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Pharm > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Sig: E Caps

S and the other s

A

Sleep disturbances

Suicide

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2
Q

Sig: E Caps

i

A

Loss of interest

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3
Q

Sig: E Caps

g

A

Guilt

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4
Q

Sig: E Caps

e

A

lack of Energy

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5
Q

Sig: E Caps

c

A

lack of Concentration

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6
Q

Sig: E Caps

a

A

Appetite changes

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7
Q

Sig: E Caps

p

A

Psychomotor retardation/agitation

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8
Q

decreases in DOPAMINE cause

A 
anhedonia
↓ motivation
apathy
↓ attention
cognitive slowing
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9
Q

decreases in NOREPINEPHRINE cause

A

lethargy

↓ alertness

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10
Q

decreases in SEROTONIN cause

A

Obsessive-compulsive symptoms

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11
Q

Causes of Depression: Pharmacologic

A 
Steroids- oral contraceptives, anabolic
Methyldopa
Clonidine
Montelukast
Beta blockers- propranolol
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12
Q

Causes of Depression: Immunologic

A

SLE

RA

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13
Q

Causes of Depression: Nutritional

A

Vitamin deficiency-B12, C, folate, B1, B6

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14
Q

Causes of Depression: Infectious

A

Tertiary syphilis
AIDS
TB

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15
Q

Causes of Depression: Neoplastic

A

Pancreatic cancer

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16
Q

Causes of Depression: Endocrine

A 
Hypothyroidism
Post-partum
Menses-related
Cushing’s
Addison’s
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17
Q

Causes of Depression: Neurological

A 
MS
Parkinson’s
Head trauma
Stroke
Dementia
Sleep apnea
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18
Q

Outcome of Treatment for Major Depressive Disorder - 5- R’s

A 
Response
Remission
Recovery
Relapse
Recurrence
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19
Q

Duration of therapy: First depressive episode

A

6-9 months

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20
Q

Duration of therapy: Second episode

A

4-5 years

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21
Q

Duration of therapy: Third episode

A

indefinitely

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22
Q

Acute Phase

A

6-12 weeks

Goal: remission

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23
Q

Continuation Phase

A

additional 4-5 months

Goal: management of residual symptoms and relapse prevention

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24
Q

Maintenance Phase

A

at least 1 year

Goal: prevent recurrence

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25
Q

1st line for MDD

A 
Fluoxetine (Prozac)
Citalopram (Celexa)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline
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26
Q

In addition to depression, SSRIs can be used for

A 
Anxiety disorders
Panic disorders
OCD
PTSD
Perimenopausal vasomotor symptoms
bulimia
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27
Q

SSRI adverse effects

A

N/V/D
Sexual dysfunction
Bleeding risk (decr PLT aggregation)
Hyponatremia (elderly)

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28
Q

SSRI Discontinuation Syndrome

A 
Flu-like symptoms
Agitation
Vivid dreams
Poor concentration
GI
headache
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29
Q

Serotonin Syndrome is aka

A

Hyperpyrexic Crisis

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30
Q

Serotonin Syndrome Symptoms- FLUSH

A

Flu-like: fatigue, fever, sweating, myalgia, N/V
Lightheaded, dizzy
Uneasiness, agitation, tremor, hyperreflexia
Sleep and sensory disturbances, confusion
Headache

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31
Q

Treatment for serotonin syndrome

A

cyproheptadine

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32
Q

SSRIs pregnancy category

A

most are C, but paroxetine is D

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33
Q

SSRIs: monitor for

A

sexual dysfunction, hepatic and/or renal dysfunction

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34
Q

SNRI examples

A

Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Levomilnacipran (Fetzima)

35
Q

SSRI uses

A

Major depression
Chronic pain disorders
Fibromyalgia
Perimenopausal symptoms

36
Q

Duloxetine is first line for

A 
Diabetic peripheral neuropathic pain (DPNP)
GAD
Fibromyalgia
Chronic musculoskeletal pain
Stress urinary incontinence (SUI)
37
Q

What do you recommend for

A

Diabetic peripheral neuropathic pain (DPNP)

38
Q

What do you recommend for

A

GAD

39
Q

What do you recommend for

A

Fibromyalgia

40
Q

What do you recommend for

A

Chronic musculoskeletal pain

41
Q

What do you recommend for

A

Stress urinary incontinence (SUI)

42
Q

Duloxetine ADRs

A 
Dry mouth
Insomnia
Dizziness
Incr LFTs
INcr BP
Sexual dysfunction
Decr appetite
43
Q

Duloxetine: Monitor/ Caution:

A

HTN
Not recommended in patients with substantial alcohol use
Chronic liver disease

44
Q

Levomilnacipran is an SNRI approved for

A

fibromyalgia

45
Q

Levomilnacipran ADRs

A 
Hyperhidrosis
Sexual dysfunction
Urinary hesitancy
Incr heart rate and BP
N/V/C
46
Q

Levomilnacipran: you have to limit the MDD when used with

A

a strong CYP3A4 inhibitor

47
Q

Tricyclic Antidepressants (TCA) are divide into 2 groups:

A

Tertiary amines

Secondary amines

48
Q

Tricyclic Antidepressants (TCA), Tertiary amines description

A

More intolerable anticholinergic and sedative adverse effects

49
Q

Tricyclic Antidepressants (TCA), Secondary amines description

A

More potent on a mg to mg basis

50
Q

Tricyclic Antidepressants (TCA), ADRs

A 
Anticholinergic
Alpha 1 blockade
Orthostatic hypotension, sedation, sexual dysfunction
Histamine blockade
Sedation, weight gain
Fast sodium channel blockade
Cardiac-arrythmias
51
Q

Tricyclic Antidepressants (TCA), overdose treatment

A

sodium bicarbonate

52
Q

Tricyclic Antidepressants (TCA) are the preferred medication for

A 
Pregnancy
pain/fibromyalgia, migraine
Insomnia
Severe depression
Parkinson’s
53
Q

Tricyclic Antidepressants (TCA), use caution with

A 
Elderly
Daytime sedation
Dementia
Suicidal
Overweight, bipolar
Cardiac abnormalities
54
Q

Serotonin Modulators, 3 examples

A

Trazodone

Nefazodone

55
Q

Trazodone (Serotonin Modulator) Adverse effects:

A 
Sedation
N/V/C
Orthostasis
Headache
Asthenia
Priapism
56
Q

Nefazodone (Serotonin Modulator) Adverse effects:

A 
Sedation
N/V/C
Hepatotoxicity
Orthostasis
Headache
Asthenia
57
Q

Trazodone, Vortioxetine, and Nefazodone (Serotonin Modulator) are preferred meds for

A

Patients with depression-related anxiety and agitation
Insomniacs
Sexual dysfunction with other agents

58
Q

Trazodone, Vortioxetine, and Nefazodone (Serotonin Modulator) need to be used cautiously with

A

Noncompliant patients

Hepatic dysfunction

59
Q

Vortioxetine (Serotonin Modulator) Adverse effects

A

N/V/C
Serotonin syndrome
Risk of bleeding
bilpolar-> risk of activation of mania

60
Q

Vortioxetine (Serotonin Modulator), has several medications inhibit the metabolism of vortioxetine

A

Bupropion, fluoxetine, paroxetine, quinidine

61
Q

Vortioxetine (Serotonin Modulator), there are 3 medications that induce the metabolism

A

Rifampin, carbamazepine, phenytoin

62
Q

Unicyclic medication example

A

Bupropion

63
Q

Tetracyclic medication example

A

Mirtazapine

64
Q

Bupropion drug class

A

Unicyclic

65
Q

Mirtazapine drug class

A

Tetracyclic

66
Q

Bupropion ADRs

A

Insomnia, anxiety, agitation, nausea, anorexia, seizures

67
Q

Bupropion: One of the ADRs is seizures, what factors make the risk of seizure higher?

A

Head trauma, history of sz, CNS tumor, bulimia/anorexia, alcoholics

68
Q

Bupropion is preferred for

A

Intolerant to SSRI
+SSRI to reverse sexual dysfunction
Smoking cessation

69
Q

With Bupropion be careful with people who have

A

Abrupt d/c of alcohol/sedatives
Seizure
Hepatic dysfunction

70
Q

Mirtazapine ADRs

A 
Sedation
Weight gain
Constipation
Incr TG, cholesterol
Dizziness
71
Q

Mirtazapine is preferred for

A

Mixed panic disorder/depression

Mixed anxiety/depression

72
Q

Mirtazapine use caution for

A

Hepatic dysfunction
Overweight
Cognitive slowing

73
Q

MAOIs examples

A

Phenelzine
Tranylcypromine
Selegiline

74
Q

Describe MAOIs in 2 words

A

irreversible and nonselective

75
Q

To whom would you recommend an MAOI

A

someone that didn’t respond to anything else, its last resort

76
Q

MAOI ADRs

A 
Anticholinergic effects
Hypertensive Crisis (noradrenergic syndrome)
77
Q

MAOI: Hypertensive Crisis (noradrenergic syndrome) is caused by

A

Tyramine rich foods- red wine,beer, sardines, aged cheeses, shrimp, chocolate
Medicaitons- amphetamines, linezolid, dopamine, decongestants, DM, meperidine

78
Q

MAOI 3 instructions related to interactions

A

Avoid foods high in tyramine and for 2 weeks after d/c
14 day wash out- SSRIs, SNRIs, TCA + MAOI
5 week wash out fluoxetine + MAOI

79
Q

MAOI: Avoid foods high in

A

tyramine and for 2 weeks after d/c

80
Q

MAOI: 14 day wash out-

A

SSRIs, SNRIs, TCA + MAOI

81
Q

MAOI: 5 week wash out

A

fluoxetine + MAOI

82
Q

Selegiline (MAOI) Metabolites include

A

amphetamine and methamphetamine

83
Q

MAOIs are preferably used for what conditions

A 
Atypical depression (mood reactivity, irritability, psychomotor retardation, hypersomnia
Refractory depression
Associated panic attacks
Bulimia
Compliant patients
84
Q

MAOIs should be used cautiously with

A

Non compliant patients
Insomniacs
agitation

Pharm (23 decks)

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