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Loca > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Monoamine hypothesis

A

deficiency in monoamines (serotonin, norepinephrine, dopamine) linked to depressive symptoms

developed bc of reserpine

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2
Q

MOA

A

monoaminase

enzyme that degrades serotonin, norepinephrine, dopamine

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3
Q

serotonin

A

5 HT

throughout the body

stimulates peristalsis (GI tract - 90%)

CNS (mood, sexual behavior, sleep, temp, etc.)

Cardiovascular

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4
Q

dopamine

A

CNS - reward, emotion, cognition, memory

endocrine - prolactin secretion

cardio - norepinephrine/epinephrine release

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5
Q

high dopamine

A

schizophrenia

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6
Q

low dopamine

A

parkinson’s

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7
Q

norepinephrine

A

cardiovascular (a-1= vasoconstriction, b-1 = increased HR)

fight or flight (increased RR, blood sugar, relax intestinal muscles)

CNS (concentration, alertness)

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8
Q

depression medication classes (6)

A

SSRI

SNRI

select antidepressants

TCAs

MAOis

Herbals

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9
Q

which class of medications are NEVER used first line

A

MAOi, Herbals, sometimes TCAs

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10
Q

how long is a “trial” of antidepressants

A

4-8 weeks

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11
Q

what other factors must be considered before starting an antidepressant?

A

Tapering

other things causing depression – beta blockers***

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12
Q

SSRI mechanism

A

selectively inhibits reuptake of serotonin into pre synaptic neuron (SERT receptor)

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13
Q

SSRI names

A
  1. Fluoxetine/Prozac
  2. Sertraline/Zoloft
  3. Paroxetine/Paxil
  4. Citalopram/Celexa
  5. Escitalopram/Lexapro
  6. Fluvoxamine
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14
Q

Fluoxetine

A

Prozac

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15
Q

Sertraline

A

Zoloft

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16
Q

Paroxetine

A

Paxil

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17
Q

Citalopram

A

Celexa

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18
Q

Escitaplopram

A

Lexapro

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19
Q

dosage of Celexa

A

20-40 mg/day MAX

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20
Q

SSRI side effects(systems/specific)

A

***GI (n/v, dry mouth)

CNS (sedation, insomnia, sucidial ideation )
Erectile dysfunction
hyponatremia (ADH elevation)
anticholinergic
perimenopausal women - helps hot flashes
QTc prolongation

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21
Q

anticholinergic symptoms

A

anti-SLUDGE

dry mouth, eyes, urinary retention, constipation

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22
Q

QT prolongation

A

prolonging of QT interval (normal - 400 msec, this - 500+ msec)

risk factors: medication hypokalemia)

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23
Q

drug interactions of SSRI

A

other serotonergic medications

+CYP drug

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24
Q

Fluoxetine drug interactions

A

CYP2C19 inhibitor

clopidogrel (2C19 substrate - unable to work if taken with Flux.)

also tamoxifen

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25
Q

SNRI (drug list)

A
  1. Venlafaxine/Effexor
  2. Descenlafaxine
  3. Duloxetine/Cymbalta
  4. Levonmillnacipran
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26
Q

SNRI mechanism

A

selectively inhibits reuptake of serotonin and norepinephrine

NET and SERT

27
Q

SNRI side effects

A

GI (n/v/dry mouth)

CNS (insomnia, libido, suicidal ideation)

Erectile dysfunction

** Increased BP (N.e.) (usually not clinically sig. but keep in mind for uncontrolled HTN)

28
Q

specific duloxetine side effects

A

Anti-cholinergic symptoms and liver toxicity

29
Q

SNRI drug interactions

A

other seroternergic meds

duloxetine specific CYP1A2

30
Q

duloxetine drug interactions

A

CYP 1A2 substrate

with CIPRO (1A2 inhibitor) it competes with the substrate and decreases its ability to work

31
Q

other indications

duloxetine

A

diabetic neuropathy

fibromyalgia

chronic musculoskeletal pain

32
Q

other indications

venlafaxine

A

off table diabetic neuropathy

33
Q

venlafaxine

A

effexor

34
Q

duloxetine

A

cymbalta

35
Q

bupropion (gen., mechanism)

A

other medication
used after SNRI

inhibits norepinephrine and dopamine reuptake (no MAO or serotonin activity)

NET and DAT receptor blocker

36
Q

bupropion brand name

A

wellbutrin

37
Q

bupropion side effects

A

increased seizure risk*** (dose related)

CNS function (headache, insomnia, irritability, decreased appetite, improved sexual dysfunction, smoking cessation (Zyban))

38
Q

bupropion drug interactions

A

MAO inhibitors – can lead to hypertensive crisis

39
Q

other antidepressant list

A
  1. mirtazapine
  2. vortioxetine
  3. trazodone
  4. nefazodone
  5. vilazodone
40
Q

mirtazapine

A

pre-synaptic a-2 agonist (increased Ne and serotonin)

pronounced sedation (can be used in insomnia) weight gain

41
Q

vortioxetine

A

inhibits serotonin reuptic (5HT1A agonist)

improved cognition, SE of SSRI

brand name only

42
Q

trazodone

A

inhibits serotonin reuptake, 5ht2A antagonist

causes orthostatic hypotension, sedation, priapism

43
Q

nefazone

A

inhibits serotonin reuptake , 5HT2A antagonist

less risk of trazodone SE

can cause liver toxicity, potent CYP3A4 inhibitor

44
Q

vilazodone

A

inhibits serotonin reuptake, 5HT1 agonist

clinical advantage unknown, brand name only

45
Q

TCA drug list

A
  1. amitriptyline
  2. imipramine
  3. despiramine
  4. nortriptyline
46
Q

TCA mechanism

A

selectively inhibits reuptake of serotonin and norepinephrine

antihistamine and anticholinergic effects

Na channel blocker***

47
Q

TCA side effects

A 
anticholinergic 
orthostatic hypertension 
cardiotoxicity 
narrow therapeutic index -- suicidal ideation
GI/CNS
48
Q

TCA overdose management

A

sodium bicarbonate for cardiac toxicity

mixed with dextrose

49
Q

TCA drug interactions

A

antiocholinergic agents

other serotonergic medication

50
Q

MAOi drug list

A
  1. isocarboxazid
  2. phenelzine
  3. selegilline** parkinson’s
  4. tranylcypromine
51
Q

MAOi mechanisms

A

increases endogenous concentrations of norepinephrine, dopamine, serotonin they inhibition of monoamine oxidase

not first therapy – reserved for patients refractory to SSRI, SNRI, bupropion

52
Q

MAOi side effects

A

orthostatic hypotension

CNS (decreased libido, anorgasmia)

weight gain

hypertensive crisis

53
Q

MAOis hypertensive crisis**

A

avoid tyramine containing foods (breaks down into n.e. and dopa)

metabolism is inhibited by MAOis so there is an excess – causes HTN

treat with alpha blocker

54
Q

drug interactions MAOi

A

other srotonergic meds (2 week washout)

antihypertensive meds

55
Q

serotonin syndrome

A

excess of serotonin

can be idiosyncratic, accidental interaction or intentional over dose

56
Q

symptoms of serotonin syndrome

A

tremor, hyperreflexia
muscle rigidity

hyperthermia
agitaiton/diaphoresis
increased bowel sounds (diarrhea)

57
Q

serotonin syndrome management

A

discontinue meds
monitor the vitals
serotonin antagonist - cyproheptadine

58
Q

cyproheptadine

A

non-sepcfic antagonist of 5HT-1 and 5HT-2 receptors

ONLY oral (may be given via NG tube)

can be used in allergies and anorgasmia

59
Q

resistant depression treatment

A

second generation antipsychotics

ariprprazole, brexipiprazole, quetiapine

olanzapine/fluoxetine are FDA approved

60
Q

herbals for depression

A

SAMe- S-adenosyl methionine

st. john’s wart

61
Q

SAMe

A

Metabolite

found that there was a remission and adverse events decreased

62
Q

BEERs list

A

anticholinergic (urinary retention, constipation)

chronic seizures

SIADH
SSRIs

63
Q

pregnancy and depression meds

A

maternal depression adversely affects child development

both meds and untreated cause problems os must weigh risk v. benefits

Loca (4 decks)

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