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!!!!! Pharm Spring 16 Exam 2 !!!!! > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

SSRIs can act on

A
  1. serotonin
  2. norepi
  3. dopamine
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2
Q

regardless of acting on serotonin, norepi or dopamine ALL SSRIs __________

A

block the repuptake of serotonin

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3
Q

some of the side effects caused by SSRIs is due to the ________.

A

Alpha 2 receptor blockade

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4
Q

oldest SSRI that works on serotonin only and also has a very active metabolite

A

Fluoxetine (Prozac)

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5
Q

has an active metabolite and a shorter elimination half time that fluoxetine

A

Sertraline (Zoloft)

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6
Q

SSRI with the longest elimination half time. How long is it?

A

Fluoxetine (Prozac) 3-6 Days

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7
Q

three other SSRIs that only act on serotonin

A
  1. Paroxitine (Paxil)
  2. Fluvoxamine (Luvox)
  3. Escitalopram (Lexapro)
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8
Q

SSRIs that act on NE and serotonin

A
  1. Buproprion (wellbutrin)
  2. Trazadone (desyrel)
  3. Nefazadone (serzone)
  4. Venlafaxine (effexor)
  5. Duloxetine (cymbalta)
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9
Q

What makes SSRIs have a higher index of safety than other antidepressants

A
  1. Minimal effects on blood pressure
  2. Minimal changes in conduction
  3. Minimal changes in the seizure threshold
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10
Q

if one antidepressant isn’t working the patient should….

A

try another one, because they have a high index of safety

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11
Q

Biggest complaint with SSRI see effects

A

Sexual dysfunction and weight gain

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12
Q

insomnia/fatigue agitation headache N/V rarely orthostatic hypotension

A

side effects of SSRIs

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13
Q

SSRI constellations with anesthesia

A
  1. Inhibits CYP 450 system
  2. Potential anti platelet activity - increased bleeding risk
  3. Serotonin Syndrome
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14
Q

Due to excess availability of serotonin in the CNS

A

Serotonin syndrome

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15
Q

Presents as muscle rigidity, hyperreflexia, diaphoresis, ataxia, shivering, fever and confusion

A

Serotonin syndrome

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16
Q

drugs that could potentiate a serotonin syndrome

A

phenylpipridine opioids:

  1. Methadone
  2. demerol
  3. tramadol
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17
Q

Methadone, demeorl and tramadol

A

weak serotonin repuptake inhibitors that could possibly potentiate a serotonin syndrome

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18
Q

SSRIs at lower doses can be used to treat_________ by inhibiting the overactive inflammatory response systems

A

chronic pain syndromes

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19
Q

Tricyclics are _________________.

A

Tertiary of Secondary amines

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20
Q

Tertiary amines inhibit ____________ reuptake while Secondary amines inhibit ____________ reuptake

A

Serotonin AND Norepi only Norepi

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21
Q

elimination half time of tricyclics

A

10-80 hours

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22
Q

how are tricyclics metabolized

A

by the liver

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23
Q

Tricyclics are highly ____________ and strongly _________.

A

lipid soluble - easily absorbed GI protein bound - to tissue and plasma proteins

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24
Q

_________ should not be given with tricyclics because they can cause CNS toxicity with _________, _________, ___________

A

MAOI

  1. hypothermia
  2. seizure
  3. coma
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25
Q

Because ___________ cause anticholinerdic side effects caution should be executed with __________. they are highly unpredictable and can cause an increase in ___________. An indirect agent should be aboided because an increase in _________ may be exaggerated due to larger amounts of _________ available at the synapse. Insead a ___________ acting agent should be used and with ________.

A

Tricyclic Antidepressants

Sympathetomimetics

Blood Pressure

Blood Pressure

Norepi

Direct

lower doses

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26
Q

Tricyclics and the cardiovascular system

A
  1. depresses conduction of the atria and ventricals- prolonged PR, Wide QRS and flat or inverted T-waves
  2. Orthostatic Hypotension - r/t activation of presynaptic Alpha-2 causing vasodilation
  3. Decreaed seizure threshold
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27
Q

Tricyclic overdose

A

Cardiotoxic effects, Seizure potential and CNS depression can be fatal

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28
Q

Tricyclics and Volitile anestheisa gasses

A

May need a higher MAC because more NE is present

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29
Q

Tricyclics and Opioids

A

Decrese opioid dose

30
Q

Tricyclics and Induction agents

A

Most agents are cardiac depressants-

  1. with conduction changes from tricyclics
  2. induction agents can cause dangerous arrhythmias
31
Q

Tricyclics and Barbituates

A

Decrease barbituate dose

32
Q

Tricyclics and Anticholonergic

A

Because of the Anticholinergic side effectspt more likely to have post op delerium

try to use something that does not cross the BBB like glycopyrolate instead of atropine

33
Q

Flushing, dry mouth and skin, mydriasis,

progressively red hot and dry

treated with physostigmine

A

Anticholonergic toxicity or Central anticholinergic syndrome wth Tricyclics

34
Q

life threatening, intractable myocardial debression or ventricular dysrhythmias usually cause of death

A

Tricyclic Overdose

35
Q

Tertiary amines

A

Tricyclics- inhibit serotonin and NE reuptake at presynaptic terminals

  1. Amytriptyline (elavil)
  2. Imipramine (tofranil)
  3. Clomiparime (anafanil)
36
Q

Secondary amines

A

Tricyclic antidepressants that inibit NE reuptake at the presynaptic terminals

  1. Desipramine (norpramin)
  2. nortruptyline (pamelor)
37
Q

Presenting features of tricyclic overdose

A

agitation, excitement, delerium which progresses to seizures, respiratory depression, cardiac dysrhythmias and sudden death.

there are hypotensive anticholinergic effects

38
Q

how long will someone need to be monitored for a tricyclic overdose?

A

10 days, they can still have dysrhythmias for 10 days

39
Q

what is given for anticolonergic psychosis

A

physostigmine

40
Q

Levophed

A

direct acting agent for blood pressure support that can be used with tricyclics

41
Q

Acidosis and tricyclic overdose

A

Acidosis may INCREASE unbound drug causing dysrhythmias

Give HCO3- to keep PH normal

42
Q

Why should tricyclics be weaned

A

to prevent withdrawl symptoms

43
Q

MAO is found in the __________________ and functions to _________________ inculding 1._______, 2.__________, 3._________, 4.__________

A

outer mitochondrial membrane

inactivate monoamines

dpoamine

serotonin

epinepherine

norepinepherine

44
Q

MAOIs mechanism of action

A

block the enzyme that metabolizes biogenic amines, thereby increasing neurotransmitters in the CNS and peripheal autonomic nervous system

45
Q

Deaminate: Serotonin, NE, Epi

A

MAO A

46
Q

platelts contain exclusively _________ also 60% of MAO in the brain is ________

A

MAO A

Type A

47
Q

Deaminate: Phenylethylamine

A

MAO B

48
Q

Selecive MAO-B inhibitor at lower doses and non-selective at higher doses

A

Selegiline (eldepryl)

dont need to follow tyrosine free diet at lower doses

49
Q

List to Memorize of MAOIs

A
  1. Brofaramine
  2. selegiline (eldepril)
  3. Iproniazid
  4. isocarboxazid (marplan)
  5. Phenelzine (nardil)
  6. Meclobemide
  7. befloxatone
  8. Tranycupromine (parnate)
50
Q

Why do MAOIs have such a long duration of action

A

they bind irreversibly to MAO- the body actually has to form NEW enzymes to continue break down bioamines

51
Q

MAOIs have NO effect on the ___________ and do NOT produce __________.

A

Seisure Threshold

Cardiac dysrythmias

52
Q

Where is the MAO enzyme present?

A

liver, GI tract, kidneys, lungs

53
Q

most common side effect with MAOIs

A

orthostatic hypotension

especially with the elderly

54
Q

Side effects of MAOIs

A
  1. Anticholonergic like effects
  2. impotancy/anorgasmy
  3. weight gain
  4. sedation ir mild stimulate effects
  5. Orthostatic hypotension
55
Q

What metabolizes tyramine

A

MAO A in GI tract and liver

56
Q

Tyromine is a precursor for ______ and ______ and can act as a _____________________.

A
  1. Dopamine
  2. NE
  3. catchecholamine releasing agent
57
Q

What happens when a person on an MAOI eats tyramine

A

Massive release of endogenous catechacholamines leading to a hypertensive crisis that can be lethal

hyperpyrexia

CVA

58
Q

MAOI dietary restricions

A
  1. Cheese
  2. Fava beans
  3. red wine
  4. avacado
  5. cured meats, sourcrout
59
Q

Drug ABSOLUTELY CONTRAINDICATED with MAOI - what do we use it for?

A

Meperidine (demerol)- used for post op shivering

60
Q

MAOI drug cautions: Can cause CNS excitation, delerium, seizure, DEATH

A
  1. Tricyclic antidepressants
  2. opioids
  3. cold-allergy drugs
  4. sympathomimetics
  5. nasal decongestants
  6. SSRIs
61
Q
  1. Serious headache
  2. vomiting
  3. chest pain
A

Symtoms to report with MAOI - could be the start of a Catechacholamine surge

62
Q

Excitatory response may look like serotonin syndrome

A

MAOI and Meperidine (Demerol)

63
Q

can inhibit the neuronal serotonin uptake

A

Meperedine (Demerol)

64
Q

Agitation, skeletal musle rigidity, hyperpyrexia (high fever)

A

Excitatory response of MAOI with Meperedine (Demerol)

Type I

65
Q

Hypotension, Respiratory depression, Coma

A

Depressive response of MAOI with Meperedine (Demerol)

Type II

66
Q

Why does Meperedine (Demerol) react with MAOIs

A

MAOIs inhibits one of the enzymes that breaks down Meperedine (demerol).

67
Q

Morphine and Opioids with MAOIs

A

respiratory depressive effects cand be enhanced with MAOIs

68
Q

Four RULES for MAOIs and Anesthetics

A
  1. minimize the possibility of sympathetic nervous system stimulation or drug induced hypotension
  2. Caution with sympathetomimetics - Use DIRECT acting agents, NO EPHEDRINE
  3. Caution with opoids- NO Meperidine (Demerol)
  4. May need a higher MAC- r/t extra biogenic amines circulating
69
Q

MAOI and Sympathomimetics

A
  1. May get an exagerated response from indirect acting drugs- NO EPHEDRINE
  2. Use direct acting agesnt like Phenylephrine
  3. Decrease dose by 1/3 an titrate to effect - can always give more, but cant take back what you have given
70
Q

Hyperthemia, Mydriasis, Tachycardia, Seizure and death

A

MAOI overdose- only treatable with supportive care.

71
Q
  1. Dizziness
  2. Myalgias - muscle pain
  3. Paresthesia
  4. irritability
  5. insomnia
  6. visual disturbances
  7. tremors
  8. letahrgy
  9. N/V/D
A

Discontinuation of antidepressants

!!!!! Pharm Spring 16 Exam 2 !!!!! (11 decks)

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