Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BB Test 3 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

__-__% of depression patients will improve with placebo treatment.

A

30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antidepressants of all classes may increase the risk of _____________________ in children.

A

Suicidal thinking and behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_________________ are the standard for antidepressant efficacy.

A

Tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some common examples of tricyclic antidepressants?

A
  • Tertiary amines
    • Imipramine
    • Amitryptyline
  • Secondary amines
    • Desipramine
    • Nortriptyline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pharmacological activity of tricyclic antidepressants:

A
  • All are about equally efficacious
  • All have 2-3 week latency
  • Don’t elevate mood in non-depressed patient
  • May be combined with lithium when treating bipolar disorder
  • Used for treatment of chronic neuropathic pain (greatest use today)
  • May cause insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Imipramine and Amitryptyline, tertiary amine tricyclic antidepressants, more effectively inhibit the reuptake of (serotonin/norepinephrine).

A

Serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Desipramine and Nortriptyline, secondary amine tricyclic antidepressants, more effectively inhibit the reuptake of (serotonin/norepinephrine).

A

Norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PCKN of tricyclic antidepressants:

A
  • Slowly absorbed
    • Peak plasma levels in 2-8 hours
    • Delay in gastric emptying time
  • Significant “first pass” effect
    • Enterohepatic circulation
  • Significant protein binding
  • Large volume of distribution
  • T1/2 ranges from 12-72 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the CNS adverse effects of tricyclic antidepressants?

A
  • Delirium, confusion, and manic reactions
  • Sedation and/or weight gain
  • Tremors
  • Reduced seizure threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the autonomic adverse effects of tricyclic antidepressants?

A
  • Significant antimuscarinic activity
    • Tertiary amines > secondary amines
    • Dry mouth (teeth loss), blurred vision, constipation, urinary retention
  • α-adrenergic antagonist activity
    • secondary amines > tertiary amines
    • Orthostatic hypotension, reflex tachycardia, and arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the drug interactions of tricyclics?

A

Causes hypertensive crisis when combined with MAO inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the contraindication of tricyclic antidepressants?

A

Do not use in patients with narrow angle glaucoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should tricyclics only be prescribed in 1 week supplies?

A

Acute overdoses of lethal levels can be achieved with amounts that are readily available to the patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatment course for an acute overdose of tricyclics?

A
  • Maintain respiration
  • Gastric lavage (stomach pump) with activated charcoal
  • Supportive care
  • Antiarrhythmic agents for arrhythmias
  • Benzodiazepines for seizures
  • Bicarbonate to correct acidosis and to increase plasma protein binding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When tricyclics are combined with MAO inhibitors, what crisis results?

A

Hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When switching to a MAO inhibitor from a tricyclic, allow a __ week washout period.

A

1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When switching to a tricyclic from a MAO inhibitor, allow a __ week washout period.

A

2 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the withdrawal signs of tricyclics?

A
  • Sleep disturbances and nightmares
  • GI upset
  • Irritability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some common examples of selective serotonin reuptake inhibitors (SSRIs)?

A
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram

“Flashbacks Paralyze Senior Citizens”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pharmacological activity of SSRIs?

A
  • Can be combined with lithium in bipolar disorder
  • Do not elevate mood in normal patients
  • Main advantage over tricyclics is safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are SSRIs used to treat?

A
  • Bipolar disorders (with lithium)
  • Panic disorders
  • Generalized anxiety disorder
  • Obsessive compulsive disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

(T/F) Fluoxetine is 10x more potent than sertraline.

A

False. Sertraline is 10x more potent than fluoxetine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PCKN of SSRIs:

A
  • Well absorbed orally
  • Rate of metabolism is age dependent
    • Children > young adults > over 60
  • Exception: Fluoxetine and sertraline are metabolized to active metabolites by the liver
  • Fluoxetine T1/2: 2-3 days
  • Paroxetine T1/2: 22 hrs
  • Sertraline T1/2: 25 hrs
  • Citalopram T1/2: 33-38 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The active metabolite of fluoxetine is _____________.

A

Norfluoxetine (7-15 day half-life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute overdose is more serious in (tricyclics/SSRIs).

A

Tricyclics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some adverse effects of SSRIs?

A
  • CNS stimulation
  • Nausea and vomiting
  • Headache
  • Sexual dysfunction
  • Black Box warning for cardiac birth defects
27
Q

Sexual dysfunction is more common in (tricyclics/SSRIs).

A

SSRIs

28
Q

What are the contraindication of citalopram?

A
  • Citalopram may cause QT prolongation
    • Not to be prescribed to patients with history of congenital long QT syndrome
    • If QT is >500msec, citalopram should be discontinued
29
Q

When SSRIs are combined with MAO inhibitors, what condition may result?

A

Serotonin syndrome

30
Q

What are the drug interactions of SSRIs?

A
  • Causes serotonin syndrome when combined with MAO inhibitors
  • SSRIs inhibit mixed function oxidases (CYP2D6)
    • Reduces metabolism of other drugs
    • Sertraline and citalopram do not inhibit P450 system
  • Fluoxetine binds to plasma proteins
    • Displaces warfarin and digoxin
31
Q

What are the symptoms of serotonin syndrome?

A
  • SMARTS
    • Sweating
    • Myoclonus
    • ANS instability
    • Rigidity
    • Temperature increase (hyperthermia)
    • Seizures
32
Q

What are the symptoms associated with withdrawal from SSRIs?

A
  • Less symptoms with longer T1/2 compounds
    • Dizziness
    • Nausea
    • Paresthesias
    • Tremors
    • Anxiety
    • Palpitations
33
Q

What are some common examples of selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)?

A
  • Venlafaxine
  • Duloxetine
34
Q

What is the pharmacological activity of SSNRIs?

A

Block reuptake of both serotonin and norepinephrine (equally) with minimal antimuscarinic and α-adrenergic antagonist effects

35
Q

Venlafaxine has a 10x (higher/lower) affinity for 5-HT than sertraline, an SSRI.

A

Lower

36
Q

Venlafaxine has a 11x (higher/lower) affinity for 5-HT than amitriptyline, a tricyclic.

A

Higher

37
Q

Venlafaxine, an SSNRI, is more selective for (5-HT/NE) transporters.

A

5-HT

38
Q

What are some common examples of miscellaneous antidepressants?

A
  • Bupropion
  • Trazodone
  • Nefazodone
  • Mirtazapine
39
Q

What is the pharmacological activity of miscellaneous antidepressants?

A
  • Effective in treating bipolar disorder in combination with lithium
  • Does not elevate mood in normal patients
40
Q

(T/F) The mechanism of action for bupropion might involve dopamine and norepinephrine transporters, but has little to no effect on 5-HT and MAO.

A

True.

41
Q

The active metabolite of bupropion is _______________.

A

Hydroxybupropion

42
Q

What is the mechanism of action for Trazodone?

A
  • Blocks 5-HT 2a receptor
  • Modest antagonist at H1 receptor (histamine receptor)
  • Weak but selective inhibitor of SERT with little effect on NET
  • Weak to moderate antagonism of α-2 adrenergic receptors
43
Q

What is the mechanism of action for Nefazodone?

A
  • Blocks 5-HT 2a receptor
  • Inhibits SERT and NET
44
Q

What are the adverse effects of Mirtazepine?

A
  • Sedation (opposite of Bupropion)
  • Increased appetite and weight gain (opposite of Bupropion)
    • Can be used to an advantage, such as in anorexic patients
  • Dry mouth and constipation
  • No sexual side effects
45
Q

What are the drug interactions associated with miscellaneous antidepressants?

A

Do not combine any with MAO inhibitors

  • Bupropion
  • Trazodone
  • Nefazodone
  • Mirtazapine
46
Q

What are some common examples of monoamine oxidase inhibitors (MAO inhibitors)?

A
  • Phenelzine
  • Tranylcypromine
  • Selegiline
47
Q

What is the pharmacological activity of MAO inhibitors?

A
  • Used in depression only when refractory to other drugs
  • Narcolepsy
48
Q

What is the mechanism of action for MAO inhibitors?

A
  • Inhibition of both MAO-A and MAO-B
    • Selegiline is specific for MAO-B
  • Increase norepinephrine, dopamine, and serotonin levels
    • Takes 2-3 days for optimum inhibition of 70% to be reached
49
Q

What is the pharmacokinets of MAO inhibitors?

A
  • Good oral absorption
  • Slow elimination
  • Termination of activity is dependent upon the synthesis of new enzyme
50
Q

What are some adverse effects of MAO inhibitors?

A
  • Insomnia
  • Agitation
  • Hyperthermia
  • Convulsions
  • Hypo or hypertension
  • Rare hepatotoxicity
51
Q

What are the drug and food interactions of MAO inhibitors?

A
  • Interacts with:
    • Sympathomimetics
    • Tricyclics
    • SSRIs
    • Foods (such as wine and cheese - tyramine)
52
Q

What are some common examples of atypical antipsychotics?

A
  • Aripiprazole
  • Quetiapine
  • Olanzapine
  • Risperidone
53
Q

_____________, taken from the Hypericum perforatum plant, is commonly prescribed for mild to moderate depression in Europe.

A

St. John’s wort

54
Q

(T/F) St. John’s wort activates CYP3A4 and CYP2C9. It also activates CYP1A2 only in females.

A

True.

55
Q

What are the adverse effects of St. John’s wort?

A
  • GI symptoms
  • Dizziness
  • Confusion
  • Sedation
  • Photosensitivity
  • May aggravate mania in bipolar patients and psychosis in schizophrenics
56
Q

(T/F) Ketamine has a rather slow onset and short-lasting antidepressant effects in otherwise treatment-resistant patients.

A

False. Ketamine has a fast onset and a sustained antidepressant effect in otherwise treatment-resistant patients.

57
Q

What are the two first line treatments of major depression?

A
  • SSRIs
  • SSNRIs
58
Q

__________ is the only SSRI approved for depression in children and adolescents.

A

Fluoxetine

59
Q

(T/F) 2nd generation antidepressants (the miscellaneous antidepressants) are not effective in the severely depressed. Bupropion is the exception to this rule.

A

True.

60
Q

_____________, a tricyclic, has the cheapest generic form of medication.

A

Imipramine

61
Q

Which two antidepressants have lowest incidence of sexual side effects?

A
  • Bupropion (decreased appetite and awake)
  • Mirtazepine (increased appetite and sedation)
62
Q

What are some adverse side effects seen with Trazodone (2nd generation antidepressent)?

A
  • Drowsiness
  • Priapism (permanent impotence)
63
Q

What are some adverse side effects seen with Nefazodone (2nd generation antidepressent)?

A
  • Hepatotoxicity
  • Dry mouth
64
Q

What are some adverse side effects seen with Bupropion (2nd generation antidepressant)?

A
  • Agitation (most frequent reson for discontinuation)
  • Decreased appetite (opposite of Mirtazepine)
  • Sedation (opposite of Mirtazepine)
  • No sexual side effects

BB Test 3 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions