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antidepressants Flashcards

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1
Q

TCAs (drugs)

A

amitriptyline, nortriptyline, clomipramine, desipramine, doxepin, imapramine, protriptyline, trimipramine

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2
Q

TCA moa

A

inhibit the repute of 5-HT and NE, potentiating/prolonging their effects; also block mACh, alpha-adrenergic, and histamine receptors

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3
Q

TCA adverse effects

A

anti-alpha adrenergic effects: orthostatic hypotension
anti-muscarinic effects: burred vision, worsening of glaucoma, dry mouth, constipation, urinary retention, tachycardia, confusion
histamine block: sedation
weight gain and sexual disturbances

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4
Q

TCA overdose

A

low therapeutic index
CV effects - arrhythmias, myocardial depression, worsening of CHF,
acidosis, delerium, seizures

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5
Q

serotonin syndrome

A

hyperpyrexia, hyperreflexia, tremor shivering, myoclonus, seizure, confusion, delerium, CV collapse, coma; can be fatal

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6
Q

SSRIs recommended for breastfeeding

A

paroxetine and sertraline

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7
Q

meds for OCD

A

SSRIs

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8
Q

SSRI overdose

A

serotonin syndrome

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9
Q

SSRIs adverse effects

A

nausea, decreased libido, sexual dysfunction, low incidence of CV and anti-ACh effects

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10
Q

paroxetine in pregnancy

A

increased risk of birth defects; category D

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11
Q

SSRIs with most CYP interactions

A

fluoxetine, paroxetine, fluroxamine

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12
Q

trazadone moa

A

moderate inhibition of 5-HT repute; primarily acts as a 5-HT2a antagonist and a 5-HT1a partial agonist

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13
Q

trazodone use

A

depression characterized by anxiety and sleep disturbances

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14
Q

vilazodone moa

A

potent 5HT1a partial agonist and SSRI

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15
Q

vortioxetine moa

A

potent blocker of SERT and high efficacy partial 5-HT1a and 1b agonist and 5-HT1d, 3a, and 7 antagonist; weak NET and beta1-AR blocker

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16
Q

venlafaxine and duloxetine moa

A

inhibit 5-HT and NE reuptake (SNRI), without having anti-cholinergic, histaminergic, or dopaminergic properties

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17
Q

most potent SNRI

A

duloxetine

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18
Q

SNRIs

A

venlafaxine, duloxetine, amoxamine, mertazepine,

19
Q

amoxatine moa

A

SNRI; retains some DA receptor antagonism; mixed inhibition of NET>SERT=DAT

20
Q

amoxatine adverse effects

A

risk of extrapyramidal motor symptoms

21
Q

buproprion moa

A

weak blocker of DAT, SERT, and NET; active metabolite is an NE reuptake inhibitor

22
Q

buproprion adverse effects

A

agitation, restlessness, anxiety, risk of seizure

23
Q

maprotiline adverse effects

A

seizure risk

24
Q

maprotiline moa

A

selective NE reuptake inhibitor

25
Q

MAOIs

A

tranylcypromide, isocarboxazid, phenelzine

26
Q

MAOI moa

A

blocks oxidative metabolism of monamines by irreversible inhibition of MAO-A and MAO-B in nerve terminals

27
Q

MAO-A oxidizes what NTs?

A

NE, 5-HT, and tyramine

28
Q

MAO-B oxidizes what NT?

A

DA

29
Q

MAOI adverse effects

A

sleep disturbances, orthostatic hypotension, weight gain, sexual dysfunction

30
Q

MAOI interactions

A

tyramine foods (aged wine, cheese steak, etc)
sympathomimetics - acute HTN reaction
merperidine and dextromethorphan cause hyperpyrexia, delerium, convulsions, coma, and death
SSRIs (serotonin syndrome)

31
Q

MAOI indications

A

unresponsive to other anti-depressants and for whom ECT is not suitable; panic disorder; agoraphobia

32
Q

lithium moa

A

poorly understood; possible inhibition of IP3 signaling

33
Q

litium adverse effects

A

narrow therapeutic index; tox at > 1.5mEq/L
neuro: tremor, ataxia, hyperactive, aphasia, sedation, fatigue
glandular: edema, hypothyroid
renal: nephrogenic DI
CV: bradycardia and tachycardia (“sick sinus”)
derm: acne, folliculitis, psoriasis exacerbation

34
Q

lithium interactions

A

diuretics and NSAIDs

35
Q

anticonvulsants for bipolar disorder

A

valproate and carbamazepine

36
Q

valproate moa

A

inhibits Na and T-type Ca channels; stimulates GABA synthesis; increases K conductance

37
Q

carbamazepine moa

A

Na channel inhibition

38
Q

valproate metabolism

A

Cyp 2C - inhibits its own metabolism; reduce dose over time

39
Q

carbamazepine metab

A

CYP 3A4 and 2C inducer - induces own metab.; increase dose over time

40
Q

carbamezepine adverse effects

A

diplopia, ataxia, rash idiosyncratic reaction; aplastic anemia

41
Q

SSRI effect on NE

A

SSRIs also cause NE release when NE is low, as it is in depression

42
Q

norfluoxetine (active metabolite of fluoxetine) pharmacokinetics

A

half life of 7-10 days; CYP inhibitor

43
Q

SSRIs

A

escitalopram, fluoxetine, paroxetine, sertraline, fluroxamine, citalopram

44
Q

lithium PK

A

rapid distribution to total body water

psych (12 decks)

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