Antidepressants Flashcards
0
Q
Antidepressants are also used to treat what type of conditions?
A
Anxiety disorders; generalized anxiety disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorders
1
Q
Antidepressants have been historically marketed to treat what condition?
A
Depression
2
Q
What other conditions are antidepressants used to treat?
A
Bulimia nervosa, diabetic neuropathy pain, fibromyalgia pain, as well as to facilitate smoking cessation
3
Q
Citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine, and sertraline are what category of antidepressants?
A
Selective serotonin reuptake inhibitor’s (SSRIs)
4
Q
Celexa
A
Citalopram
5
Q
Lexapro
A
Escitalopram
6
Q
Paroxetine
A
Paxil
7
Q
Fluoxetine
A
Prozac
8
Q
Fluvoxamine
A
Luvox
9
Q
Sertraline
A
Zoloft
10
Q
Desvenlafaxine, venlafaxine, duloxetine, milnacipran, and levomilnacipran represent what category of antidepressants?
A
Serotonin norepinephrine reuptake inhibitor’s (SNRIs)
11
Q
Amitriptyline, clomipramine, Desipramine, imipramine, trimipramine, nortriptyline, and Proptriptyline represent what category of antidepressants?
A
Tricyclic antidepressants (TCAs)
12
Q
Elavil, Endep
A
Amitriptyline
13
Q
Anafranil
A
Clomipramine
14
Q
Norpramin
A
Desipramine
15
Q
Tofranil
A
Imipramine
16
Q
Surmontil
A
Trimipramine
17
Q
Pamelor
A
Nortriptyline
18
Q
Vivactil
A
Proptriptyline
19
Q
Phenelzine, selegiline, and tranylcypromine represent what class of antidepressants?
A
Monoamine oxidase inhibitor’s (MAOIs)
20
Q
Nardil
A
Phenelzine
21
Q
Emsam
A
Selegiline
22
Q
Parnate
A
Tranylcypromine
23
Q
What is wellbutrin?
A
Bupropion
24
What is Remeron?
Mirtazapine
25
What is Serzone?
Nefazadone
26
What is Desyrel?
Trazodone
27
What is Viibryd?
Vilazadone
28
What is brintellix?
Vortioxetine
29
Monoamine oxidase inhibitors work by inhibiting what two enzymes? What three neurotransmitters are prevented from breaking down as a result? What is the end result?
Monoamine oxidase A and B; dopamine, serotonin, and norepinephrine; the levels of these neurotransmitters are increased in the synapse
30
Which two categories of antidepressants inhibit the reuptake of serotonin and norepinephrine? They do this by inhibiting what?
Tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors; They do this by blocking monoamine reuptake transporters
31
What neurotransmitter do SSRIs inhibit the reuptake of? They do this by blocking what?
Serotonin; monoamine reuptake transporters
32
Bupropion inhibits the reuptake of which two neurotransmitters? It does this by blocking what?
Norepinephrine and dopamine; by blocking the monoamine reuptake transporters
33
Trazodone, nefazodone, and mirtazapine inhibit the reuptake of which neurotransmitter? How else do they work?
Serotonin; they also have additional serotonin receptor antagonist activity
34
Vilazadone blocks the reuptake of which neurotransmitter? It is also a partial agonist of which receptor?
Serotonin; the 5HT-1A receptor
35
Vortioxetine inhibits the reuptake of which neurotransmitter? It is a partial agonist at which receptor? Which receptor does it antagonize?
Serotonin; 5HT-1A; 5HT-3
36
What are the FDA-approved uses of antidepressant medications?
Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder, bulimia nervosa, diabetic neuropathy, fibromyalgia, and smoking cessation.
37
What two uses are non-FDA approved for antidepressants?
Premature ejaculation and insomnia
38
What is the classic black box warning for antidepressant medications?
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24-year-olds)
39
What are three very common side effects of serotonergic antidepressant agents?
Gastrointestinal side effects, sexual dysfunction, and CNS effects
40
Which specific side effect of serotonergic antidepressant agents is seen in the geriatric population?
Hyponatremia
41
Why do serotonergic antidepressant agents put some patients at risk of bleeding?
Serotonin-related platelet impairment
42
Can serotonin syndrome occur with monotherapy?
Yes, but it is more common when using more than one Serotonergic medication
43
What side effect is very common with tricyclic antidepressants?
Anticholinergic side effects
44
The TCAs amoxapine and maprotilene are known to cause what specific side effect?
Seizures
45
Patients run the risk of what specific side effect if tricyclic antidepressants elevate to supratherapeutic levels in the blood?
Cardiac abnormalities
46
What may happen if a monoamine oxidase inhibitor is used in combination with a sympathomimetic medication and/or tyramine-containing foods and beverages?
Hypertensive crisis
47
What may be the outcome if bupropion is used at higher doses or is rapidly titrated?
Seizure
48
What could the use of bupropion in combination with such medications as antipsychotics, stimulants, and hypoglycemic drugs lead to? Why?
Seizures; because these are drugs that lower the seizure threshold
49
Duloxetine (Cymbalta) and nefazodone (Serzone) are potentially toxic to which organ? They should be avoided in patients with what type of dysfunction?
Hepatotoxicity; hepatic dysfunction
50
Pristiq
Desvenlafaxine
51
Cymbalta
Duloxetine
52
Savella
Milnacipran
53
Fetzima
Levomilnacipran
54
Effexor
Venlafaxine
55
Venlafaxine (Effexor), paroxetine (Paxil) and duloxetine (Cymbalta) are associated with a withdrawal syndrome for what pharmacological reason? What three instances increase the likelihood of a withdrawal syndrome?
Shorter half-life (approximately 12-16 hours); it occurs particularly with missed doses, marked dose reductions, and abrupt discontinuation
56
What adverse effect is venlafaxine (Effexor) commonly associated with? What are three rarely seen adverse effects?
Dose-related increases in blood pressure; increased triglycerides and cholesterol levels, interstitial pneumonia, and pulmonary eosinophilia
57
Remeron (mirtazapine) can cause what two rare, but serious, side effects?
Agranulocytosis and neutropenia
58
Which three antidepressants are known inhibitors of CYP 450 enzymes?
Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
59
Which 3 specific CYP 450 enzymes is Prozac (fluoxetine) a potent inhibitor of?
CYP 1A2
CYP 2C19
CYP 2D6
60
Sertraline (Zoloft) is a moderate inhibitor of what three specific CYP 450 enzymes?
CYP 2C19
CYP 2D6
CYP 3A4
61
Paroxetine (Paxil) is a potent inhibitor of which CYP 450 enzyme? What other antidepressant also strongly inhibits this specific enzyme?
CYP 2D6; Bupropion
62
What have studies consistently found regarding antidepressant medications?
Studies have found that the agents are similar in efficacy
63
What are the major determining factors for selecting a specific antidepressant?
Tolerability, personal or family history of response, and cost
64
Why are the "newer" antidepressant agents considered the first-line of therapy? Which two categories of antidepressants are excluded from being first-line therapy for these reasons?
Because they are safer (including in overdose) and easier to tolerate.
These findings were recently identified in the study "paroxetine versus other antidepressant agents for depression" by purgato et al (2014)
65
What did the STAR*D study conclude regarding antidepressant therapy?
They concluded that when evaluating the efficacy of a therapeutic regimen:
1 – maximize the antidepressant dose
2 – ensuring adequate trial duration
3 – adding another antidepressant agent may produce additional therapeutic benefits and can be an alternative earlier in therapy
66
True or false: the STAR*D study used a "real world" design to evaluate patients with at least 1-3 previous trials
True
67
Is electroconvulsive therapy safe in pregnancy?
Yes, it has no known teratogenic effects and may be preferred to antidepressant pharmacological therapy in some cases
68
All antidepressant agents are categorized as category C, with regard to pregnancy, except which one?
Paroxetine (Paxil)
Category D
69
True or false: most studies have not identified an increase in congenital malformations associated with antidepressant exposure
True
70
The risk of cardiovascular and other congenital malformations may be higher with which antidepressant?
Paroxetine (Paxil)
71
SSRI exposure late in the third trimester may lead to what non-teratogenic side effects in the newborn?
Respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, low birth weight, vomiting, hypoglycemia, hypo or hypertonia, hyperreflexia, jitteriness, irritability, constant crying, lower Apgar scores and tremor.
72
The effects of antidepressants during the third trimester may be due to toxic effects of the SSRI or drug withdrawal due to discontinuation. Therefore, what technique should be used? And for how long prior to delivery?
Consider tapering or discontinuing antidepressant medication 10-14 days prior to delivery
73
What do we know about the long-term effects of in utero SSRI exposure on infant development and behavior?
Nothing
74
Do psychotropic agents cross into the breastmilk?
Yes, they all due to some extent
75
If a mother on antidepressant medications chooses to breast-feed… How should that be managed?
The baby should be monitored for side effects secondary to medication exposure
76
What do we know about the long-term effects for the baby from exposure to antidepressant medications through breastmilk?
Nothing
