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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
1st line for MDD
``` Fluoxetine (Prozac) Citalopram (Celexa) Escitalopram (Lexapro) Paroxetine (Paxil) Sertraline ```
26
In addition to depression, SSRIs can be used for
``` Anxiety disorders Panic disorders OCD PTSD Perimenopausal vasomotor symptoms bulimia ```
27
SSRI adverse effects
N/V/D Sexual dysfunction Bleeding risk (decr PLT aggregation) Hyponatremia (elderly)
28
SSRI Discontinuation Syndrome
``` Flu-like symptoms Agitation Vivid dreams Poor concentration GI headache ```
29
Serotonin Syndrome is aka
Hyperpyrexic Crisis
30
Serotonin Syndrome Symptoms- FLUSH
Flu-like: fatigue, fever, sweating, myalgia, N/V Lightheaded, dizzy Uneasiness, agitation, tremor, hyperreflexia Sleep and sensory disturbances, confusion Headache
31
Treatment for serotonin syndrome
cyproheptadine
32
SSRIs pregnancy category
most are C, but paroxetine is D
33
SSRIs: monitor for
sexual dysfunction, hepatic and/or renal dysfunction
34
SNRI examples
Duloxetine (Cymbalta) Venlafaxine (Effexor) Levomilnacipran (Fetzima)
35
SSRI uses
Major depression Chronic pain disorders Fibromyalgia Perimenopausal symptoms
36
Duloxetine is first line for
``` Diabetic peripheral neuropathic pain (DPNP) GAD Fibromyalgia Chronic musculoskeletal pain Stress urinary incontinence (SUI) ```
37
What do you recommend for
Diabetic peripheral neuropathic pain (DPNP)
38
What do you recommend for
GAD
39
What do you recommend for
Fibromyalgia
40
What do you recommend for
Chronic musculoskeletal pain
41
What do you recommend for
Stress urinary incontinence (SUI)
42
Duloxetine ADRs
``` Dry mouth Insomnia Dizziness Incr LFTs INcr BP Sexual dysfunction Decr appetite ```
43
Duloxetine: Monitor/ Caution:
HTN Not recommended in patients with substantial alcohol use Chronic liver disease
44
Levomilnacipran is an SNRI approved for
fibromyalgia
45
Levomilnacipran ADRs
``` Hyperhidrosis Sexual dysfunction Urinary hesitancy Incr heart rate and BP N/V/C ```
46
Levomilnacipran: you have to limit the MDD when used with
a strong CYP3A4 inhibitor
47
Tricyclic Antidepressants (TCA) are divide into 2 groups:
Tertiary amines | Secondary amines
48
Tricyclic Antidepressants (TCA), Tertiary amines description
More intolerable anticholinergic and sedative adverse effects
49
Tricyclic Antidepressants (TCA), Secondary amines description
More potent on a mg to mg basis
50
Tricyclic Antidepressants (TCA), ADRs
``` Anticholinergic Alpha 1 blockade Orthostatic hypotension, sedation, sexual dysfunction Histamine blockade Sedation, weight gain Fast sodium channel blockade Cardiac-arrythmias ```
51
Tricyclic Antidepressants (TCA), overdose treatment
sodium bicarbonate
52
Tricyclic Antidepressants (TCA) are the preferred medication for
``` Pregnancy pain/fibromyalgia, migraine Insomnia Severe depression Parkinson’s ```
53
Tricyclic Antidepressants (TCA), use caution with
``` Elderly Daytime sedation Dementia Suicidal Overweight, bipolar Cardiac abnormalities ```
54
Serotonin Modulators, 3 examples
Trazodone | Nefazodone
55
Trazodone (Serotonin Modulator) Adverse effects:
``` Sedation N/V/C Orthostasis Headache Asthenia Priapism ```
56
Nefazodone (Serotonin Modulator) Adverse effects:
``` Sedation N/V/C Hepatotoxicity Orthostasis Headache Asthenia ```
57
Trazodone, Vortioxetine, and Nefazodone (Serotonin Modulator) are preferred meds for
Patients with depression-related anxiety and agitation Insomniacs Sexual dysfunction with other agents
58
Trazodone, Vortioxetine, and Nefazodone (Serotonin Modulator) need to be used cautiously with
Noncompliant patients | Hepatic dysfunction
59
Vortioxetine (Serotonin Modulator) Adverse effects
N/V/C Serotonin syndrome Risk of bleeding bilpolar-> risk of activation of mania
60
Vortioxetine (Serotonin Modulator), has several medications inhibit the metabolism of vortioxetine
Bupropion, fluoxetine, paroxetine, quinidine
61
Vortioxetine (Serotonin Modulator), there are 3 medications that induce the metabolism
Rifampin, carbamazepine, phenytoin
62
Unicyclic medication example
Bupropion
63
Tetracyclic medication example
Mirtazapine
64
Bupropion drug class
Unicyclic
65
Mirtazapine drug class
Tetracyclic
66
Bupropion ADRs
Insomnia, anxiety, agitation, nausea, anorexia, seizures
67
Bupropion: One of the ADRs is seizures, what factors make the risk of seizure higher?
Head trauma, history of sz, CNS tumor, bulimia/anorexia, alcoholics
68
Bupropion is preferred for
Intolerant to SSRI +SSRI to reverse sexual dysfunction Smoking cessation
69
With Bupropion be careful with people who have
Abrupt d/c of alcohol/sedatives Seizure Hepatic dysfunction
70
Mirtazapine ADRs
``` Sedation Weight gain Constipation Incr TG, cholesterol Dizziness ```
71
Mirtazapine is preferred for
Mixed panic disorder/depression | Mixed anxiety/depression
72
Mirtazapine use caution for
Hepatic dysfunction Overweight Cognitive slowing
73
MAOIs examples
Phenelzine Tranylcypromine Selegiline
74
Describe MAOIs in 2 words
irreversible and nonselective
75
To whom would you recommend an MAOI
someone that didn't respond to anything else, its last resort
76
MAOI ADRs
``` Anticholinergic effects Hypertensive Crisis (noradrenergic syndrome) ```
77
MAOI: Hypertensive Crisis (noradrenergic syndrome) is caused by
Tyramine rich foods- red wine,beer, sardines, aged cheeses, shrimp, chocolate Medicaitons- amphetamines, linezolid, dopamine, decongestants, DM, meperidine
78
MAOI 3 instructions related to interactions
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
MAOI: Avoid foods high in
tyramine and for 2 weeks after d/c
80
MAOI: 14 day wash out-
SSRIs, SNRIs, TCA + MAOI
81
MAOI: 5 week wash out
fluoxetine + MAOI
82
Selegiline (MAOI) Metabolites include
amphetamine and methamphetamine
83
MAOIs are preferably used for what conditions
``` Atypical depression (mood reactivity, irritability, psychomotor retardation, hypersomnia Refractory depression Associated panic attacks Bulimia Compliant patients ```
84
MAOIs should be used cautiously with
Non compliant patients Insomniacs agitation

Pharm (23 decks)

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