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SMUSPG-Behavioral > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Medical Conditions That May Cause Depression

A 
Hypothyroidism
Pregnancy/post-partum
Perimenopause
Diabetes
CNS
Parkinson’s,Alzheimer’s
MS
Epilepsy
CV,CVA),(CAD
CHF
IBS
AIDS
RA
Fibromylagia
Cancer
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2
Q

Medications/Substances That May Cause Depression

rawal (chronic use)

A 
CV Agents
Clonidine
Resperine
Propranolol(beta blockers)
Sedative Hypnotics
ETOH
Barbiturates
Hormonal Therapy
Steroids (prednisone) 
Oral contraceptives
Tamoxifen
Interferon
Isotretinoin
Keppra
Efavirenz
Varenicline
Stimulant withd
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3
Q

Norepinephrine (NE) Effects

A

mood (depression), beta1

attention (post-syn alpha2)

Limbic: agitation, emotions, energy level

Cerebellum: tremor

Brainstem: BLOOD PRESSURE

Spinal cord: heart rate (beta1) or bladder (alpha1)

Other: Erectile function

Use with caution with CV disease

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4
Q

Serotonin (5HT) effects

A

> 12 subtypes
Frontal-regulate mood

Basal ganglia: control movements (akathesia, agitation), obsessions and compulsions (5HT2A)

Limbic area: anxiety and panic (5HT2A and 5HT2C)

Hypothalamus: appetite and eating behavior (bulimia) (5HT3)

insomnia (5HT2A)

Spinal cord: sexual dysfunction (orgasm and ejaculation)

Brain stem vomiting center: nausea and vomiting (5HT3)

Gut: appetite, GI motility (cramps, diarrhea)

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5
Q

Serotonin deficiency syndrome

A

may include depression, anxiety, panic, phobias, obsessions, compulsion, food craving

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6
Q

Dopamine (DA) effects

A

Psychomotor activation
Anti-Parkinson effect
Psychosis aggravation

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7
Q

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

A

-opram, xetine, xamine, traline

citalopram (Celexa)- QT heart. most tolerable
escitalopram (Lexapro)
fluoxetine (Prozac)- long 1/2
fluvoxamine (Luvox)-not ok
paroxetine (Paxil)-ANTIACH, wt gain
sertraline (Zoloft)

MOA: Inhibition 5-HT transporter in the neurons of (Block the reuptake of serotonin)
leads to an INCREASE in the synaptic cleft
DOC

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8
Q

Tricyclic antidepressants (TCAs)norepinphrine and serotonin

A 
-pramine, -tyline, -apine, -xepin
Tertiary Amines: 
amitriptyline (Elavil)-ANTIACH
clomipramine (Anafranil)
doxepin (Silenor)
imipramine (Tofranil)-ANTIACH
protriptyline (Vivactil)

Secondary Amines:
desipramine (Norpramin)- ANTIACH
nortriptyline (Pamelor)-ANTIACH
amoxapine (generic only)

MOA-unknown
Pain indications
High SE
NO Elderly
Narrow TI
OD lethal, sucideal-15d
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9
Q

Serotonin norepinephrine reuptake inhibitors (SNRI)

-done, -pran, xine, tine, iline

A

venlafaxine (Effexor)
desvenlafaxine (Pristiq)-metabolite of ven
duloxetine (Cymbalta)- dec. dose renal
levomilnacipran (Fetzima)- CYP34a drug interaction

MOA- blocks reuptake of serotonin and NE

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10
Q

Dopamine & Norepinephrine Reuptake Inhibitor

A

bupropion (Wellbutrin, Zyban, Aplenzin)
smoking cessation
less sex dysfx

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11
Q

Monoamine oxidase inhibitors (MAOIs)

A 
-line, -omine,-zine, zid
selegiline (Emsam)
tranylcypromine (Parnate)
phenelzine (Nardil)
isocarboxazid (Marplan)

MOA- inhibit degradtion of NE, 5HT and DA
Dont use w/in 2 wks of d/c serotonin (fluoxeetin 5wks)
Serotoin syndrome
ADE- CV, CVB, Liver/Kidney
FATAL hypertensive
AVoid tyramine- aged foods

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12
Q

Antidepressants
Receptor Antagonist Effects
Muscarinic (ACh)

A 
Blurry vision
Dry mouth
Tachycardia
Constipation
Urinary retention
Cognitive impairment (elderly)
AVOID Elderly
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13
Q

Receptor Antagonist Effects

Histamine (H)

A 
Sedation
Weight gain
Hypotension
CNS sedative potentiation of antihypertensives, sedatives
Cognitive impairment (elderly)
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14
Q

Antidepressants
Receptor Antagonist Effects
Alpha-1

A 
Orthostatic hypotension
Dizziness
Reflex tachycardia
Anti-Hypertensive medication potentiation
Sedation
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15
Q

Antidepressants
Receptor Antagonist Effects
5HT2a, c

A 
Vasodilation (dec BP)
Anxiolytic-dec anxiety
Insomnia
Anti-depression
Anti-hallucinatory
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16
Q

SSRI indications

A 
MDD
GAD 
PTSD
OCD - fluvoxamine
Panic disorder
PMDD 
Bulimia
Pain disorders
17
Q

SSRI ADE

A

nausea,
sexual dfx
Dry mouth, headache, insomnia, sedation, diarrhea, constipation

Less common
Akathesia, anxiety/agitation, increased sweating, bruxism
Rare
Serotonin syndrome

18
Q

Discontinuation syndrome**: SSRI

A

Ideal to taper over 7-10 days
1-7 days after d/c
Fluvoxamine worse
Fluoxetine-lease

Flu like symptoms, vivid dreams, tremor, dizziness, crying nausea, poor concentration, sensory disturbance

19
Q

Others no class

A

maprotiline (Ludiomil)

vilazodone (Viibryd)
vortioxetine (Trintellix)

20
Q

Serotonin syndrome

A 
combining 5HT agents
MAOI+
anxiety
shivering
diaphoresis-sweat
mania
hyperreflexia
Gi
Confusion
ANS instability or DEC BP and HR
21
Q

mirtazapine (Remeron)

A

ANTIACH (NASSAS)
block autorecpetor Inc NE and 5HT
Sedation Wt gain

22
Q

Nefazodone (Serzone)

A

Rare liver dysfx
no wt gain, sex, agitation
potent 3A4 inhib- many drug interactions

23
Q

trazodone (Desyrel, Oleptro ER)

A

Sedation- used for insomina
-no dependence
Priopism-painful erection

24
Q

Sucical ideation

A

All TCAs
SSRI
others
Risk hign <24yo

25
Q

DEMENTIA

A

AVOID
TCA
ANTIach

26
Q

ASTHMA

A

AVOID

MAOIS- interfer w/ sns bronchodialators

27
Q

CV DISEASE

A 
AVOID
TCA
ECT
bupropion
SSRIs
28
Q

MAOI

A

AVOID
TCA
ANTIach

29
Q

EPILESY

A

AVOID
TCA
burpropion

30
Q

NARROW ANLGE GLUACOMA

A

AVOID
TCA
ANTIach

31
Q

BLOOD PRESSURE

A 
Dec BP
TCA
trazadone
nefazadone
MAOIs

INCrease BP
Venofaxine
Levomicopran

32
Q

INSOMINIA

A 
SEDATION PROPERITES
nefazadone
trazondone
paroxetine
mertazapine
33
Q

ANXIETY

A

nefazadone
mertazapine
SSRI

34
Q

Decreased energy melancholy

A

bupropion
despramine
venalfaxine

35
Q

Tips for pat

A 
Be patient
Long onsert >6week
must reach optimal dose
67% respond
33% dont
REsponese >50% dec s/s, NO REPSONSE SWITCH

Remision- sx fee <7 Ham-d

Treatment resistant >1 failed treatment (inc chronic, 2-3x relapse, Inc risk of mortality

36
Q

TCA d.c synddrome

A

lethargy, na, HA, GAD, sleep, akathisia, parkinson

cholerngeic rebound

37
Q

Tape Needs

A

NO
fluextein
bupropion

Yes
TCA
SPCVEN

SMUSPG-Behavioral (11 decks)

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