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Pharm Test 3 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Antidepressant selection is based upone what three things?

A

past history of response
side effect
coexisting medical conditions

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2
Q

What kind of drug are TCAs?

A

antidressants

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3
Q

What kind of drug are MAOIs?

A

antidepressants

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4
Q

SSRI

A

selective serotonin reuptake inhibitors

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5
Q

SNRIs

A

serotonin/norepinephrine reuptake inhibitors

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6
Q

What EKG change may you see while taking TCAs?

A

QT elongation

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7
Q

What are some examples of antihistaminic side effects?

A

sedation and weight gain

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8
Q

What are some examples of anticholinergi side effects?

A

dry mouth, dry eyes, constipation

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9
Q

What are some examples of antiadrenergic side effects?

A

orthostatic hypotension, sedation, sexual dysfunction

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10
Q

What are the active metabolites of tertiary TCAs?

A

desipramine

nortriptyline

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11
Q

Tertiary TCAs act primarily on ______________ receptor

A

serotonin

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12
Q

What are secondary TCAs?

A

often the metabolites of tertiary TCAs

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13
Q

What kind of drug is desipramine?

A

secondary TCAs

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14
Q

What kind of drug is notrtriptyline?

A

secondary TCAs

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15
Q

What kind of side effects may you see with TCAs?

A

antihistaminic
anticholinergic
antiadrenergic

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16
Q

MAOIs block the inactivation of what amines?

A

norepinephrine
dopamine
serotonin

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17
Q

MAOIs ________________ the synaptic levels of certain amines

A

increase

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18
Q

What are the AE of MAOIs?

A 
orthostatic hypotension
weight gain
dry mouth
sedation
sexual dysfunction
sleep disturbance
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19
Q

What should you avoid while taking MAOIs?

A

tyramine

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20
Q

What is serotonin syndrome?

A

it can develop if MAOIs are taking with meds that increase serotonin or have sympathomimetic action

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21
Q

What are the Sx of serotonin syndrome?

A

abdominal pain, diarrhea, sweats, tachycardia, HTN myoclonus, irritability, delirium

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22
Q

What can serotonin syndrome lead to?

A

hyperpyrexia
cardiovascular shock
death

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23
Q

How can you avoid serotonin syndrome?

A

wait 2 weeks before switching from an SSRI to an MAOI

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24
Q

What drug needs to have a 5 week waiting period when switching drugs d/t the long half life?

A

fluoxetine

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25
Q

What is the MOA of SSRIs?

A

block presynaptic serotonin reuptake

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26
Q

What is the MC AE of SSRIs?

A 
GI upset
sexual dysfunction
anxiety
restlessness
nervousness 
insomnia, fatigue, sedation, dizziness
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27
Q

What is discontinuation syndrome?

A

happens w/SSRIs

agitation, nausea, disequilibrium, dysphoria

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28
Q

______________ has a short half life with no active metabolite, which means no build up (good if hypomania develops)

A

paroxetine

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29
Q

What are two pro’s of paroxetine?

A

short half life

sedating properties

30
Q

Paroxetine has significant _______________ inhibition

A

CYP2D6

31
Q

What are some AE of paroxetine?

A

weight gain
anticholinergic effects
discontinuation syndrome

32
Q

Sertraline has very weak _______ interactions

A

P450

33
Q

What length half life does sertraline have?

A

short half life

lower build up of metabolites

34
Q

Which has more sedating properties, sertraline or paroxetine?

A

paroxetine

35
Q

A ___________ stomach is required for the absorption of sertraline

A

full

36
Q

Fluoxetine has a __________ half life

A

Long
decreased risk of discontinuation syndrome
increased risk of metabolite buildup

37
Q

What is a possible initial AE of fluoxetine?

A

increased anxiety and insomnia

38
Q

Fluoxetime is more likely to induce __________ than other SSRIs

A

mania

39
Q

In what type of patient should you use fluoxetine cautiously? why?

A

hepatic illness. b/c it has a long half life and there is a risk of metabolite buildup

40
Q

What are two pros of citalopram?

A

low inhibition of p450

intermediate 1/2 life

41
Q

What is it a good thing that citalopram has a low inhibition of p450?

A

less drug/drug interaction

42
Q

What EKG change may you see with citalopram?

A

QT elongation

dose dependant, doses greater than 40 not recommended

43
Q

What is the MOA behind citaloprams sedating properties?

A

mild antagonism at H1 histamine receptor

44
Q

Citalopram has __________ GI AE than sertraline

A

less

45
Q

Escitalopram has a ________ inhibition of p450 enzems

A

low

46
Q

escitalopram is _________ effective than citalopram in acute response and remission

A

more

47
Q

Which SSRI has the shortest half life?

A

fluvoxamine

48
Q

What is a unique pro of fluvoxamine?

A

analgesic properties

49
Q

Fluvoxamine is a strong inhibitor of ___________ and __________

A

CYP1A2

CYP2C19

50
Q

Inhibit both serotonin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects

A

SNRIs

51
Q

What are SNRIs used to treat

A

depression, anxiety and neuropathic path

52
Q

______________ has almost no activity against P450

A

venlafaxine

53
Q

Why are desvenlafaxine and venlafaxine good for geriatric populations?

A

short half life and fast renal clearance avoids build up

54
Q

Venlafaxine can cause an increase in ___________ BP

A

diastolic

55
Q

What drug can cause significant nausea, especially with the IR tablet?

A

venlafaxine

56
Q

Tapering of venlafaxine is recommended after ________ of administration

A

2 weeks

57
Q

What is a con AE of desvenlafaxine?

A

dose related increase in total CHOL LDL and TG

58
Q

There is some data that suggests _________ may have some efficacy for the physical symptoms of depression

A

duloxetine

59
Q

Duloxetine is a _____________ and _____________ inhibitor

A

CYP2D6

CYP1A2

60
Q

You cannot break the capsule of this drug as its active ingredient is not stable within the stomach

A

duloxetine

61
Q

This drug is a 5HT2 and 5HT3 receptor antagonists

A

mirtazapine

62
Q

Mirtazapine is _____________ at low doses

A

very sedative

63
Q

MOA of buproprion

A

reuptake inhibition of dopamine and norepinephrine

64
Q

This drug is a second line ADHD agent

A

buproprion

65
Q

You do NOT want to give this drug to a person suffering from anorexia/bulemia d/t risk of seizure

A

buproprion

66
Q

This drug has some abuse potential because it can iduce psychotic sx at high doses

A

buproprion

67
Q

For a treatment naive patient, you want to start with what kind of drug?

A

SSRI

citalopram, fluoxetine, sertraline

68
Q

Paxil and mirtazapine are poor first line choices because of thier ________ and____________ effects

A

sedation

weight gain

69
Q

What drug is contraindicated in a pt with HTN issues

A

venlafaxine

70
Q

What drug may help with neuropathic pain?

A

TCAs

71
Q

_____________ has an indication for neuropathic pain, dpression and anxiety

A

duloxetine

Pharm Test 3 (5 decks)

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