Antidepressants Flashcards
The half-life of this SSRI is about one week
fluoxetine (prozac)
SSRI is the abbreviation for this
Selective Serotonin Reuptake Inhibitor
If an SSRI with a short half life
is abruptly stopped it
may result in this
Discontinuation Syndrome
SSRI’s and MAOI’s used in combination carry a high
risk of this side effect
serotonin syndrome
This is the most likely SSRI
to cause the side effect
of weight gain
paroxetine (paxil)
The washout period when
switching from an MAOI
to any SSRI is this
2 weeks
This SSRI is the S-enantiomer of citalopram (celexa)
escitalopram (lexapro)
These two SSRI’s have very
short half lives & should
be tapered to be
discontinued
paroxetine (paxil) & fluvoxamine (luvox)
This is a common side effect of all SSRI’s & the doctor should specifically ask about it as the patient may otherwise be too embarrassed to talk about it
sexual side effects
The mechanism of action of
SNRI’s is this
Serotonin Norepinephrine Reuptake Inhibitor
This SNRI is the psychoactive metabolite of another SNRI
desvenlafaxine (pristiq)
Whether the dose is very high,
moderate, or low, this neurotransmitter’s reuptake is blocked by venlafaxine (effexor)
serotonin
At very high doses (>375mg/d) of venlafaxine (effexor) this neurotransmitter’s reuptake may begin to be blocked
dopamine
This SNRI is preferred for painful symptoms of depression or diabetic neuropathy pain
duloxetine (cymbalta)
Patients taking SNRI’s for depression have an initial response, but then experience this
poop-out syndrome (relapse)
Also seen with SSRIs
As with all antidepressants, a depressed patient started on an SNRI who experiences activation & agitation may be having this
induced bipolar state
While venlafaxine (effexor) may cause the side effect of sweating, ironically it may be helpful to perimenopausal women with this
hot flashes/flushes
Venlafaxine (effexor) has
this relatively common, dose
dependent, cardiac system
related side effect
increased blood pressure
This medication is the most
well known NDRI (norepinephrine-dopamine reuptake inhibitor)
Bupropion (Wellbutrin)
NDRI’s are useful in treating cravings from dependence
on this substance
nicotine (useful in treating smoking cessation)
Not only do NDRI’s not have this common SSRI side effect, NDRI’s may be used to treat patients who have this SSRI side effect
Sexual dysfunction
Like most anti-depressants, at typical doses NDRI’s carry a small risk of this serious side effect but the risk increases from 0.4% to 4% at very
high doses
Seizure
Compared to SSRI’s or SNRI’s,
NDRI’s are less effective
in treating this class of
psychiatric illnesses
Anxiety Disorders
NDRI’s may be especially helpful in treating this sleep disturbance that is seen in atypical depression
Hypersomnia (> 10 hours/nite)
NDRI’s commonly do this
to a patient’s weight
Decrease (or no change)
While not a first line treatment,
NDRI’s “stimulating” effects may be helpful in treating children and adults with this disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Onset of therapeutic action for NDRIs is usually not immediate, but is delayed until this time period
2-4 weeks
NaSSA stands for this
Noradrenergic and Specific Serotonergic Agent
NaSSA’s novel mechanism of action by which norepinephrine and serotonin system activity is increased is this
Pre-synaptic alpha 2 adrenergic antagonist
The medication that is in the NaSSA class is this
mirtazepine (remeron)
SSRIs or venlafaxine (effexor) may cause these common side effects which NaSSA’s 5HT3 antagonism may help reduce or remove
GI side effects (nausea, diarrhea, stomach cramps)
This mirtazapine (remeron) side effect is more likely in women than men, before menopause than after, and is unlikely to be a problem if it has not occurred within the first 6 weeks of treatment
weight gain
Patients taking mirtazapine (remeron) and an MAO-I at the same time, or within 2 weeks
of the other, are at risk for
this serious side effect
serotonin syndrome
Mirtazapine (remeron)
is an antagonist of what receptors?
a presynaptic receptor, serotonin post synaptic receptors, and histamine post synaptic receptor
NaSSA onset of therapeutic effect on insomnia and anxiety is typically in this time period
almost immediately
The cytochrome P450 enzyme system that is significantly effected by mirtazepine (remeron) is
None!
A tertiary amine, amitriptyline (elavil), is metabolized to a secondary amine which is
this TCA
nortriptyline (pamelor)
Blurred vision, urinary hesitancy, dry mouth, and constipation are due to this neurotransmitter receptor activity by TCA’s
anticholinergic activity
A tertiary amine, imipramine (tofranil), is metabolized to a secondary amine which is
this TCA
desipramine (norpramin)
TCA’s may be more effective than SSRI’s in treating depression for this sex of the clinical population
Men
Fluoxetine (prozac), paroxetine (paxil), bupropion (wellbutrin), duloxetine (cymbalta) and other medications may increase all TCA’s concentration by
inhibiting this p450 enzyme
cytochrome p450 2D6
Which psych drugs inhibit cytochrome p450 2D6, increasing TCA concentration?
Fluoxetine (prozac), paroxetine (paxil), bupropion (wellbutrin), duloxetine (cymbalta)
Side effects of dizziness, sedation, and hypotension likely result from TCA’s antagonist activity
of this receptor
alpha adrenergic-1 receptor
Side effects of sedation and weight gain from TCA’s are likely due to antagonist activity at this receptor
histamine (H1)
TCA’s mechanism of action for treating depression is this
serotonin and norepinephrine reuptake inhibition
The dangerous side effects from a TCA overdose are cardiac arrhythmias caused by
blockade of this
sodium channels
