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Antidepressants Flashcards

1
Q

What are the 3 advantages of SSRIs?

A
  1. Low incidence of side effects, most of which resolve w/ time
  2. No food restrictions
  3. Much safer in overdose
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2
Q

What are the 6 SSRIs?

A
  1. Fluoxetine (Prozac)
  2. Paroxetine (Paxil)
  3. Sertraline (Zoloft)
  4. Fluvoxamine (Luvox)
  5. Citalopram (Celexa)
  6. Escitalopram (Lexapro)
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3
Q

Which SSRI has the longest half-life?

A

Fluoxetine

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4
Q

What is benefit of a drug with long half life?

A
  1. Good for non-compliant pts

2. No need to taper

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5
Q

Which SSRI is safe in pregnancy and approved for use in children?

A

Fluoxetine

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6
Q

What are the side effects from over-stimulation of 5HT3 receptor? (3)

A

5HT3 = GI system (diarrhea, nausea, vomiting)

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7
Q

What are the side effects from over-stimulation of 5HT2C receptor? (2)

A

5HT2C = CNS (anxiety, mental agitation)

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8
Q

What are the side effects from over-stimulation of 5HT2A receptor? (6)

A

5HT2A = CNS, spinal cord (anxiety, mental agitation, akathisia, insomnia, myoclonus (rate of 0.2%), sexual dysfunction)

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9
Q

What is serotonin discontinuation/withdrawal syndrome? (4)

A

headache, dizziness, irritability, fatigue (upon abrupt discontinuation)

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10
Q

Which SSRI has the fewest drug-drug interactions?

A

Citalopram

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11
Q

Which SSRI has highest risk for GI disturbances?

A

Sertraline

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12
Q

Which SSRI can elevate levels of neuroleptics, leading to increased side effects?

A

Fluoxetine

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13
Q

What is fluoxetine also used for?

A

Bulimia

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14
Q

Which SSRI is indicated for OCD?

A

Fluvoxamine (Luvox)

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15
Q

When does therapeutic effect of SSRIs take place?

A

3-4 wks after administration

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16
Q

Other than Citalopram and Escitalopram, which SSRI has very few drug interactions?

A

Sertraline

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17
Q

Which SSRI has more anticholinergic effects (ex. sedation, constipation, wt gain)?

A

Paroxetine

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18
Q

Which SSRI has shorter half-life, thus leading to withdrawal syndrome if not taken consistently?

A

Paroxetine

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19
Q

How can the sexual s/e of SSRIs be treated? (3)

A
  1. Augmenting the regiment with buproprion
  2. Change to non-SSRI antidepressant
  3. Add medications like Sildenafil (Viagra) for men
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20
Q

What is the serotonin syndrome? (6)

A

Caused by taking 2 drugs, both of which increase serotonin

  • Hyperthermia
  • myoclonus
  • autonomic instability (diaphoresis, shivering, tachycardia, htn)
  • rigidity (neuromuscular excitability)
  • delirium
  • coma –> death
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21
Q

Which other medication is contraindicated with SSRIs and why?

A

MAOIs = need washout of 2 wks prior to initiation of SSRI treatment

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22
Q

How long do the side effects of SSRIs last?

A

resolve within a few wks

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23
Q

What are the different classes of anti-depressants? (8)

A
  1. SSRI
  2. SNRI
  3. TCA
  4. MAOI
  5. NaSSAs (Norad + specific serotonergic antidep.)
  6. SARI (serotonin antagonist + reuptake inhibitors)
  7. NDRI (norad + dopamine reuptake inhibitors)
  8. SSRI + SPA (serotonin partial agonist)
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24
Q

What are the 4 SNRIs?

A
  1. Venlafaxine (Effexor)
  2. Duloxetine (Cymbalta)
  3. Desvenlafaxine (Pristiq)
  4. Levomilnacipran (Fetzima)
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25
Q

What is duloxetine used for?

A

Diabetic neuropathy, fibromyalgia, neuropathic pain

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26
Q

What additional s/e are seen in SNRIs?

A

Norepi s/e = Agitation, tremor, tachycardia, HTN

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27
Q

Mechanism of action of NDRI?

A

Norepi-dopamine reuptake inhibitors

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28
Q

What is the 1 example of NDRI? (1)

A

Bupropion (Wellbutrin)

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29
Q

What is bupropion indicated for? (2)

A

adult ADHD, smoking cessation

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30
Q

What is bupropion NOT indicated for? (2)

A
  • pts w/ seizure d/o

- pts w/ active eating disorders

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31
Q

Why is bupropion not indicated for pts w/ seizures?

A

b/c bupropion can lower seizure threshold

32
Q

What are the s/es of bupropion? (NDRI) (5)

A
  • activation
  • insomnia
  • nausea
  • tremor
  • increased anxiety (b/c not serotonergic at all)
  • note: NO WEIGHT GAIN OR SEXUAL DYSFX (b/c no serotonin)
33
Q

Mechanism of action of SARI?

A

Serotonin antagonist and reuptake inhibitors

- blocks reuptake pumps with simultaneous 5HT2A blockade

34
Q

What is a benefit of using SARI?

A

no 5HT2A s/es = CNS, spinal cord (anxiety, mental agitation, akathisia, insomnia, myoclonus (rate of 0.2%), sexual dysfunction)

  • thus, can use in pts w/ anxiety and insomnia
  • also, no sexual dysfunction
35
Q

What are the general side effects of SARI? (4)

A
  • sedation
  • nausea
  • dizziness
  • orthostatic hypotension
36
Q

What are the example of SARI? (2)

A
  1. Trazodone

2. Nefazodone

37
Q

Serious adverse effect of trazodone?

A

Priapism (rare)

38
Q

Serious adverse effect of nefazodone?

A

Rare Liver toxicity (black box warning)

39
Q

What are the indications for SARI (3)

A
  1. Refractory major depression
  2. Major depression w/ anxiety
  3. Major depression w/ insomnia
40
Q

What is an example of NaSSA?

A

Mirtazapine (Remeron)

41
Q

Mechanism of action of NaSSA? (2)

A

Noradrenergic and specific serotonergic antidepressants

  1. antagonism at central alpha 2 autoreceptors –> disinhibition of NE and 5HT –> increase NE (leading to stimulation of serotonin neuron)
  2. Stimulation of alpha 1 receptors on serotonin neurons –> boost 5HT release
42
Q

Do not use venlafaxine in pts with—?

A

Untreated or labile BP (b/c it can raise blood pressure)

43
Q

What is mirtazapine useful for? (2)

A

Refractory major depression, esp in pts who need to 1. GAIN weight and 2. helps with sleep

44
Q

What are the 2 SSRI + SPA

A
  1. Vilazodone

2. Vortioxetine

45
Q

Mechanism of TCAs?

A
  • antagonism at serotonin, NE reuptake pumps

- blocks HAM receptors

46
Q

Tertiary amines vs. secondary amines?

A
  • tertiary = more HAM blockade

- secondary = fewer s/es, less sedating, safer in overdose

47
Q

Examples of tertiary amines TCAs? (5)

A
  1. Amitriptyline
  2. Clomipramine
  3. Doxepin
  4. Trimipramine
  5. Imipramine (Tofranil)
48
Q

Examples of secondary amine TCAs? (3)

A
  1. Desipramine
  2. Nortriptyline
  3. Protriptyline
49
Q

What is amitriptyline useful for? (3)

A

pain, headache/migraine, insomnia

50
Q

Which TCA is indicated for tx of OCD?

A

Clomipramine (most serotonin specific)

51
Q

Which TCA is indicated for panic d/o and enuresis?

A

Imipramine

52
Q

What is Doxepin useful for? (2)

A

Treating chronic pain and insomnia

53
Q

Which TCA is least likely to cause orthostatic hypotension?

A

Nortriptyline

54
Q

Which TCA is least sedating and least anticholinergic?

A

Desipramine

55
Q

What is the treatment of TCA overdose?

A

Sodium bicarb

56
Q

What are the serious adverse effects of TCAs? (3)

A

3Cs –> convulsions, coma, cardiotoxicity (QTc prolongation)

57
Q

What are the symptoms of TCA overdose? (9)

A

agitation, tremors, ataxia, delirium, hypoventilation (from CNS depression), myoclonus, hyperreflexia, seizures, coma

58
Q

MAOIs are considered more effective in —?

A

Atypical depression, refractory depression

59
Q

What are the characteristics of atypical depression? (3)

A
  1. hypersomnia
  2. increased appetite
  3. increased sensitivity to interpersonal rejection
60
Q

Mechanism of action of MAOIs?

A
  • irreversible monoamine oxidase inhibitors = prevents degredation of biogenic amines (NE, serotonin, dopamine, tyramine)
61
Q

Examples of MAOIs? (3)

A
  1. Phenelzine
  2. Tranylcypromine
  3. Transdermal selegiline
62
Q

Pros of using transdermal selegiline (EMSAM patch)?

A

does not require following the dietary restriction when used in low dosages
- but still have to avoid decongestants, opiates, and serotonergic drugs

63
Q

What must you be careful of when using MAOIs?

A

Tyramine-induced hypertensive crisis

64
Q

What are tyramine-rich foods? (5)

A

Red wine, cheese, chicken liver, fava beans, cured meats

65
Q

Mechanism of tyramine-induced hypertensive crisis?

A

Buildup of stored catecholamines

66
Q

Symptoms of hypertensive crisis? (8)

A
  • HTN
  • headache
  • sweating
  • nausea/vomiting
  • photophobia
  • autonomic instability
  • chest pain
  • arrhythmias
67
Q

Treatment of hypertensive crisis?

A

Use anti-alpha (phentolamine)

68
Q

Which antidepressants (specific) for OCD? (2)

A

Fluvoxamine (SSRI)

Clomipramine (TCA)

69
Q

Which antidepressants (2 class + 1 spec) for panic disorders

A

SSRIs
MAOIs
Imipramine (TCA)

70
Q

Which antidepressant for bulimia? (1)

A

Fluoxetine (SSRI)

71
Q

Which antidepressant for enuresis? (1)

A

Imipramine (TCA)

72
Q

Which antidepressant class for PTSD? (1)

73
Q

Which antidepressant (2 class, 1 spec) for GAD?

A

SSRI, SNRI (venlafaxine), TCAs

74
Q

Which antidepressant for migraine headaches? (1)

A

Amitriptyline (TCA)

75
Q

Which antidepressants for insomnia? (2)

A

Mirtazapine, amitriptyline (TCA)

76
Q

Which antidepressants for neuropathic pain? (3)

A

Amitriptyline, nortriptyline, duloxetine (SNRI)

77
Q

Which antidepressant for smoking cessation? (1)

Psychopharm (5 decks)

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