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Psych Exam 1 > Antidepressants - Linger > Flashcards

Antidepressants - Linger Flashcards

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1
Q

citalopram

A

SSRI

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2
Q

escitalopram

A

SSRI

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3
Q

fluoxetine

A

SSRI

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4
Q

fluvoxamine

A

SSRI

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5
Q

paroxetine

A

SSRI

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6
Q

sertraline

A

SSRI

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7
Q

duloxetine

A

SNRI

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8
Q

venlafaxine

A

SNRI

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9
Q

amitriptyline

A

TCA

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10
Q

desipramine

A

TCA

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11
Q

imipramine

A

TCA

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12
Q

nortriptyline

A

TCA

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13
Q

trazodone

A

5-HT2 antagonist

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14
Q

bupropion

A

tetracyclinc/unicyclic

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15
Q

mertazapine

A

tetracyclic/unicyclic

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16
Q

selegiline

A

MAOI

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17
Q

antidepressants

A

affect serotonin, NE, or both

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18
Q

reserpine

A

decreases biogenic amines

blocks vesicular uptake of monoamines

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19
Q

neurotrophic factor

A

BDNF
-growth factor -neurogenesis

involved mood and depression disorders

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20
Q

fluoxetine

A

long t-1/2

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21
Q

selegiline

A

transdermal and sublingual forms

-decrease food interactions

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22
Q

SSRI MOA

A

inhibit serotonin transporter - SERT

increased serotonin at synaptic cleft

80% blocked - therapeutic dosage

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23
Q

possible chronic adapatation to SSRIs

A

downregulation of postsynaptic 5-HT2 receptor density

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24
Q

SNRI MOA

A

inhibit SERT and NET

higher affinity of SERT than NET

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25
Q

TCA MOA

A

inhibit SERT and NET

different TCAs - different affinities for SERT and NET

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26
Q

TCA

A

also have high affinity - adrenergic, cholinergic, histmaine receptors
-more side effects

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27
Q

trazodone

A

5-HT2 antagonist

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28
Q

nefazodone

A

5-HT2 antagonist

counterintuitive why they work

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29
Q

suicide patients

A

more 5-HT2 receptors - overdensity

may be involved in path of depression

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30
Q

bupropion MOA

A

selective inhibitor of DAT - dopamine transporter

stimulate presynaptic release of NE and DA

no effect on serotonin

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31
Q

MAOI MOA

A

mitochondrial enzyme - MAO - metabolize monoamines to inactive metabolites

MAO-A - NE and 5-HT

cause accumulation of NE, 5-HT, DA in vesicles of nerve endings

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32
Q

tyramineselegiline MOA

A

metabolized by MAO-A and MAO-B

with MAOI - can get accumulation - not goodselective irreversible MAO-B inhibitor (low dose

and nonselective MAO-A/B inhibitor - high dose (refractory depression)

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33
Q

1-2 months

A

until max benefit of antidepressants

adequate response achieved - recommend minimum 6-12 months of tx

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34
Q

85% patients with major depressive disorder

A

have at least one recurrence in lifetime

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35
Q

> 2 MDD episodes in 5 years, or >3 episodes lifetime

A

long-term maintenance anti-depressant therapy

36
Q

tx of anxiety disorders

A

many SSRI and SNRIs approved

37
Q

antidepressants vs. benzos for anxiety

A

antidepressants - slower acting, but no risk of dependence

38
Q

OCD tx

A

respond to serotonergic agents

fluoxetine, fluvoxamine, paroxetine, clomipramine

39
Q

premenstrual dysphoric disorder tx

A

SSRIs - fluoxetine and sertraline

40
Q

smoking cessation tx

A

bupropion

reduce urge to smoke

41
Q

eating disorder tx

A

antidepressants

-tx of bulimia, not nervosa

42
Q

insomnia tx

A

amitriptyline and trazodone

depression related insomia

43
Q

HA tx

A

SSRIs less effective than TCA in chronic tension HAs

44
Q

tx pruritis

A

TCA - antihistamine

45
Q

finding right antidepressant for patient

A

empiric - trial and error

46
Q

first line tx MDD and anxiety

A

SSRI

less cardiotoxic with OD
fewer antimuscarinic properties

47
Q

pt cannot tolerate sexual dysfunction

A

bupropion

48
Q

bupropion and mirtazapine

A

common combined with other antidepressants - augment therapeutic response

49
Q

TCA and MAOI

A

lethal in OD

50
Q

patient under age 25

A

increased suicidality with all antidepressants

but untreated depression - even more risk of suicide

51
Q

adverse SSRIs

A

minor sedation and antimuscarinic

GI - N/V, upset stomach, constipation

diminished sexual function - loss libido, delayed organism

HA, insomnia, hypersomnia, weight gain

52
Q

discontinuation syndrome

A

of SSRIs
dizzy and paresthesia

withdraw agents with short half lives - paroxetine and sertraline

53
Q

short half life SSRI

A

paroxetine and sertraline

withdraw - discontinuation syndrome

54
Q

CI of SSRI

A

active manic episode

paroxetine CI in pregnant

55
Q

CI in pregnant

A

SSRI paroxetine

56
Q

SNRI ADRs

A

insomnia, anxiety, agitation

elevated BP and HR

57
Q

increased risk of bleeding

A

venlafaxine

antiplatelet aggregation effect

more cardiac toxicity in OD as well

58
Q

TCA ADRs

A

anticholinergic - drowsy, dry mouth, constipation, urinary retention, blurry vision, confusion

orthostatic hypotension (a-adrenergic block)

weight gain - H1 histamine antagonist

cardiotoxicity, arrhythmia, convulsion, hepatic dysfxn, hyponatremia

sexual dysfunction

59
Q

imipramine and amitriptyline

A

significant antimuscarinic and cardiac side effects

60
Q

CI for TCA

A

arrhythmia, recent MI, liver disease, glaucoma, mania

61
Q

5-HT2 antagonist ADRs

A

sedation and GI issues

sexual dysfxn - uncommon

orthostatic hypotension

62
Q

black box warning for hepatotoxicity

A

nefazodone 5-HT2 antagonist

63
Q

agitation, anorexia, insomnia

A

wuth bupropion

64
Q

no sexual side effects

A

mirtazapine and bupropion

65
Q

tyramine food

A

avoid if taking MAOIs

66
Q

overdose

A

TCA - most toxic - arrhythmia, altered mental status, seizure

also - MAOIs - potentially lethal - autonomic instability, hyperadrenergic symptoms, psychotic symptoms, confusion, delirium, fever, seizures

67
Q

st johns wort

A

herbal tx of depression

inducer of CYP450

68
Q

serotonin syndrome

A

interaction of MAOI with SSRI, SNRI, TCA, and some analgesics

overstiumation of 5-HT receptors

69
Q

delirium, agitation, coma, HTN, tachy, hyperthermia, diaphoreses, myoclonus, hyperreflexia, tremor

A

serotonin syndrome

70
Q

pt switched from SSRI to MAOI

A

therapy discontinued for at least 2 weeks - prior to initiation of new therapy - risk of serotonin syndrome

71
Q

tx of serotonin syndrome

A

withdrawal offending drug - sedate -benzos

intubate, ventilate

5-HT2 block - with cyproheptadine or chlorpromazine

72
Q

tyramine foods

A

chocolate, meat, pickled, aged, cheeses, alcoholi

metabolized by MAO

if take MAOI - reduce metabolism - get catecholamine release - rise in HR and BP

73
Q

attention, motivation, pleasure, reward

A

dopamine

74
Q

alertness, energy

A

NE

75
Q

obsession/compulsion

A

serotonin

76
Q

bupropion

A

DA selective - low potency

77
Q

more effective antidepressant therapy

A

combined with psychotherapy

78
Q

inhibit neuronal 5-HT reuptake - little effect on DA and NE

A

SSRIs

79
Q

bad interaction with alcohol

A

SSRI

80
Q

cardiotoxicity

A

venlafaxine

81
Q

tx smoking cessation

A

bupropion

82
Q

ADR with therapeutic TCA

A

antimuscarinic effect

arrhythmia and seizure - if OD

83
Q

three Cs of TCA overdose

A

coma, cardiotoxicity, convulsions

84
Q

tx enuresis

A

TCAs

85
Q

tx premature ejaculation

A

SSRIs

86
Q

tx bulimia nervosa

A

fluoxetine - and other SSRIs

Psych Exam 1 (16 decks)

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