

A

Used in mild to moderate depression- works synergistically with antidepressants.
Takes longer to help but has a lower rate of remission

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18
Q

When do you use pharmacotherapy for depression

A

In severe depression

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19
Q

ECT

A

Safe for pregnant and elderly
Very quickly down regulates beta receptors in the brain which correspond to a decrease in depression.
Use if patient has depression that is refractory to 2-3 drugs that have been used for at least 12 weeks

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20
Q

Pharmacotherapy

A

Takes 4 -6 weeks to see mood changes

Changes in mood correspond to decrease in beta receptor density not changes in hormone or NT levels

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21
Q

Pharmacotherapy AE

A

Transient insomnia, anxiety, and jitteriness

Sexual dysfunction occurs but this is not transient

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22
Q

Types of drugs used to tx depression

A 
SSRI
TCA
MOA
venlafaxine
Duloxetine
Nefazodone
Trazodone
Bupropion
Mirtazapine
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23
Q

SSRI- drug names

A 
Fluoxetine
Citalopram
Paroxetine
Sertaline
Fluvoxamine
Escitalopram
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24
Q

SSRI MOA

A

Blocks serotonin reuptake
5HT2 agonist
Down regulation of beta receptors

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25
SSRI AE
Insomnia, anxiety, diarrhea Sexual dysfunction Serotonin syndrome
26
How is sexual dysfunction Dealt with
PDE5 inhibitor
27
What is serotonin syndrome
Occurs when have excess serotonin, have taken to many drugs that stimulate serotonin Fishing, wheezing, hyperthermia, N/V/D Hypertension, myoclonus, headache, seizure, ataxia Treat by stopping the serotonin drugs, cooling blankets, nifedipine for HTN, clonazepam for the myoclonus, and anti convulsants for the seizures
28
SSRI withdrawal
Shooting electric pains, anxiety, flu like symptoms Headache, insomnia, dizziness Must titration down the dosage especially if using SSRIs with a short half life ie paroxetine or venlafaxine Fluoxetine doesn't have to be titrated down BC it has a long half life and active metabolite
29
Fluoxetine
SSRI with very long half life and most psychomotor activating of the SSRI so good for pts with motor depression
30
Citalopram
Least psychomotor activating of the SSRI so good for pts with psychomotor activation
31
Paroxetine
Short half life,must be tapered down | Do not give to pregnant woma
32
What SSRI do you not give in pregnancy
Paroxetine | Sertaline
33
SSRI USE
DOC for depression with comorbid anxiety | Can change between them if one doesn't work another might
34
TCA drug names
Imipramine --> desipramine Amotryptaline--> nortriptaline Dsipramine and nortriptaline are metabolites
35
TCA- MOA
Inhibit NE AND 5HT reuptake | Muscarinic, alpha 1, and H1 antagonists
36
TCA AE
Orthostatic hypotension, Weight gain, and anti cholinergic Sexual dysfunction Serotonin syndrome if given with other antidepressants Lowers the seizure threshold Cardiac events OD- can kill
37
Mechanism of cardiac toxicity for TCA
Block the NA Channels causing prolonged QT interval leading to torsades des pointes --> vfib--> death Tx OD with NAHCO3 BC it act on NA channels
38
TCA's and teratogenicity
The non metabolite TCA (Imipramine and amitriptalline) can cause heart failure, tachycardia, seizures, and urinary retention in newborns.
39
TCA uses
Alternative to SSRI. Used in depression with comorbid pain- fibromyalgia, Migraine, chronic pain, and atypical depression. B/c NE IS THE NT OF PAIN
40
TCA contraindications
History of CAD, seizure history, BPH, dementia, or constipation
41
MOA- drugs
Isocarboxacid Phenelzine Tranycypromine
42
TCA MOA
Blocks MAOA (5Ht, NE, and Tyrammine) and MAOB (DA)
43
MAO AE
Orthostatic hypotension, weight gain, anti cholinergic Sexual dysfunction Serotonin syndrome if given with other antidepressants or meperidine, tramadol, or dextrometorphan Wine and cheese syndrome TERATOGENIC
44
Wine and cheese syndrome
Hypertensive crisis that leads to fatal hemmorhages Wine and cheese have a lot of tyrammine, normally it's cleared nfirst pass metabolism, if there is an mao inhibitor then it might not be cleared this causes excess release of NE from peripheral neurons.
45
Mao drug interactions
Meperidine, phenylephrine, and sympathmimetics | Lead to hypertension, fever, and delirium
46
MAO uses
Atypical depression for tx refractory depression Other drugs have better safety profiles. When switching to Mao from another antidepressant make sure to taper off it the previous drug for at least two weeks and 5-6 weeks if it is fluoxetine.
47
Venlafaxine MOA
At low doses acts as a 5HT reuptake inhibitor, at high doses acts as a NE reuptake inhibitor
48
Venlafaxine AE
At low doses has the same AE as SSRI, including withdrawal BC of the short half life Be careful inpatients with uncontrolled HTN
49
Duloxetine MOA
Blocks NE AND 5HT reuptake at low doses
50
Duloxetine uses
Depression with pain , it is FDA approved for diabetic pain
51
Duloxetine AE
Drug interactions | Hepatotoxicity
52
Nefazodone MOA
Blocks 5HT and NE reuptake | 5HT2A, H1, M antagonist
53
Nefazodone uses
Good for depression with anxiety and insomnia and sexual dysfunction
54
Nefazodone AE
Sedation, GI complaints, drumouth, constipation
55
Nefazodone- AE
Drug interactions | Hepatotoxicity
56
Trazodone- MOA
5ht reuptake inhibitor and 5HT2 antagonist | Blocks H1 and alpha 1
57
Trazode AE
Orthostatic hypotension Very sedating Priapism
58
Trazondone uses
Used for sedation to counter insomnia with other antidepressants and hypotonic
59
Bupropion MOA
Blocked NE AND DA reuptake | This is the same MOA AS COCAINE
60
Buproprion AE
CAN INCREASE SEIZURES AND SEXUAL FUNCTION Psychomotor activation, headache, insomnia, psychosis,and anorexia Can cause weight loss
61
Bupropion use
Help patients quit skiing and to counter sedation
62
Bupropion CI
Seizure history Anxiety Bulimia
63
Mirtazapine MOA
Antagonizes the presynaptic alpha 2 receptors increasing NE RELEASE Block 5HT3 and 2,and H1
64
Mirtazapine uses
Good for DEPRESSION with comorbid anxiety, reduced sexual function and has a low risk of OD This is the sleep, sex, and food antidepressant
65
Mirtapazine AE
Sedative effect, weight gain, neutropenia, and agranulocytosis
66
What to think about when prescribing antidepressants
Comorbid conditions Which drugs has pt had success with, or their first degree relatives Adverse events
67
Treating depression phases
Acute, continuation, maintenance
68
Acute phase
Week 1- Improvement in sleep and appetite 1-3 weeks- everyday life improvements- activity, sex drive, self care, sleeping and appetite normalization 2-6 weeks- suicide and depression subside
69
Continuation phase
4-9 months of maintaining the same dose as during the acute phase to keep it in remission
70
Maintenance phase
Long term therapy depends on the person and their circumstances
71
Treatment outcomes
Response- dec symptoms by 50%, this occurs in 60% of patients Remission- attitude returns to normal, this occurs in 30% of patients, has a decreased chance of relapse
72
Treatment regimen in depression
Start with SSRI they are the safest, least AE, and most studied If that doesn't work can change meds, add bupropion or another agent, or augment to with- lithium, anticonvulsant, th, or buspirone.

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