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Emma H&N II > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

MAO inhibitors

A

phenelzine
tranylcypromine
selegiline

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2
Q

TCAs

A

amitriptyline

imipramine

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3
Q

SSRIs

A 
fluoxetine
paroxetine
sertraline
citalopram
escitalopram
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4
Q

SNRIs

A

venlafaxine

duloxetine

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5
Q

serotonin modulators

A

trazodone
vilazodone
vortioxetine

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6
Q

antidepressants

A

all work to inc levels of DA, NE, 5HT

all are Na+ channel blockers –> prolonged QRS

all have black box warning of sucidal thinking/behavior

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7
Q

MAO inhibitors

MOA?
Side effects?

A

inhibition of monoamine oxidase blocks degradation pathway for biogenic amines (DA, NE, 5-HT), thus inhibition increases levels these NTs

side effects: hypertensive crisis if administer w/ sympathomimetics (decongestants) or foods high in tyramine

avoid use w/ other antidepressants

rarely used today

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8
Q

Selegiline

A

MAO-B selective (DA)

tx: Parkinson’s, smaller doses for depression

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9
Q

black box warning that applies to all antidepressants?

A

suicidal thinking and behavior

unique to younger patients (adolescents)

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10
Q

MAO-A inhibitors selectively block ___ breakdown

A

MAO-A inhibitors selectively block NE breakdown

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11
Q

TCAs

MOA?
Side effects?

A

Primarily blocks re-uptake of NE (and some 5-HT)

side effects:

  • some binding to muscarinic ACh receptors (dry mouth/urinary retention/constipation/blurred vision)
  • weight gain
  • orthostasis
  • ECG changes, sexual dysfunction, hematologic abnormalities
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12
Q

anti-histamines also block _______ receptors

A

anti-histamines also block muscarinic receptors

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13
Q

Dissociation constant (Kd)

A

measure of post-synaptic receptor affinity

lower Kd –> more tightly bound drug to its receptor

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14
Q

the more seretogenic the drug, more likely side effect of _______________

A

the more seretogenic the drug, more likely side effect of SEXUAL DYSFUNCTION

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15
Q

TCA overdose tx

A
  • do NOT induce vomiting (–> neuro/hemodynamic deterioration, aspiration)
  • use activated charcoal/gastric lavage to bind free drug

If QRS widening…

  • alkalinize serum w/ NaHCO3 to dec metabolic acidosis
  • may need intubation w/ hyperventilation
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16
Q

SSRIs

MOA?
Side effects?

A

selectively block pre-synaptic re-uptake of serotonin

side effects:

  • NAUSEA
  • HA
  • sexual dysfunction
  • sleep disturbances
  • anxiety/restlessness/tremor

other concerns:

  • suicide risk
  • mania/hypomania
  • QT prolongation
  • hyponatremia
  • serotonin syndrome
  • antiplatelet effects
17
Q

SSRIs metabolism

A

all undergo extensive HEPATIC metabolism

18
Q

Serotonin syndrome

A

vague constellation of sx

autonomic: diaphoresis, shivering, tachycardia, hyperthermia

CNS: agitation, hallucinations, seizure, coma

GI: nausea, vomiting, diarrhea

neuromuscular: weakness, hyperreflexia, myoclonus, incoordination

19
Q

SNRIs

A

increase 5-HT and NE by blocking-reupake

20
Q

bupropion (Wullbutrin)

MOA?
Side effects?

A

primary blocks re-uptake of DA and some NE

side effects: nausea, tremors, agitation, insomnia

21
Q

bupropion should be avoided if ______, ______, or _______.

A

bupropion should be avoided if PSYCHOTIC, AGITATED, or SEIZURES.

22
Q

bupropion can also used for ______________

A

smoking cessation

Zyban

23
Q

mirtazapine (Remeron)

MOA?
Side effects?
Indications?

A

blocks activity at alpha-2 pre-synaptic receptors –> increases 5HT and NE levels (adding antagonism at other receptors)

side effects: SEDATION, WEIGHT GAIN, orthostasis, dry mouth, agranulocytosis

indications: difficulty sleeping, poor appetite, sexual dysfunction

24
Q

Consideration during initiation of antidepressants

A

small doses gradually titrated upwards

25
Q

Consideration during discontinuation of antidepressants

A

slowly to prevent withdrawal

HA, nausea, dizziness, insomnia, nervousness

26
Q

antidepressants to consider using if difficulty sleeping or poor appetite

A

mirtazapine

paroxetine

27
Q

antidepressants to consider using if sexual dysfunction

A

bupropion (lacks ability to elevate serotonin)

mirtazapine

28
Q

antidepressants to AVOID if h/o cardiovascular disease

A

TCAs
SNRIs
MAOIs

29
Q

antidepressants to AVOID if risk for OD

A

TCAs

30
Q

antidepressants to AVOID if h/o seizures

A

buproprion

31
Q

esketamine

A

NEW

NMDA receptor agonist

nasal spray for tx-resistant depression

in-office only

CNS, GI, CV side effects

32
Q

brexanolone

A

NEW

allopregnanolone analogue (steroid hormone inc during pregnancy)

IV infusion for post-partum depression, 60hr tx

mainly CNS side effects (GABA agonist)

Emma H&N II (49 decks)

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