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Therapeutics Spring 2016 > antidepressants > Flashcards

antidepressants Flashcards

1
Q

Citalopram (celexa) p450 metabolism?

A

Substrate 2c19 major

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2
Q

Adverse effects of citalopram?

A

QTc prolongation warning ekg for doses greater than or equal to 40 MG daily or patients with CV risk ; lower dose with strong 2c19 inhibitors

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3
Q

Escitalopram (lexapro) dosing adjustments?

A

Lower doses for patients taking strong 2c19 or 3 A4 inhibitors

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4
Q

What is the p450 metabolism of fluoxetine?

A

Substrate 2c9,2d6 (mjor) inhibitor: 1A2, 2C19, (moderate) 2d6 (strong)
Norfluoxetine:inhibitor 3A4 (strong)

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5
Q

What is the half life of fluoxetine?

A

7-9 days.

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6
Q

How should you adjust fluoxetine for hepatic impairment?

A

Half the dose

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7
Q

Fluvoxamine is what p450 metabolizer?

A

Strong 1A2, 2C19 inhibitor

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8
Q

What is the most common use for Fluvoxamine?

A

OCD

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9
Q

What is the P450 metabolism of Paroxetine?

A

Strong 2D6 inhibitor

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10
Q

What must be done when going off of paroxetine, even if switching to another antidepressant?

A

Must taper dose due to anticholinergic effects. This will help avoid the cholinergic rebound, even if switching to another antidepressant.

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11
Q

What pregnancy category is Paroxetine? Why?

A

Category D. Septal wall defects.

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12
Q

What is the P450 metabolism of Vilazadone (Viibryd)?

A

MAjor 3A4. Must reduce target dose to 20mg once daily when given with strong 3A4 inhibitors. Avoid use with stron 3A4 inducers. Give with food to improve absorption.

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13
Q

Vortioxetine (Brintellix) - SSRI: What type of metabolism is this and how should the dose be adjusted because of this?

A

Major 2D6 substrate. Reduce target dose to 10mg daily with strong 2D6 inhibitors or in patients that are poor 2D6 metabolizers.

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14
Q

Which antidepressants are SSRI’s?

A

Citalopram, escitalopram, Fluoxetine, Fluvoxamine, Paroxetine HCl, Sertraline, Vilazodone, and Vortioxetine.

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15
Q

Which antidepressants are SNRI’s?

A

Desvenlafaxine, Duloxetine, Levomilnacipran, Milnacipran, Venlafaxine, Buproprion, Mirtazapine, Trazodone

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16
Q

Desvenlafaxine is what type of P450 metabolizer?

A

NO significant interactions

17
Q

Why is it difficult for patients to reach the target dose of Desvenlafaxine?

A

Significant nausea, most only reach 100mg daily instead of 400mg daily. CrCl

18
Q

Duloxetine(Cymbalta) is what P450 metabolizer?

A

Major 2D6 inhibitor

19
Q

What is the most limiting side effect of Duloxetine?

A

Nausea

20
Q

What is the rule for Levomilnacipran for patients with renal impairment?

A

Do not exceed 80mg once daily in these patients or in patients on strong 3A4 inhibitors. Max of 40mg/day in severe renal impairement

21
Q

What is Milnacipran (Savella) FDA approved for treating?

A

Only for fibromyalgia. No dosing requirements for Depression.

22
Q

Venlafaxine is metabolized by what P450 enzyme? How does this impact dosing?

A

2D6, and 3A4 (major). Consider dose reduction if given with inhibitors of either of these.

23
Q

Buproprion HCl should be avoided in what patients?

A

Active seizure disorders and eating disorders

24
Q

Buproprion HCL is what P450 substrate?

A

2B6

25
Q

What is a major side effect of Mirtazipine?

A

Sedation and appetite increase occur with doses less than or equal to 15mg/day.

26
Q

What is the P450 metabolism of Trazadone?

A

major 3A4 Substrate, moderate 2D6 inhibitor

27
Q

What is the primary clinical indication of Trazadone?

A

insomnia at a dose range of 50mg - 150mg at bedtime

28
Q

What medications are TCAs?

A

Amitriptyline, Desipramine, Imipramine, Nortriptyline

29
Q

Amitriptyline is commonly used for what indication other than depression? what is the dose adjustment for this?

A

Neuropathic pain at lower doses (25 - 100mg at bedtime)

30
Q

Which TCA is not commonly used for depression?

A

Desipramine

31
Q

What is the most common clinical indication for Imipramine?

A

Mostly for children with ADHD or nocturnal enuresis at lower doses of 10 - 25mg daily.

32
Q

Other than depression, what can Nortriptyline be used for?

A

Smoking Cessation

33
Q

Which medications are MAOI’s?

A

Isocaroxazid, Phenelzine, Selegiline, and Tranylcypromine

34
Q

What are all MAOI’s indicated for and what is important to know when switching to this from another antidepressant?

A

Indicated for monotherapy only!! Must have a 2 wk washout of other antidepressants. 4 to 5 wks for fluoxetine.

35
Q

What is important to know about Selegiline patches?

A

6mg/24 hour patch does not require tyramine diet. other patch strengths do!!

Therapeutics Spring 2016 (6 decks)

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