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Pharm > Antidepressants > Flashcards

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?

A

Szs

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?

A

SSRI

42
Q

What is the MOA of sertraline?

A

SSRI

43
Q

What is the MOA of paroxetine?

A

SSRI

44
Q

What is the MOA of citalopram?

A

SSRI

45
Q

What is the MOA of Escitalopram?

A

SSRI

46
Q

What is the MOA of fluvoxamine?

A

SSRI

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?

A

SNRI

59
Q

What is the MOA of duloxetine?

A

SNRI

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?

A

Priapism

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?

A

2D6

3A4

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?

A

Li

No

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

Pharm (73 decks)

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