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Psychiatry Pharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Name the major classes of antidepressants (there are 4)

A

SSRIs, Heterocyclic antidepressants (TCAs and tetracyclics), MAOIs, and miscellaneous

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2
Q

How many patients respond to an antidepressant?

A

Approximately 60-70% of patients will respond to an antidepressant

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3
Q

How long does it take for antidepressants to start working?

A

Most require a trial of 3-4 weeks for any effect. Some people require as little as 1-2 weeks, some require 6-8 weeks for significant improvement

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4
Q

What symptoms are present in withdrawal phenomenon? (Name 5)

A

Dizziness, headaches, nausea, insomnia, malaise

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5
Q

How can we prevent withdrawal phenomenon?

A

Depending on dose, and half-life, may need to taper antidepressants when discontinuing use

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6
Q

In general, what factors should we consider in choosing an antidepressant?

A

Patient’s particular symptoms, previous treatment responses by the patient or a family member to a particular medication, side-effect profile, comorbid conditions, risk of suicide via overdose on the medication, and cost

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7
Q

How do SSRIs work?

A

SSRIs inhibit presynaptic serotonin pumps that take up serotonin, leading to increased availability of serotonin in synaptic clefts. Additionally, SSRIs cause downstream effects increasing brain plasticity - may be why the onset of antidepressant effect is delayed

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8
Q

How often should SSRIs be dosed?

A

SSRIs can be dosed daily; fluoxetine can be dosed weekly

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9
Q

Advantages of SSRIs (name 3)

A

Low incidence of side effects, most of which resolve with time, no food restrictions, and much safer in overdose

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10
Q

Name the common SSRIs (there are 6)

A

Fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram

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11
Q

Fluoxetine - trade name is:

A

Prozac

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12
Q

What is unique about fluoxetine’s half-life

A

Longest half-life with active metabolites; no need to taper

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13
Q

Who can use fluoxetine?

A

Fluoxetine is safe in pregnancy, and is approved for use in children and adolescents

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14
Q

Common side effects of fluoxetine include: (name 3)

A

Insomnia, anxiety, sexual dysfunction

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15
Q

Fluoxetine + antipsychotics = ?

A

Fluoxetine can elevate levels of antipsychotics, leading to increased side effects

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16
Q

Sertraline - trade name is:

A

Zoloft

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17
Q

Fluoxetine - type of drug?

A

SSRI

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18
Q

Sertraline - type of drug?

A

SSRI

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19
Q

Side effects of sertraline include: (name 4)

A

GI disturbances, insomnia, anxiety, and sexual dysfunction

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20
Q

Paroxetine - trade name is:

A

Paxil

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21
Q

Paroxetine - type of drug?

A

SSRI

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22
Q

Does sertraline have few or many drug interactions?

A

Very few

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23
Q

Does paroxetine have few or many drug interactions? Why?

A

Many, because paroxetine is highly protein-bound

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24
Q

Common side effects of paroxetine: (name 4)

A

Anticholinergic effects (sedation, weight gain, constipation), and sexual dysfunction

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25
Q

Is the half-life of paroxetine short or long?

A

Short. Can lead to withdrawal phenomena if not taken consistently

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26
Q

Fluvoxamine: trade name

A

Luvox

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27
Q

Fluvoxamine: type of drug?

A

SSRI

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28
Q

Fluvoxamine is used in what psychiatric condition?

A

Currently, fluvoxamine is only approved for treatment of OCD

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29
Q

Fluvoxamine common side effects: (name 2)

A

Nausea and vomiting

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30
Q

Does fluvoxamine have few or multiple drug interactions? Why?

A

Multiple, due to CYP inhibition

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31
Q

Citalopram: trade name

A

Celexa

32
Q

Does citalopram have few or multiple drug interactions?

A

Fewest drug-drug interactions of the SSRIs

33
Q

Citalopram: type of drug?

A

SSRI

34
Q

What effect does citalopram have on an EKG?

A

Dose-dependent QTc prolongation

35
Q

Escitalopram: trade name

A

Lexapro

36
Q

What effect does escitalopram have on an EKG?

A

Dose-dependent QTc prolongation

37
Q

Escitalopram: type of drug?

A

SSRI

38
Q

How does escitalopram differ from citalopram?

A

Escitalopram is the levo-enantiomer of citalopram; it has similar efficacy, and possibly fewer side effects

39
Q

Why do SSRIs have fewer side effects than TCAs and MAOIs?

A

SSRIs have serotonin selectivity (they do not act on histamine, adrenergic, or muscarinic receptors)

40
Q

Common side effects of SSRIs include: (name 10)

A

GI disturbance (nausea and diarrhea, give with food), insomnia, vivid dreams, headache, anorexia, weight loss, sexual dysfunction (decreased libido, anorgasmia, delayed ejaculation –> typically do not resolve), restlessness, hyponatremia, seizures

41
Q

Name the symptoms of serotonin syndrome

A

Fever, diaphoresis, tachycardia, hypertension, delirium, and neuromuscular excitability (especially hyperreflexia and “electric jolt” limb movements), potentially –> death

42
Q

What causes serotonin syndrome?

A

Taking two medications, both of which increase serotonin, leading to too much serotonin in the brain

43
Q

Venlafaxine: type of drug

A

SNRI

44
Q

SNRI stands for:

A

Serotonin-norepinephrine reuptake inhibitors

45
Q

Venlafaxine: trade name

A

Effexor

46
Q

Venlafaxine: uses (name 3)

A

Depression, anxiety disorders (GAD), and neuropathic pain

47
Q

Potential to for drug interaction with venlafaxine is high or low?

A

Low

48
Q

Side effects of SNRIs

A

Similar to SSRIs: GI disturbance, insomnia, vivid dreams, headache, anorexia, weight loss, sexual dysfunction, restlessness, hyponatremia, seizures?
Increased blood pressure at higher doses

49
Q

Desvenlafaxine: type of drug

A

SNRI

50
Q

Desvenlafaxine: trade name

A

Pristiq

51
Q

How does desvenlafaxine differs from venlafaxine?

A

Desvenlafaxine is the active metabolite of venlafaxine. It is expensive and without known benefit over venlafaxine

52
Q

Duloxetine: type of drug

A

SNRI

53
Q

Duloxetine: trade name

A

Cymbalta

54
Q

Duloxetine: uses (name 3)

A

Depression, neuropathic pain, fibromyalgia

55
Q

Side effects:

A

Similar to SSRIs (GI disturbance, insomnia, vivid dreams, headache, anorexia, weight loss, sexual dysfunction, restlessness, hyponatremia, seizures?), more dry mouth and constipation relating to its norepinephrine effects. Hepatotoxicity may be more likely in patients with liver disease or heavy alcohol use. Expensive.

56
Q

Buproprion: type of drug

A

Norepinephrine-dopamine reuptake inhibitor

57
Q

Buproprion: trade name

A

Wellbutrin

58
Q

How do the side effects of buproprion differ from the SSRIs?

A

Buproprion has a relative lack of sexual side effects

59
Q

Buproprion: uses (name 2)

A

Adult ADHD, smoking cessation

60
Q

Buproprion side effects (name 3)

A

Increased anxiety, increased risk of seizures and psychosis at high doses

61
Q

Buproprion contraindicated in who? (name 3)

A

Patients with seizure or active eating disorders, and in those currently on an MAOI

62
Q

Trazodone: type of drug

A

Serotonin receptor antagonists and agonists

63
Q

Trazodone: trade name

A

Desyrel

64
Q

Nafazodone: type of drug

A

Serotonin receptor antagonists and agonists

65
Q

Nafazodone: trade name

A

Serzone

66
Q

Trazodone and nafazodone: uses (name 3)

A

Major depression, major depression with anxiety, and insomnia (secondary to its sedative effects)

67
Q

Trazodone and nefazodone differ from side effects of SSRIs how?

A

Trazodone and nefazodone do not have the sexual effects of SSRIs, and do not affect REM sleep

68
Q

Side effects of trazodone and nefazodone include: (name 6)

A

Nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation, and priapism (especially with trazodone)

69
Q

Trazodone is not frequently used soley as an antidepressant. Why?

A

It causes orthostatic hypotension in higher doses

70
Q

Most common use for trazodone?

A

Used to treat insomnia when initiating an SSRI (until insomnia improves as the depression resolves)

71
Q

Nefazodone carries a Black Box warning for what?

A

Nefazodone can rarely cause serious liver failure (1 per 250,000-300,000 people) and is rarely used

72
Q

Mirtazapine: type of drug

A

Alpha2-adrenergic receptor antagonist

73
Q

Mirtazapine: trade name

A

Remeron

74
Q

Mirtazapine: uses

A

Major depression, especially in patients who have significant weight loss and/or insomnia

75
Q

Mirtazapine: side effects: (name 7)

A

Sedation, weight gain, dizziness, tremor, dry mouth, constipation, and (rarely) agranulocytosis.

76
Q

Mirtazapine has fewer or greater sexual side effects compared to SSRIs?

A

Fewer

77
Q

Mirtazapine has few or many drug interactions?

A

Few

Psychiatry Pharmacology (2 decks)

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