Antidepressants Flashcards

1
Q

What is the goal of most antidepressants?

A

Increase NTs in the synapse

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

Out of the 2 theories about how antidepressants work, which one is more accepted?

A

Eventual down-regulation of pre-synaptic receptors - it takes 3-4 weeks for them to work

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

Name 2 nonselective MAOIs.

A

Phenelzine and Tranycypromine

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

What is the original and oldest class of drugs intended to treat depression? How did they discover them?

A

MAOIs

Iproniazid - tx of TB that improved mood

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

What NTs do MAOIs increase? A vs. B?

A

A - Epi, NE, 5-HT

B - DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the major limitation of MAOIs? What foods/drugs should you avoid regarding this issue?

A

potential for HTN crisis
AVOID
1. Foods high in tryamine
2. Alpha agonist (sudafed- sympathomimetic amine)

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

What is the main difference between phenelzine and tranylcypromine?

A

Phen - sedating (like phenergan)

Tanyl - activating

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

Precautions with MAOI apply up to ________ following D/C of MAOI.

A

3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what other drugs should you avoid like taking an MAOI? Does the wash out period apply?

A

TCAs
SSRI
Meperidine (narcotic)
YES - avoid for 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T or F. Because of all the precautions with MAOIs, they are not considered first line.

A

T.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the father of the TCAs? What was their old name?

A

Imipramine - historically referred to as the thymoleptics

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

TCAs are highly effective and inexpensive, so why aren’t these used as readily any more?

A

They are dirty and toxic.

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

What does TCA stand for (tox)? What is the antidote to TCA overdose?

A

T - tonic clonic seizsure
C - cardiac arrythmia
A - anticholinergic
antidote - bicarb

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

Secondary amines are metabolites of tertiaries, and are generally ____________ tolerated when compared to tertiary amines.

A

BETTER TOLERATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T or F. Secondary amines are metabolized into tertiary amines.

A

F. Tertiary are metabolized into secondary.

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

What are the side effects of TCAs?

A

ANTICHOLINERGIC - anti parasympathethic - sympathetic
tachycardia
sedation
peristalsis stops = constipation, dry mouth
urinary retention
orthostatic hypotension, visual disturbances, conduction disturbances

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

Using TCAs in patients with histories of __________ is dangerous.

A

(ASS)
Arrythmias
Seizure
Suicidal ideation/attempts

18
Q

TCAs interact with what 3 drug classes?

A

MAOIs
antiarrythmics
CNS depressants/stimulants

19
Q

Patients are told that TCA anticholinergic effects may subside in ___ weeks and that the antidepressant effect may take up to __ weeks to develop.

A

2-3 weeks

2-4 weeks

20
Q

Name 3 off label uses of TCAs. Are TCAs more commonly used for these things?

A

YES

  1. insomnia
  2. Neuropathic pain
  3. enuresis
21
Q

What is the father of the SSRIs?

A

Fluoxetine (Prozac) “wonder drug”

22
Q

name some other brand name SSRIs.

A

Paxil
Zoloft
Celexa
Lexapro

23
Q

What is the big advantage/disadvantage of SSRIs compared to TCAs?

A

Lacks anticholinergic, CV, toxic effects

more $$$

24
Q

What is the most common AE of SSRIs? Keep in mind that there are other AEs related to specific drugs. What about drug reactions?

A

sexual dysfunction

some CYP inhibition

25
Patient presents with confusion, sweating, fever, rigidity, tachycardia, hypotension. They were taking a SSRI and a MAOI. What is going on?
Serotonin syndrome
26
How does Bupropion work? What is the major benefit of using this drug over SSRI?
Weak inhibitor of DA reuptake with little/no effect on NE or 5HT little effect on CV or sexual dysfunction
27
Bupropion increases/lowers seizure threshold.
Lowers
28
T or F. Bupropion causes weight gain.
F. weight loss
29
What antidepressant drug is also used for smoking cessation?
Bupropion
30
How does Trazodone work? It seems illogical...
Serotonin 2 receptor antagonist and weak SSRI.
31
What group of people may benefit the most from Trazodone?
People with depression and insomnia (it is highly sedating)
32
How does Venlafaxine (Effexor) work?
Blocks reuptake of NE and 5HT | not chemically related to TCAs or SSRIs
33
What are the major AEs of venlafaxine?
CV effects - HTN, tachycardia, increases serum lipids | sexual dysfunction
34
Which drug is typically reserved for last line/Pre-ECT therapy?
Venlafaxine.
35
How does Duloxetine (Cymbalta) work?
SSRI with NE blocking properties
36
What 3 conditions are Duloxetine used for other than depression? (claim to fame)
peripheral neuropathy, fibromyalgia, incontinence
37
Mirtazepine has what 3 side effects?
sedation weight gain no sexual effects
38
What herbal remedy is a weak SSRI, MAOI?
St. John's Wart
39
Sometimes, people are given 5-10mg of _________ to get over the hump when starting an antidepressant.
Ritalin - amphetamine
40
What Abx has weak MAOI properties?
Linezolid