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Pharm > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Which chemicals are imbalanced in affective disorders such as depression

A

NE, Serotonin, and Dopamine

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2
Q

What percentage of antidepressants are bound to plasma proteins

A

90-95%

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3
Q

Where are antidepressants metabolized and excreted

A

By the liver, and excreted in the urine

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4
Q

Do antidepressants have a large or small therapeutic index

A

small

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5
Q

Do antidepressants have long or short half-lives

A

long

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6
Q

what are the 5 general classes of antidepressants

A

Tricyclics, SSRIs, SNRI, Atypical, and MAOI

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7
Q

What is the general MOA for antidepressants overall

A

increase adrenergic or serotonergic transmission

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8
Q

What is the MOA for Tricyclics, SSRIs, and SNRIs

A

Block the NE or serotonin (5-HT) transporters at the presynaptic terminals

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9
Q

What is the MOA for MAOIs

A

inhibit the breakdown of NE and Serotonin (5-HT) (increase the amount of NE and serotonin in the presynaptic terminal)

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10
Q

How do tricyclics prevent the reuptake of both NE and 5-HT

A

by inactivating the “amine” pump on the presynaptic nerve terminal

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11
Q

What other receptors do tricyclics have an effect on

A

Muscarinic, histamine H1, and Alpha 1 receptors

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12
Q

Amitryptyline

A

Tertiary Amine Tricyclic

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13
Q

Clomipramine

A

Tertiary amine tricyclic

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14
Q

Doxepin

A

Tertiary Amine Tricyclic

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15
Q

Imipramine

A

Tertiary amine tricyclic

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16
Q

Trimipramine

A

tertiary amine tricyclic

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17
Q

TACID

A

tertiary amine tricyclics (NE, 5-HT) (Trimipramine, Amitryptyline, Clomipramine, Imipramine, Doxepin)

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18
Q

Amoxapine

A

Secondary Amine Tricyclic (NE)

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19
Q

Desipramine

A

secondary amine tricyclic

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20
Q

maprotiline

A

Secondary amine tricyclic

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21
Q

Nortryptyline

A

Secondary amine tricyclic

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22
Q

Protryptyline

A

secondary amine tricyclic

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23
Q

DAMNP

A

Secondary Amine Tricyclics (Desipramine, Amoxapine, Maprotiline, Nortryptyline, Protryptyline)

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24
Q

what is the first choice for monopolar depression

A

SSRI

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25
Q

CEFFSP

A

SSRI

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26
Q

Citalopram

A

SSRI

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27
Q

Escitalopram

A

SSRI (also approved for adolescents)

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28
Q

Fluoxetine

A

SSRI (t1/2=72 hr)

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29
Q

Fluvoxamine

A

SSRI

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30
Q

Paroxetine

A

SSRI (noted for its anticholinergic side effects; good for social phobia)

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31
Q

Sertraline

A

SSRI (t1/2=36 hr)

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32
Q

These drugs have less antimuscarinic and antihistaminic effects than tricyclics, but more adrenergic effects compared to SSRIs

A

SNRI

33
Q

Duloxetine

A

SNRI

34
Q

Milnacipran

A

SNRI

35
Q

Levomilnacipran

A

SNRI

36
Q

Venlafaxine

A

SNRI

37
Q

Desvenlafaxine

A

SNRI

38
Q

Does Mom Love Vicki Davis

A

SNRI (Duloxetine, Milnacipran, Levomilnacipran, Venlafaxine, Desvenlafaxine

39
Q

Bupropion

A

Atypical antidepressant

40
Q

What is the MOA for Bupropion

A

blocks reuptake of dopamine and NE, 3 fold increase in seizures

41
Q

Mirtazapine

A

Atypical antidepressant

42
Q

Trazodone

A

Atypical antidepressant

43
Q

Can block histamine receptors , Alpha 2 receptors, and 5-HT receptors, and sedation is the most prominent adverse effect

A

Mirtazapine

44
Q

widely prescribed as a sedative hypnotic for those with difficulty sleeping. Reduced problem with anticholinergic effects

A

Trazodone

45
Q

Nefazodone

A

Atypical Antidepressant

46
Q

Back box warning for rare but fatal liver toxicity

A

Nefazodone

47
Q

Vilazodone

A

Atypical

48
Q

“dual action” antidepressant: can block serotonin reuptake transporter and act as partial agonist at 5-HT receptor

A

Vilazodone

49
Q

Vortioxetine

A

Atypical

50
Q

Inhibits the serotonin reuptake transporter, along with mixed agonist/antagonist effects at serotonin receptors. Partial agonist at 5-HT

A

Vortioxetine

51
Q

These drugs are used mostly for treatment-resistant depression or “refractory” depression

A

MAOIs

52
Q

These drugs inactivate the enzyme that metabolizes NE and serotonin

A

MAOI (monoamine oxidase Inhibitor)

53
Q

Which type of antidepressants require dietary changes to regulate tyramine consumption

A

MAOIs

54
Q

Isocarboxazid

A

MAOI

55
Q

Phenelzine

A

MAOI

56
Q

Tranylcypromine

A

MAOI

57
Q

Selegiline

A

MAOI (transdermal patch)

58
Q

PITS

A

MAOI (Phenelzine, Isocarboxazid, Tranylcypromine, selegiline)

59
Q

What are common adverse effects of antidepressants

A

CV (orthostatic hypotension), seizures, sexual dysfunction, blood abnormalities, abnormal bleeding, serotonin syndrome, manic episodes

60
Q

Agitation, hallucinations, coma, or other changes in mental status; coordination problems or muscle twitching, vomiting or diarrhea

A

Serotonin syndrom

61
Q

What are some drug interactions with antidepressants

A

CNS depressants, antimuscarinic agent, or MAOIs; Symptahomimetic agents also (synergistic effect), and tamoxifen

62
Q

Which antidepressant should you not mix with tamoxifen

A

SSRIs

63
Q

Why is the drug interaction of tamoxifen and SSRIs bad

A

Tamoxifen is metabolized by CYP2D6 and SSRIs inhibit CYP2D6

64
Q

Which drug is the best choice for bipolar depression

A

Lithium

65
Q

Does Lithium bind to plasma proteins

A

No

66
Q

Where can lithium be excreted

A

Urine and breast milk (women who are breastfeeding shouldn’t be on lithium)

67
Q

Does lithium undergo metabolization

A

no, because it’s an ion

68
Q

What is lithium’s MOA

A

Unknown; but know it alters reuptake of ST, NE, and DA. It also decreases protein kinases in the brain tissue

69
Q

What are the adverse effects of lithium

A

nausea, diarrhea, drowsiness, dry mouth and thirst, weight gain, insomnia, polyuria, acquired nephrogenic diabetes

70
Q

What symptom does lithium toxicity not have that neuroleptic malignant syndrome or serotonin syndrome have

A

hyperthermia

71
Q

What drug interaction does lithium have

A

diuretics, NSAIDs, and ACE inhibitors

72
Q

This is the first drug given FDA approval for long term prophylactic treatment of bipolar disorder without an indication of acute mania

A

lamotrigine

73
Q

this drug is FDA approved for mania and is extensively used off-label for long-term prophylactic treatment of bipolar patients

A

Valproate

74
Q

This drug is sometimes used for treatment-resistant bipolar disorder and remains under investigation

A

carbamazepine

75
Q

Which antipsychotics are used for maintenance therapy

A

respieridone, aripiprazole and olanzapine, clozapine, and quetiapine

76
Q

This antipsychotic is used for bipolar maintenance

A

risperidone

77
Q

This antipsychotic is used for mania prophylaxis

A

aripiprazole and olanzapine

78
Q

This antipsychotic is used for refractory mania

A

clozapine

79
Q

This antipsychotic is used for bipolar depression

A

quetiapine and lurasidone

Pharm (8 decks)

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