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Antidepressants Flashcards

1
Q

What are the two major downfalls of antidepressants?

A

long dosing before takes effect

Elderly are more susceptible to adberse effects

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2
Q

What is the monoamine/biogenic amine hypothesis?

A

Deficiency in the level of 5HT, NE and DA lead to depression

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3
Q

All currently available antidepressants do what?

A

Enhance the synaptic availability of monoamines

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4
Q

What is the neurotrophic hypothesis of depression?

A

Loss of brain derived neurotrophic factor (BDNF)

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5
Q

What is the MOA of brain derived neurotrophic growth factor?

A

Activate TRK- B receptors, causing an increased neuronal survival and growth

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6
Q

What are the four major categories of antidepressants?

A
  1. MAOIs
  2. tricyclics
  3. SSRIs
  4. Atypical antidepressants
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7
Q

What is the MOA of TCAs?

A

Block the reuptake of NE by NET

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8
Q

What is the MOA of SNRIs?

A

Block the reuptake of NE and 5HT via inhibiting SERT and NET

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9
Q

What is the role of presynaptic autoreceptors like 5HT-1A?

A

Inhibit the release of neurotransmitters

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10
Q

Which type of antidepressants are used to treat chronic pain?

A

TCAs and SNRIs

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11
Q

What are the drugs that cause psychomotor activation, antiparkinsonian effects, psychosis?

A

DA uptake blockade

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12
Q

What are the antidepressants that cause sedation, drowsiness, weight gain, hypotension?

A

H1 receptor blockade

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13
Q

What is the first generation of antidepressants?

A

MAOIs

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14
Q

What are the indications for MAOIs?

A

Resistant depression

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15
Q

What is the MOA of MAOIs?

A

Increase synaptic availability of NE and 5HT by blocking their catabolism via MAO

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16
Q

What is the MOA of MAO-A?

A

Degrades tyramine, NE, 5HT

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17
Q

What is the MOA of MAO-B?

A

targets mainly DA

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18
Q

What are the three major MAOIs?

A

Phenelzine
tranycypromine
Selegiline

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19
Q

What is the MOA of Phenelzine?

A

Irreversible, non-selective MAO-A and MAO-B inhibitors

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20
Q

What is the MOA of tranylcypromine?

A

Irreversible, non-selective MAO-A and MAO-B inhibitors

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21
Q

What is the MOA of moclobemide?

A

Reversible MAO-A inhibitor

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22
Q

What is the MOA of selegiline?

A

Irreversible MAO-B inhibitor

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23
Q

What is low dose selesgiline used for? High dose?

A 
Low= Parkinson's
High = Antidepressant
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24
Q

What is the most common side effect of MAOIs?

A

Orthostatic hypotension

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25
Q

What is the major food interaction that MAOIs have?

A

Tyramine from cheeses will cause a hypertensive crisis

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26
Q

What are the drug interactions that MAOIs have?

A

SSRIs

TCAs

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27
Q

What are the symptoms of MAOI overdose?

A

Hyperthermia
Seizures
Shock
Delirium

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28
Q

Which class of antidepressants has the highest rate of sexual dysfunction?

A

MAOIs

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29
Q

What is the MOA of tyramine?

A

Triggers the release of catecholamines in the synapse

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30
Q

What was the first TCA discovered?

A

Imipramine

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31
Q

What is the major clinical use of TCAs other than depression?

A

Chronic pain conditions

OCD

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32
Q

What is the MOA of TCAs?

A

Inhibit the reuptake of both 5HT and NE by inhibiting SERT and NET

33
Q

What are the three main TCAs?

A

Imipramine
Desipramine
Amitriptyline

34
Q

What is the MOA of imipramine? What is this used to treat besides depression?

A

TCA

Enuresis

35
Q

What is the MOA of desipramine? What is this used to treat besides depression?

A

TCA

neuropathic pain

36
Q

What is the MOA of amitriptyline? What is this used to treat besides depression?

A

TCA

Sedative

37
Q

What is the major issue of prescribing TCAs in the elderly?

A

falls d/t orthostatic hypotension

38
Q

What are the toxic CNS effects of TCAs?

39
Q

What is the most serious side effect of TCAs?

A

Cardiac toxicity

40
Q

What are the three Cs of TCA overdose?

A

Convulsions
Coma
Cardiac arrhythmias

41
Q

What is the MOA of fluxetine?

42
Q

What is the MOA of sertraline?

43
Q

What is the MOA of paroxetine?

44
Q

What is the MOA of citalopram?

45
Q

What is the MOA of Escitalopram?

46
Q

What is the MOA of fluvoxamine?

47
Q

What are the six SSRIs?

A 
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
48
Q

What are the short term side effects of SSRIs?

A

Nausea
GI upset
Diarrhea

49
Q

What are the long term side effects of SSRIs?

A

Sexual dysfunction

50
Q

What is the major drug interaction of SSRIs?

A

Serotonin syndrome

51
Q

What is the common cause of serotonin syndrome?

A

Switching medications prior to letting effect wear off

52
Q

Which SSRI has the longest half life? How long before out of system?

A

Fluoxetine

4- weeks

53
Q

What are the early symptoms of serotonin syndrome?

A 
Lethargy
Restlessness
Mental confusion
Flushing
Diaphoresis
tremor
54
Q

How do you treat serotonin syndrome?

A

Supportive

55
Q

Most of the SSRI do what to p450 enzymes?

A

Inhibit them

56
Q

What are the side effects of suddenly stopping SSRIs?

A

Dizziness
Paresthesias
Anxiety

57
Q

What is the MOA of SNRIs?

A

Inhibit reuptake of 5HT and NE

58
Q

What is the MOA of venlafaxine?

59
Q

What is the MOA of duloxetine?

60
Q

What is the major difference between SNRIs and TCAs, since both work to inhibit serotonin and NE reuptake?

A

Better side effect profile

61
Q

Which of the SNRIs is used to treat chronic pain?

A

Duloxetine

62
Q

What is the MOA of trazodone?

A

Blocks H1 and 5HT2 receptor

63
Q

What is the major side effect of trazodone?

64
Q

What is the MOA of buproprion?

A

Blocks NE and DA reuptake, and increases the release of catecholamines

Wellbutrin

65
Q

What is the MOA of mirtazapine?

A

Blocks alpha 2 receptors, and increases synaptic release of 5HT and NE

66
Q

What is the cause of the antiemetic properties of mirtazapine?

A

Blocks 5HT2 and 5HT3 receptors

67
Q

What are the side effects of SNRIs

A

Noradrenergic effects (increase BP)

68
Q

What are the side effects of 5HT2 antagonists like trazodone?

A

Sedation and priapism

69
Q

What are the two p450 enzymes that are particularly inhibited by antidepressants?

70
Q

What are the three potent inhibitors of CYP2D6?

A

Paroxetine
Fluoxetine
Fluvoxamine

71
Q

Why should you never combine SSRIs and TCAs?

A

Will cause serotonin syndrome

72
Q

What is the main treatment for bipolar disorder? Does this act fast?

73
Q

What are the two anticonvulsants used in the treatment of the manic phase of bipolar disorder?

A

valproic acid

Carbamazepine

74
Q

What is the MOA of lithium?

A

Stabilizes the post synaptic terminal

75
Q

What are the major side effects of lithium?

A

Tremor

Hypothyroidism

76
Q

What is the renal issue caused by lithium? MOA?

A

Nephrogenic DI

Blocks vasopressin/ADH response in the renal tubule

77
Q

What are the skin reactions with Li?

A

Acne vulgaris

Psoriasis

78
Q

What are the two major drug-drug interactions with Li? What happens here?

A

Thiazide and loop diuretics

Diminished the Li clearance since Na depletion promotes the reabsorption of both Na and Li.

This causes an increase in Li in the serum

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