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Pharm Brainscapes by Cheryl and Phil > Antidepressants Ch 32 > Flashcards

Antidepressants Ch 32 Flashcards

1
Q

What does MOA stand for?

A

Mechanism of Action

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2
Q

What does MAOI stand for

A

Monoamine oxydase inhibor

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3
Q

What is the mechanism of action of MAOI’s?

A

Monoamine oxidase is an enzyme that breaks down the monoamines in the synapse. MAOI’s INHIBIT this enzyme preventing the destruction of all monoamines, causing levels to rise.

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4
Q

What are 3 monoamines?

A

Seratonin, Dopamine, Norepinephrine

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5
Q

Explain why clients must avoid tyramine while taking an MAOI.

A

Food/drink with tyramine will cause a serious interaction with MAOI’s resulting in a hypertensive crisis.

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6
Q

Give several examples of foods and drinks containing tyramine.

A

Aged cheeses, cured meats, fermented cabbage, soy sauce, fish sauce, yeast extract, broad bean pods (eg, fava beans), improperly stored/spoiled foods.

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7
Q

What is the most common psychiatric disorder in the US?

A

Depression

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8
Q

About ____% of the population will experience depression during their lives?

A

30

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9
Q

The incidence of depression in women is _______ that of men.

A

Double

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10
Q

Depressed mood and loss of pleasure or interest in all or nearly all of one’s usual activities and pastimes describes:

A

Depression

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11
Q

For a diagnosis of depression to be made, symptoms must be present most of the day, nearly every day, for at least ___ weeks.

A

2

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12
Q

The etiology of depression is not completely understood, but some support exists for the ___________ deficiency hypothesis of depression.

A

Monoamine

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13
Q

Drugs for depression are divided into five major classes:

A 
SSRI's
SNRI's
TCA's
MAOI's
Atypical
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14
Q

What does SSRI stand for?

A

Selective serotonin reuptake inhibitor

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15
Q

What does SNRI stand for?

A

Serotonin Norepinephrin reuptake inhibitor

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16
Q

What does TCA stand for?

A

Trycyclic antidepressant

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17
Q

Which types of antidepressants are more dangerous and less well tolerated and generally reserved for patients who did not respond well to the first line of drugs? (2)

A

TCA’s

MAOI’s

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18
Q

Once a drug has been selected for initial treatment of depression it should be used for__ to __weeks to assess efficacy.

A

4-8 weeks

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19
Q

During treatment with antidepressants is it possible for the risk of suicide to increase?

A

Yes, especially initially

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20
Q

Because antidepressant drugs can be used to commit suicide, two precautions should be observed:

A
  1. Prescriptions should be written for the smallest number of doses consistent with good patient management.
  2. Dosing of inpatients should be directly observed to ensure that each dose is swallowed, and not “cheeked,” to prevent the patient from accumulating multiple doses that might be taken with suicidal intent.
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21
Q

Side effects of SSRI’s

A

Nausea, agitation/insomnia, and sexual dysfunction (especially anorgasmia).

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22
Q

What can happen when SSRI’s are used late in pregnancy?

A

SSRIs can lead to a withdrawal syndrome and persistent pulmonary hypertension in the infant.

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23
Q

What SSRI serves as the prototype for the group? (This was also the first SSRI available)

A

Fluoxetine

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24
Q

Therapeutic results of SSRI’s

A

Therapeutic effects are the result of adaptive cellular changes that take place in response to prolonged uptake blockade.

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25
Q

Explain the mechanism of action of SSRI’s

A

The SSRIs selectively block neuronal reuptake of serotonin (5-HT). This increases the concentration of 5-HT in the synapse, causing increased activation of postsynaptic 5-HT receptors.

(Basically not having enough serotonin makes people get depressed and so blocking it from getting reabsorbed helps people to have enough serotonin)

26
Q

What else is fluoxetine approved to treat?

A 
bipolar disorder,
obsessive-compulsive disorder
panic disorder
bulimia nervosa
premenstrual dysphoric disorder
27
Q

How can sexual dysfunction be managed for a patient taking fluoxetine? (2)

A

1.In some cases, reducing the dosage or taking “drug holidays” (e.g., discontinuing medication on Fridays and Saturdays) can help. 2.Another solution is to add a drug that can overcome the problem.

28
Q

Fluoxetine and other SSRIs cause weight gain; about one-third of patients continue putting on weight—up to __ pounds or more.

A

20

29
Q

What does serotonin syndrome look like? Signs and symptoms?

A

Signs and symptoms include altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration), as well as incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

30
Q

When does serotonin syndrome resolve?

A

The syndrome resolves spontaneously after discontinuation of the drug.

31
Q

What can cause withdrawal syndrome when taking an SSRI?

A

Stopping taking it abrubtly

32
Q

What are the symptoms of withdrawal syndrome from an SSRI?

A

Symptoms include dizziness, headache, nausea, sensory disturbances, tremor, anxiety, and dysphoria.

33
Q

Use of fluoxetine and other SSRIs late in pregnancy poses a small risk of two adverse effects in the newborn:

A
  1. neonatal abstinence syndrome and

2. persistent pulmonary hypertension of the newborn

34
Q

Fluoxetine should not be combined with MAOIs and other serotonergic drugs because of an increased risk of :

A

Serotonin Syndrome

35
Q

The SNRIs have pharmacologic effects similar to those of the ________’s

A

SSRIs

36
Q

What are SNRI’s used to treat?

A

Major depression
Generalized anxiety disorder Social anxiety disorder
Panic disorder.

37
Q

Side effects of SNRI’s

A

Nausea, headache, anorexia, nervousness, sweating, somnolence, and insomnia. Dose-dependent weight loss may occur secondary to anorexia.

38
Q

Side effects of TCA’s

A
  • Sedation
  • orthostatic hypotension
  • anticholinergic effects (Can’t see, -can’t spit can’t pee, can’t shit).
  • The most dangerous effect is cardiac toxicity. When taken in overdose, TCAs can readily prove lethal.
39
Q

What is the mechanism of action of TCA’s?

A

Block neuronal reuptake of NE and 5-HT, thereby intensifying transmission at noradrenergic and serotonergic synapses. Antidepressant effects are due to adaptive changes brought on by prolonged uptake blockade.

(Basically the same mechanism as SNRI’s but TCA’s are less selective and affect more receptors).

40
Q

What else besides depression can TCA’s treat?

A
  • bipolar disorder
  • fibromyalgia syndrome
  • neuropathic pain
  • chronic insomnia
  • ADHD and
  • panic disorder
  • obsessive-compulsive disorder
41
Q

Combining a TCA with an MAOI can lead to severe ___________, owing to excessive adrenergic stimulation of the heart and blood vessels.

A

Hypertension

42
Q

Do TCA’s increase or decrease anticholinergic effects?

A

Because TCAs have anticholinergic actions of their own, they intensify the effects of other anticholinergic medications.

43
Q

Do TCA’s have a high or low therapeutic index?

A

Low.

The lethal dose is only 8 times the average therapeutic dose.

44
Q

What drugs are as effective as SSRI’s and TCA’s but are more dangerous?

A

MAOI’s

45
Q

What is MAO and what does it do?

A

Monoamine oxidase.
This is an enzyme found in the liver, intestinal wall and neurons that inactivates NE, 5-HT and dopamine.
If you have too much of this and all of your happy juice is getting inactivated that will make you depressed.
MOA also deactivates tyramine, so it is necessary for eating certain tyramine containing foods.

46
Q

What is the MOA of MAOI’s? (Thats a tongue twister!)

A

Inhibition of MAO-A in nerve terminals. By inhibiting MAO-A, the drugs increase the amount of NE and 5-HT available for release and thus intensify transmission at noradrenergic and serotonergic junctions.

(Basically inhibiting MAOI keeps MAO from eating up all the happy juice.)

47
Q

What are the two types of MAO?

A

MAO-A

MAO-B

48
Q

Why do MAOI’s make tyramine containing foods toxic?

A

Normally MAO’s eat up tyramine, but when they are being inhibited they do not. So when you eat things with tyramine like aged cheese or eat fava beans with chianti you end up with too much tyramine.

49
Q

How do MAOI’s stimulate the CNS?

A

Directly

50
Q

What is the actual adverse affect related to too much tyramine?

A

Hypertension

51
Q

What is an atypical antidepressant that acts like amphetamine and also depresses appetite?

A

bupropion

52
Q

What is the MOA of bupropion?

A

Unclear but may be related to blockade of dopamine and/or NE uptake.
The drug does NOT affect serotonergic, cholinergic, or histaminergic transmission and does not inhibit MAO.

53
Q

Which antidepressant increases sexual desire and pleasure?

A

bupropion

54
Q

What 2 uses does bupropion have other than depression that are related to sexual dysfunction?

A
  1. Counteract sexual dysfunction in patients taking SSRIs

2. Increase sexual interest in women with hypoactive sexual desire disorder.

55
Q

Side effects of bupropion:

A 
agitation
headache
dry mouth
constipation 
weight loss
gastrointestinal upset
dizziness
tremor
insomnia
blurred vision
tachycardia.
56
Q

What atypical antidepressant’s mechanism of action is blockade of presynaptic alpha2-adrenergic receptors that serve to inhibit release. The benefit of this drug is increased release of 5-HT and NE.

A

Mirtazapine

57
Q

Side effects of mirtazapine?

A
  • Somnolence is the most prominent adverse effect.
  • Weight gain
  • increased appetite
  • elevated cholesterol
  • Sexual dysfunction is minimal.
58
Q

What is amitriptyline’s relation to nortriptylene?

A

Amitriptyline blocks NE and 5-HT, while Nortriptyline blocks only NE

[From Google (med-expert) : “Nortriptyline, a major metabolite of amitriptyline, is a secondary amine. It is less sedating and better tolerated than amitriptyline. But both have similar side effects, toxicities, and pharmacologic activity.”

59
Q

Why are TCA’s no loner the first line of treatment for depression?

A

They are more dangerous and less well-tolerated.

60
Q

What is the mechanism behind: blurred vision, dry mouth, urinary retention, constipation, orthostasis and sedation.

A

Anticholerginic Drugs (muscarinic antagonists) which block the actions of acetylcholine at muscarinic receptors. (p.119)

61
Q

How can dry mouth be relieved in patients taking anticholergincs non-pharmacologically?

A

Dry mouth: sipping fluids, chewing sugar free gum, treating mouth with fake saliva and using alcohol free mouthwash.

Pharm Brainscapes by Cheryl and Phil (6 decks)

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