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pharm III exam 1 > antidepressants > Flashcards

antidepressants Flashcards

1
Q

Amitriptyline (Elavil®)

A
  • tertiary amine
  • Tricyclic Antidepressants (TCAs)
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2
Q

Imipramine (Tofranil®)

A
  • tertiary amine
  • Tricyclic Antidepressants (TCAs)
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3
Q

Nortriptyline (Pamelor®)

A
  • secondary amine
  • Tricyclic Antidepressants (TCAs)
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4
Q

Desipramine (Norpramin®)

A
  • secondary amine
  • Tricyclic Antidepressants (TCAs)
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5
Q

Phenelzine (Nardil®)

A

Monoamine Oxidase Inhibitors (MAOIs)

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6
Q

Selegiline (Deprenyl®)

A

Monoamine Oxidase Inhibitors (MAOIs)

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7
Q

Fluoxetine (Prozac®)

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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8
Q

Paroxetine (Paxil®

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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9
Q

Sertraline (Zoloft®)

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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10
Q

Citalopram (Celexa®

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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11
Q

Venlafaxine (Effexor®)

A

5-HT and NE Reuptake Inhibitors (SNRIs)

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12
Q

Duloxetine (Cymbalta®)

A

5-HT and NE Reuptake Inhibitors (SNRIs)

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13
Q

which neurotransmitter is responsible for reward, motivation, euphoria, and movement

A

dopamine

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14
Q

which neurotransmitter is responsible for reward, arousal, alertness, decisions, and flight or fright

A

NE/noradrenaline

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15
Q

which neurotransmitter is responsible for mood, emotion, memory, sleep, and cognition

A

serotonin (5-HT)

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16
Q

what is the Monoamine Hypothesis of depression

A
  • amine neurotransmitters are DA, NE, and serotonin
  • depression results from abnormal or decressed neurotransmission of dopamine, norepinephrine and serotonin
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17
Q

evidence for the Monoamine Hypothesis is that patients treated with Reserpine which depletes neurons of noradrenaline (NE) and serotonin (5-HT) developed what

A
  1. depression
    * This suggested that depression had something to do with a deficit of NE and 5-HT.
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18
Q

the antidepressant effect takes 2-3 weeks due to

A

neural plasticity

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19
Q

differentiate between short term effects and long term effects of uptake inhibitors

A
  1. Normal - amine levels in synapse are modulated by reuptake and presynaptic inhibition
  2. short term Uptake inhibitors - amine levels in synapse are increased BUT so does feedback inhibition so synaptic amine levels are balanced
  3. Long-term - Antidepressants downregulate auto-receptors (which control firing rate of neuron by negative feedback); increasing firing rate of amine neurons
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20
Q

MOA of tricyclic antidepressants

A
  • inhibit re-uptake of NE and serotonin
  • also block a-adrenergic, histamine and muscarinic receptors
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21
Q

list uses of tricyclic antidepressants

A
  • depression: not first line
  • chronic pain (TMJ)
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22
Q

List the tertiary amines TCA

A
  • amitriptyline (Elavil®)
  • imipramine (Tofranil®)
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23
Q

MOA of tertiary amines. adverse effects?

A
  • primarily inhibit serotonin re-uptake
  • produce more seizures and are more sedating than secondary amines
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24
Q

List the secondary amines TCA

A
  • nortriptyline (Pamelor®)
  • desipramine (Norpramin®)
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25
Q

MOA of secondary amine TCA

A

primarily block NE re-uptake

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26
Q

List the 4 dopamine pathways

A
  1. nigrostriatal
  2. mesolimbic
  3. mesocortical
  4. tubero-infundibular
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27
Q

TCAs are metabolized by

A

CYP2D6: thus drug interactions are very common

28
Q

List the side effects of TCA

A
  • weight gain
  • histamine receptor blockade -> sedation
  • cholinergic blockade -> blurred vision, tachycardia, constipation, dry mouth, impaired memory
  • a1 receptor blockade -> postural hypotension, reflex tachycardia
  • analgesia
  • SIADH -> hyponatremia
  • sexual dysfunction
  • decrease in sz threshold
29
Q

can TCAs be used in pregnant patients

A

yes

30
Q

TCA toxicity can lead to what cardiac abnormality

A
  • Torsades de pointes
    • antidote: magnesium
31
Q

Monoamine oxidase inhibitors and TCAs together can result in what condition? what are the signs of this condition?

A
  • serotonin syndrome
    • severe CNS toxicity
      • fever
      • convulsions
      • coma
32
Q

List the Selective Serotonin Reuptake Inhibitors (SSRIs)

A
  • Fluoxetine (Prozac®)
  • Paroxetine (Paxil®)
  • Sertraline (Zoloft®)
  • Citalopram (Celexa®)
33
Q

Escitalopram (Lexapro)

A

SSRI

34
Q

obsessive compulsive disorder and social anxiety are usually treated with what SSRI

A
  • Paroxetine (Paxil)
35
Q

of the SSRIs, which is the most likely to inhibit CYP450 enzymes? specially which enzymes?

A
  • Fluoxetine
36
Q

SSRI drug of choice in an elderly patient? why?

A
  • sertraline (zoloft)
    • due to shorter half life of 26 hours
    • least likely to interact with other drugs
37
Q

DOC for depression

A
  • SSRI
    • specifically Citalopram
38
Q

MOA of SSRIs

A

selectively inhibits serotonin reuptake

39
Q

list the side effects of SSRIs

A
  • mild side effects
    • sexual dysfunction
40
Q

fluoxetine has what drug interaction with codeine

A
  • it inhibits the conversion of codeine to morphine
41
Q

SSRIs + MAOI will cause

A

serotonin syndrome

42
Q

SSRI + St johns wart or amphetamines will cause

A

serotonin syndrome

43
Q

SSRI/MAOI/ or TCA + tramadol can cause

A
  • tramadol is a mu agonist
  • inhibits NE/serotonin uptake and can cause seizures and serotonin syndrome
44
Q

MOA of serotonin-norepinephrine reuptake inhibitors

A
  • inhibit reuptake of NE and 5-HT reuptake
45
Q

side effect of venlafaxine

A

may increase blood pressure

46
Q

side effects of duloxetine

A
  • hepatotoxicity
  • bilateral acute angle-closure glaucoma
47
Q

MOA of Monoamine oxidase inhibitors

A

irreversibly inhibit MAOs which metabolize NE, DA, and serotonin -> get increased amounts of these

48
Q

MOA of MAO-A

A
  • metabolize NE, DA, and serotonin in both the CNS and periphery (GI tract)
49
Q

MOA of MAO-B

A
  • selectively metabolizes DA in the CNS but not the GI tract
50
Q

MOA of Phenelzine

A
  • inhibits both MAO-A and MAO-B
    • increases NE, serotonin, and DA
    • drug of last choice
51
Q

MOA of Selegiline

A
  • selectively inhibits MAO-B
    • increases DA
    • fewer side effects
52
Q

side effects of Phenelzine

A
  • hypertensive crisis
53
Q

with what medication should you avoid use with tyramine? why

A
  • MAOI: phenelzine
  • foods with tyramine: red wine, beer, aged cheese
  • MAO-A is inhibited in GI tract, tyramine causes release of amines and with limited metabolism by MAO-A can get severe hypertension
54
Q

MAOI + SSRIs or TCAs can lead to

A

serotonin syndrome

55
Q

MAOI + OTC cold and cough medication containing sympathomimetic amines (ephedrine or amphetamines) can lead to

A

severe hypertension

56
Q

MAOIs affect on 2D6

A

inhibit 2D6

57
Q

MOA of Buproprion (wellbutrin)

A
  • inhibits DA reuptake
58
Q

when is Buproprion (wellbutrin) used

A
  • ADHD
  • alcoholism (reduces craving)
59
Q

side effects of Buproprion (wellbutrin)

A
  • seizures: CI in patients with h/o sz
  • anxiety, insomnia, tremor
  • tachycardia
  • sexual dysfunction rare
60
Q

MOA of Mirtazapine

A
  • blocks presynaptic alpha 2 receptors which inhibits release of NE and 5-HT
    • increases relase of NE and 5-HT
61
Q

side effects of Mirtazapine

A
  • blocks histamine receptors -> drowsiness
62
Q

good drug to use in patient who is depressed with insomnia or anxiety

A

Mirtazapine

63
Q

MOA of Atomoxetine

A
  • selective inhibitor of NE reuptake
64
Q

use of Atomoxetine

A
  • ADHD
    • does not cause euphoria so good for addicts
65
Q

MOA and use of Trazodone

A
  • 5-HT receptor antagonist
  • sedating -> more often used as sleep aid and pain management
66
Q

St. johns wort may be effective in mild depression but it should not be combined with what

A
  • other antidepressants
    • will cause serotonin syndrome
67
Q

Side effect of Trazodone

A

Liver failure

pharm III exam 1 (11 decks)

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