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Psych 1 > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

SSRIs
SNRIs
Atypical
Tricyclic

A

Escitalopram, fluoxetinem sertraline

Duloxetine, venlafaxine

Bupropion, mirtazapine

Amittriptyline, nortrip

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2
Q

Antidepressants vs mood stabilizers

A

Antidepressants for MD

Mood for BPD

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3
Q

Monoamine hypothesis

A

Depression causedb y monoamine deficiency

Diminished serotinin, adrenergic, dopaminerigc NT

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4
Q

SSRIs
SNRIs
Atypical
TCAs

effect on monoamines and onset

A

Serotonin

Serotonin and NE

Individual effects on serotonin, NE, or dopamine

Serotonin and NE

Onset make take several weeks so MOA could be more complicated

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5
Q

Most to least specific

A

SSRIs
SNRIs
Atypical
TCAs

Incidence and variety of adverse effects increase as you move to TCAs

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6
Q

Options for resistant depression

MOno

comb

A 
Increase dose 
Switch to different class or same class

Careful use from two classes
Augmenting drug

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7
Q

Augmenting drugs

A

Apriprazole is most common
Lithium

Most are known to increase synthesis/release of monoamines

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8
Q

Use of SSRIs in depression

A

Usually drug of choice due to low incidence of side effects

Long delay for effects to occur (6-8 weeks)

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9
Q

SSRIs MOA

A

Main receptor is SERT, presynaptic transporter which removes 5HT from synaptic cleft

Additional targets could also enhance on pre and post membrane

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10
Q

BDNF effect

A

Increase serotonin means increase in BDNF means increase neuronal growth and synapse formation means reorganzation

In hippocampus

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11
Q

What is unique about escitalpram, sertraline and fluoxetine

A

Escitalopram is most specific

Sertraline is also weak inhibitor of dpoamine reuptake in addition to being an SSRI

FLu blocks NE reuptake and 5HT2C receptors in addition to SSRI

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12
Q

Discontinuation syndrome

A

GI symptoms, need to taper dose

Fluoxetine is best for this because long lived active mtabolite

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13
Q

SSRIs with CYP450 interactions

A

Fluoxetine and Sertraline

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14
Q

Serotonin syndrome

A

Basically all antidepressants except for bupropion and atypicals

Early - NM probs, cog probs, temp control

Late - Tonic-clonic convulsions

Any drugs that increase sertoonin

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15
Q

Adverse effects of SSRIs

A

Nausea, GI, cramping
Activating/insominia
Anorgasmia
Anti-platelet effect

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16
Q

SSRIs and pregnancy and black box

A

Paroxetine is only one

Postnatal adaptation syndrome and pulmonary hypertension risk

Pediatric suicidality below 24

17
Q

Venlafaxine special

A

NE reuptake inhibition is lower so it behaves more like SSRI at low doses

18
Q

SNRIs vs SSRIs and adverse effects

A

More widely used in chronic pain disorders

Sexual adverse effects
Discontinuation symptoms
Nausea/GI cramping all from serotonergic…more with venlafaxine

Hypertension from noradrenergic effect

19
Q

Bupropion unique, interaction, contraindcation

A

NE reuptaker inhibitor and Dopamine reuptake inhibitor

NO serotonin effects so no sexual/GI

Enhanced noradrenergic and dopaminergic transmission

CYP2D6

Lowers seizrue threshold so no in epilepshy

20
Q

MIrtazapine mech

A

Blocks presynaptic alpha 2 adrenergic inhibitory receptors to increase CNS noradrenergic and seroteonergic activity

H1 histaminergic blocker for sedation and increased appetite

LIttle 5-HT uptake inhibition so decreased SSRI like adverse effects

21
Q

Sturctures of TCA s

A

Nortriptyline is active mtabolite of amitriptyline

22
Q

Antidepressant mechansim of action for antidepressant

A

serotonin reuptake and NE reuptake blocker s

23
Q

Secondayr vs teriatry amines

A

Secondary affect NE more than 5-HT

Teritary more balanced

24
Q

TCA other uses and overdosage

A

Neuropathic pain

INitial excitatory phase…subsequant depressant phase…cardiac arrythmias

Suicide prevention needs to be considers

25
Q

TCA adverse effects

A

Anti-histaminergic (sedation)
Anti-muscarinic
Anti-adrenergic (orthostatic hypotension)
Cardiac toxocity (Na blcok)

26
Q

What should you start on?

What should be used for tx resistant or refractory

A

SSRI, SNRI, bupropion, mirtazpine

TCAs and MAOIs

27
Q

What to avoid in

HTN
Cardaic
Obesity
Chronic pain

A

SNRIs, TCAs

TCAs

SSRIs/SNRIs/Buproprion usually preferred…avoid mirtazapine/TCAs

Tx with SNRIs or TCAs

Psych 1 (17 decks)

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