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Pharm III Unit 1 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

PET scan of pt w/ major depressive disorder

A

decreased overall brain activity

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2
Q

Neurotrophic hypothesis

A

deficits in nerve growth factors (BDNF) → structural changes & neuronal loss in the brain, especially hippocampus and frontal cortex

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3
Q

Neuroendocrine hypothesis

A

dysregulation of the HPA axis→ altered glucocorticoid function

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4
Q

Biogenic amine hypothesis

A

Abnormal neurotransmission of dopamine, NE, & serotonin

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5
Q

Evidence of biogenic amine hypothesis

A

Reserpine –> depletes NE –> depression

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6
Q

Antidepressant targets

A

Reuptake of serotonin, NE, and dopamine (neuronal plasticity after 2-3 weeks)

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7
Q

TCA inhibit reuptake of ___ and block ____

A

NE and 5-HT;

alpha-adrenergic, histamine and muscarinic receptor

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8
Q

SSRI inhibit reuptake of

A

5-HT

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9
Q

SNRIs inhibit reuptake of

A

NE and 5-HT

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10
Q

MAOIs inhibit the metabolism of

A

NE, DA, and 5-HT

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11
Q

Reuptake inhibition is immediate, but effects are

A

Delayed due to the feedback inhibition; only long-term use will down-regulate auto-receptors –> increase 5-HT neuron firing

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12
Q

antidepressant drug for chronic pain (TMJ)

A

TCA

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13
Q

Tertiary amines TCA

A

Amitriptyline, imipramine

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14
Q

Secondary amines TCA

A

Nortriptyline, Desipramine

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15
Q

Difference between tertiary and secondary TCA

A

Teritary: 1. primarily inhibit 5-HT reuptake; 2. produces more seizure; 3. more sedating

Secondary amines: primarily block NE reuptake

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16
Q

All antidepressants should be

A

Tapered gradually if possible

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17
Q

TCA metabolized by

A

CYP2D6

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18
Q

Histamine receptor blockade side effects

A

drowsiness, fatigue, sedation

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19
Q

Cholinergic blockade side effect

A

Blurred vision, tachycardia, constipation, urinary retention, dry mouth, palpitations, impairment of memory and cognition

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20
Q

Alpha 1 receptor blockade side effects

A

Cardiac depression and arrhythmia, postural hypotension, dizziness, reflex tachy

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21
Q

SE: SIADH –> water intoxication and hyponatremia

A

TCA

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22
Q

SE: Analgesia (from NE acting on alpha 2 receptors to decrease glutamate)

A

TCA

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23
Q

Toxicity/Overdose: Tosades de pointes

A

TCA

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24
Q

Torsades de pointes tx

A

Magnesium, isoproterenol and cardiac pacing

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25
Q

Tx for arrhythmia +/- seizure from TCA overdose

A

Lidocaine, propranolol, phenytoin

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26
Q

Tx of TCA overdose

A

Cardiac monitoring, supportive

Treat torsades de pointes, prevent seizure, restore acid/base balance

27
Q

Tx for acid/base balance from TCA overdose

A

Sodium bicarbonate and potassium chloride

28
Q

TCA drug interactions

A

MAOIs, SSRIs, sympathomimetic drugs (amphetamine), alcohol/CNS depressant, anticholinergic drugs

29
Q

TCA combined with MAOIs

A

Serotonin syndrome!

30
Q

DOC for OCD

A

Paroxetine

31
Q

DOC for social anxiety

A

Paroxetine

32
Q

SSRI that inhibit CYP450

A

Fluoxetine

33
Q

DOC for depression

A

Citalopram/ Escitalopram

34
Q

Least likely SSRI to interact w/ other drugs –> preferred in elder

A

Sertraline

35
Q

TCA metabolized by

A

CYP450s (2D6)

36
Q

SE: CNS stimulation (anxiety or insomnia) may occur with which SSRI

A

Fluoxetine, sertraline

37
Q

SSRI causes serotonin syndrome if combined w/

A
  1. MAOI, 2. St john’s wort, or 3. amphetamine
38
Q

SSRI and beta blocker combo

A

heart block and hypotension

39
Q

SSRI combined with codein

A

Fluoxetine inhibits conversion to the active compount

40
Q

SSRI combined with meperidine

A

Increases 5-HT; serotonin syndrome

41
Q

SSRI combined with tramadol

A

Increased risk of seizure

42
Q

SNRI drugs (2)

A

Venalfaxine, duloxetine

43
Q

MAO-A and B difference

A

MAO-A: metabolize NE, DA, and 5-HT in BOTH CNS and periphery

MAO-B selectively metabolizes DA in CNS ONLY

44
Q

Drug of last choice for depression

A

Phenelzine

45
Q

Phenelzine increases which neurotransmitter

A

NE, 5HT, DA

46
Q

Selegiline increases which neurotransmitter

A

DA

47
Q

MAOI used in Parkinson’s

A

Selegiline

48
Q

SE: Hypertensive crisis due to tyramine!!

A

Phenelzine

49
Q

Foods w/ tyramine

A

Red wine, beer, aged cheese, meats

50
Q

MAOI combined w/ what drugs causes severe HTN

A

OTC cold and cough meds (sympathomimetic amines - phenylephrine, ephedrine, amphetamine)

51
Q

MAOI combined w/ which drug groups can cause serotonin syndrome and lead to hyperprexia

A

Meperidine, dextromethorphan, TCAs, SSRI

52
Q

MAOI inhibits

A

CYP450 enzymes (2D6)

53
Q

Extended release for quitting smoking

A

Bupropion

54
Q

Do not give pt Bupropion who has

A

hx of seizures

55
Q

Reason why the gf is on Bupropion

A

sexual dysfunction side effects are rare

56
Q

Advantage in depressed pts w/ insomnia and anxiety

A

Mirtazapine

57
Q

Drug that eliminates side effects associated w/ SSRIs

A

Mirtazapine

58
Q

SSRIs common side effects

A

anxiety, insomnia, N, sexual dysfunction

59
Q

Non-stimulant tx for ADHD

A

Atomoxetine

60
Q

Atomextine SE

A

GI distress and insomnia

61
Q

Not a good antidepressant, used mostly as sleep aid

A

Trazodone

62
Q

SE: Priapism

A

Trazodone

63
Q

Pt on fluoxetine for his depression comes into the clinic complaining of pain, what pain med do you prescribe?

A

Acetaminophen or NSAID. NO OPIOID!!

64
Q

Other MAOI side effects

A

Orthostatic hypotension, wt gain, anticholinergic effects

Pharm III Unit 1 (9 decks)

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