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Block 8; Week 1 > Antidepressants-Craviso > Flashcards

Antidepressants-Craviso Flashcards

1
Q

What do the current antidepressants do?

A

target monoamine levels

take several weeks to work as they increase BDNF levels

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2
Q

What percentage of patients are refractory to multiple antidepressants?

A

20%

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3
Q

What are the 4 major classes of antidepressants?

A
  1. SSRIs. First line.
  2. SNRIs
  3. Newer Antidepressant: inhibit reuptake of dopamine
  4. Monoamine Oxidase INhibitors-inhibit metabolism of NE & serotonin
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4
Q

Which category do tricyclic antidepressants fall into?

A

SNRI
work on a variety of receptors
NE & serotonin affected
side effects!!!

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5
Q

Give examples of common SSRIs.

A 
FLUOXETINE (Prozac; Prozac Weekly)
SERTRALINE (Zoloft)
PAROXETINE (Paxil)
CITALOPRAM (Celexa) 
ESCITALOPRAM (Lexapro)
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6
Q

What is an important effect that SSRis have on the liver?

A

some of them can be potent inhibitors of cytochrome P450 enzymes. Esp CYP2D6. If another drug metabolized by this is taken…can build up to toxic levels.
they are themselves metabolized in the liver

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7
Q

Which SSRis have a high & low potential for inhibiting Cyt p450 enzymes?

A

high potential: fluoxetine, paroxetine

low potential: citalopram, escitalopram

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8
Q

What are important adverse side effects of SSRIs?

A 
sexual dysfunction
GI issues
insomnia, restlessness
anorexia, weight loss or weight gain
QT prolongation w/ citalopram
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9
Q

Which SSRI if taken during pregnancy can cause cardiovascular malformations of the fetus?

A

paroxetine

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10
Q

What can happen if you have taken an SSRI long term & stop suddenlY?

A

nausea, dizziness, anxiety, tremor, palpitations

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11
Q

Once again, which SSRI can cause QT prolongation?

A

citalopram

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12
Q

Which SSRIs can cause serotonin syndrome?

A

MAO inhibitors

or other drugs that enhance serotonin neurotransmission

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13
Q

What are the symptoms of serotonin syndrome?

A

Cognitive: headache, confusion
Autonomic: shivering, sweating
Somatic: tremor, hyperreflexia

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14
Q

What is the issue with prescribing SSRis to adolescents?

A

linked to increased risk of suicide

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15
Q

What are the 2 antidepressants approved for used in children & adolescents?

A

fluoxetine (SSRI)

escitalopram

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16
Q

What are additional uses of SSRIs, aside from alleviating depression?

A 
anxiety disorders
seasonal affective disorder
bulimia nervosa
migraine prophylactic
PMS, hot flashes
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17
Q

Which drugs is used for seasonal affective disorder?

A

paroxetine

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18
Q

Which drug is used for bulimia nervosa?

A

fluoxetine

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19
Q

Which drug is used for migraine prophylactic?

A

fluoxetine

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20
Q

Which drug is used for PMS & hot flashes?

A

paroxetine

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21
Q

What are important SNRIs to keep in mind?

A

Venlafaxine: Effexor
Duloxetine: Cymbalta
TCAs

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22
Q

What are some tricyclic antidepressants?

A

nortriptyline, imipramine, amitryptyline

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23
Q

What are some important new antidepressants?

A

Bupropion-Wellbutrin (dopamine reuptake inihbitor)
Mirtazapine-Remeron
Trazodone-Desyrel
Vilazodone-Virbyl

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24
Q

What are 2 important MAOIs?

A

Selegiline-Eldepryl

Phenelzine-Nardil

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25
What are some important classes of bipolar disorder medications?
``` Lithium Valproic Acid Carbamazepine Atypical antipsychotics Benzodiazepines Lamotrigine-only bipolar depression ```
26
Which drugs belong in the category of atypical antipsychotics used to treat bipolar disorder?
``` QUETIAPINE (Seroquel) OLANZAPINE (Zyprexa) RISPERIDONE (Risperdal) ARIPIPRAZOLE (Abilify) LURASIDONE (Latuda) – bipolar depression only ASENAPINE (Saphris) ```
27
What are 2 important benzodiazepines used to treat bipolar disorder?
lorazepam (ativan) | clonazepam (klonopin)
28
What does venlafaxine/effexor do?
SNRI blocks reuptake of NE & 5-HT weakly inhibits DM reuptake
29
What are the adverse side effects of venlafaxine/effexor?
same as SSRIs: sexual dysfunction, insomnia, GI) | could increase BP
30
What are additional uses of venlafaxine/effexor? What is the name of its metabolite?
anxiety disorders neuropathic pain **desvenlafaxine (pristiq)
31
What does duloxetine/cymbalta do? What are its adverse side effects?
SNRI | contraindicated if you have liver problems
32
What are additional uses for duloxetine/cymbalta?
fibromyalgia diabetic peripheral neuropathy generalized anxiety disorder
33
What do tricyclic antidepressants do?
block reuptake of NE & 5-HT | type of SNRIs
34
Which TCAs block 5-HT more than NE?
imipramine/tofranil & amitriptyline/elavil
35
Which TCAs block NE more than 5-HT?
nortriptyline/aventyl
36
Why aren't TCAs used anymore?
``` can be fatal w/ overdose can commit suicide w/ this drug lower seizure threshold block 3 types of receptors to varying degrees: mACH, alpha1, H1 cardiotoxicity **also: sexual dysfunction & weight gain ```
37
What is an additional use of amitriptyline?
migraine prophylactic
38
Which TCA has the greatest ability to block additional receptors?
amitryptiline
39
What are the effects of blocking mACH?
sedation, cognitive impairment, confusion, delirium, blurred vision, dry mouth, tachycardia, urinary retention
40
What are the effects of blocking alpha 1 receptors w/ TCAs?
orthostatic hypotension, sedation
41
What is the effect of blocking H1 receptor w/ a TCA?
sedation
42
What should TCAs not be taken with?
MAO inhibitors--risk of HTN & serotonin syndrome anticholinergics & antihistamines-they already block these receptors enough! CNS depressants-they already cause sedation people!!
43
What does bupropion or Wellbutrin do?
blocks reuptake of dopamine, also possibly some NE & 5-HT
44
What are the adverse side effects of buproprion aka Wellbutrin?
restlessness, insomnia, anxiety risk of seizure activity (dose-related) contraindicated for those with a history of seizures, and eating disorders (electrolyte imbalances) may precipitate psychotic episodes in susceptible individuals b/c schizophrenia etc are due to excessive dopamine levels. Note: few sexual side effects compared to other antidepressants
45
WHat is zyban?
sustained release form of Wellbutrin used as an aid for smoking cessation
46
What does mirtazapine/remeron do?
new antidepressant antagonist @ presynaptic alpha 2 adrenergic autoreceptors (no neg. feedback for NE & 5-HT release). blocks 5-HT2 & 5-HT3 receptors no sexual side effects
47
What are the adverse side effects of mirtazapine? How does this relate to its old use?
sedation, somnolence dizziness stimulates appetite, weight gain **used to be used to treat insomnia
48
What does trazodone/desyrel do?
blocks 5-HT reuptake | antagonist @ 5-HT2 receptors & 5-HT1a
49
What are the adverse side effects of trazodone?
``` significant drowsiness and dizziness GI upset (nausea and vomiting) orthostatic hypotension can cause protracted erection (priapism)   ```
50
WHat does vilazodone/vibryd do?
SSRI | partial agonist of 5-HT1a receptors
51
What are the adverse side effects of vilazodone?
insomnia GI disturbances no sexual side effects, no weight gain
52
HOw do MAOIs work?
block MAO, the enzyme in the nerve terminal that converts NTs into inactive products
53
When should MAOIs be prescribed?
for those who can't tolerance normal antidepressants last choice, tho b/c could get HTN crisis w/ certain foods also used in Parkinson's disease.
54
Why can MAOIs cause a massive HTN crisis w/ ingestion of certain foods?
MAO also found in the liver where it breaks down tyrimine. | somehow displaces NE in nerve terminals when it is blocked in the liver. Massive release of NE causes HTN crisis.
55
Which foods are high in tyrimine?
salami certain cheeses red wine
56
What is selegiline/eldepryl?
MAOI reversible inhibitor of MAO can be transdermal as ensam bypasses the gut so central MAO enzymes are intact, less risk of hypertensive crisis
57
WHat is phenelzine/nardil? What are some of its negative side effects?
``` irreversible inhibitor of MAO sexual impotence insomnia weight gain orthostatic hypotension ```
58
How do you get drug interactions w/ MAOIs?
don't take w/ tyramine-containing food or w/ sympathomimetics b/c of risk for HTN crisis. don't take w/ SSRIs & 5-HT receptor agonists for risk of serotonin syndrome.
59
What are the features of a manic bipolar episode?
exaggerated optimism and self-confidence decreased sleep without experiencing fatigue grandiose delusions, inflated sense of self-importance excessive irritability; aggressive behavior racing speech, flight of ideas impulsiveness, poor judgment easily distracted reckless behavior
60
What is considered rapid cycling bipolar disorder?
more than 4 full cycles per year
61
What is the first line drug for bipolar disorder?
Lithium-works thru long term neuroplastic changes * *ineffective for rapid cyclers * *good for mania or depression of bipolar patients
62
What are the immediate effects of lithium?
inhibition of inositol substrates | altering G proteins associated w/ beta adrenergic & M1 Ach receptors.
63
When are there peak plasma levels of lithium? How is it eliminated? WHat is its half life?
peak plasma: 1-2 hours eliminated by kidney t1/2: 20-24 hours *renal clearance proportional to plasma concentration
64
Which physiologic states are associated w/ a decrease in renal clearance?
``` dehydration CHF renal disease old age **if these happen--can have increased lithium levels ```
65
LIthium interferes somehow with sodium reabsorption. Thus...if you have good lithium retention you could have what happen to sodium?
sodium depletion!
66
Which drugs decrease the clearance of lithium--increase lithium levels?
loop & thiazide diuretics NSAIDs ACE inhibitors
67
Which drugs increase clearance of lithium-less lithium retention?
osmotic diuretics acetazolamide caffeine theophylline
68
At therapeutic levels...what are the side effects of lithium?
``` drowsiness, forgetfullness GI polyuria, thirst weight gain mild tremor ```
69
With long term use what are the adverse side effects of lithium?
degeneration of kidney & thyroid
70
When should lithium not be used?
during first trimester of pregnancy & during breast feeding
71
At the level of 2.5 mEq/L what does lithium produce?
ataxia gross tremor cardiac arrhythmias coma and convulsions (can cause death)
72
What is valproic acid/depakote used for?
anti epileptic drug can be used for mania & mixed states
73
What is carbamazepine used for?
anti epileptic drug for mania & mixed states
74
What are benzodiazepines used for?
sometimes used to help treat acute mania & agitation

Block 8; Week 1 (13 decks)

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