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BSP Exam II > Antidepressants & Mood Stabilizers > Flashcards

Antidepressants & Mood Stabilizers Flashcards

1
Q

MOA of SSRIs

A

Inhibit the presynaptic reuptake of 5-HT (via SERT)

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2
Q

Indications for SSRIs

A

1st line for major depression and GAD

Other indications: panic disorder, PTSD, OCD, bulimia, social anxiety disorder

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3
Q

Adverse effects of SSRIs

A 
Hyponatremia (SIADH)
QT prolongation
Sexual dysfunction
Weight gain
Drowsiness
Suicidality
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4
Q

Clinical features of serotonin syndrome

A

Hyperthermia

Hypertension

Neuromuscular hyperactivity (e.g., hyperreflexia, clonus)

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5
Q

T/F: Opioids can interact with serotonergic medications and cause serotonin syndrome

A

True

[risk of serotonin syndrome is increased with any drug that increases serotonin levels]

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6
Q

Treatment for serotonin syndrome and its MOA

A

Cyproheptadine

Acts as a 5-HT2 blocker

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7
Q

SSRIs may increase suicidality; what age group is at highest risk of this adverse effect?

A

Children, adolescents, young adults

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8
Q

SSRIs are at high risk of drug-drug interactions due to CYP450 metabolism. What 2 SSRIs are only considered mild inhibitors, and are thus at least risk of causing these drug-interactions?

A

Citalopram

Sertraline

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9
Q

List antidepressants and mood stabilizers associated with risk for serotonin syndrome

A 
SSRIs
SNRIs
TCAs
MAOIs
Trazodone
Lithium
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10
Q

List 8 drugs included in SSRI category

A 
Citalopram
Fluoxetine
Sertraline
Escitalopram
Paroxetine
Fluvoxamine
Vilazodone
Vortioxetine
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11
Q

Which SSRI is at highest risk for drug-interactions due to its broad and strong inhibition of CYP450?

A

Fluoxetine

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12
Q

Of the SSRIs, which one is only used for OCD and SAD?

A

Fluvoxamine

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13
Q

SSRI that is also a partial agonist on 5-HT1A

A

Vilazodone

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14
Q

SSRI that is also a partial agonist on 5-HT1B, an agonist on 5-HT1A, and an antagonist on 5-HT1D, 5-HT3, and 5-HT7

A

Vortioxetine

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15
Q

MOA of SNRIs

A

Inhibit the presynaptic reuptake of NE and 5-HT via actions on NET and SERT

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16
Q

Indications for SNRIs

A

First line option for major depression and GAD

Panic disorder, PTSD, diabetic neuropathy, chronic pain (e.g., neuropathic pain), fibromyalgia, stress urinary incontinence, vasomotor symptoms of menopause

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17
Q

Adverse effects of SNRIs

A

Serotonin syndrome

Hypertension

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18
Q

List drugs included in the category of SNRIs

A 
Duloxetine
Venlafaxine
Desvenlafaxine (metabolite of venlafaxine)
Levomilnacipran
Milnacipran
Amoxapine
All TCAs
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19
Q

SNRI commonly utilized for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain, and stress incontinence

A

Duloxetine

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20
Q

Levomilnacipran may be used to treat ______

A

Fibromyalgia

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21
Q

Tetracyclic atypical antidepressant that acts as an SNRI and a dopamine agonist

A

Amoxapine

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22
Q

TCAs act as SNRIs but also affect what other receptors?

A

H1 histamine receptors

Alpha-1 adrenergic receptors

Muscarinic (cholinergic) receptors

[also block cardiac fast Na+ channels]

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23
Q

Indications for TCAs

A

Resistant depression

Diabetic neuropathy

Chronic pain (e.g., neuropathic pain)

Migraine prophylaxis

Enuresis

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24
Q

What is the difference between TCAs that are secondary vs. tertiary amines?

A

Secondary amines inhibit NE > 5-HT

Tertiary amines inhibit both NE/5-HT relatively equally, except clomipramine and amitriptyline which inhibit 5-HT>NE

25
Q

Tertiary amine TCAs inhibit both NE/5-HT equally, except clomipramine and amitriptyline which inhibit 5-HT>NE.

Which other TCAs are considered tertiary amines?

A

Doxepin

Imipramine

26
Q

Tertiary amine TCA used for OCD

A

Clomipramine

[remember that SSRIs are first line for this!]

27
Q

Tertiary amine TCA utilized for enuresis

A

Imipramine

28
Q

Secondary amine TCAs inhibit NE > 5-HT. What are the 3 secondary amine TCAs?

A

Amoxapine
Desipramine
Nortriptyline

29
Q

Adverse effects of TCAs

A

Sexual dysfunction

Inhibition of mAChRs —> dry mouth, constipation, blurred vision, urinary retention

Increased appetite and weight gain

Sedation

Orthostatic hypotension

Cardiotoxicity (‘quinidine-like’ effect)

Seizures

Serotonin syndrome

30
Q

Treatment for cardiotoxicity associated with TCA overdose

A

Sodium bicarb

31
Q

TCAs are relatively contraindicated in what pt population due to severe anticholinergic and antihistamine effects?

A

Elderly

32
Q

What unicyclic atypical antidepressant is considered an NDRI (noradrenergic-dopamine reuptake inhibitor)?

A

Buproprion

33
Q

MOA of Buproprion

A

Inhibits NET and DAT

Also shown to increase NE/DA presynaptic release

34
Q

T/F: Buproprion exerts CNS activating effects and is highly likely to induce sexual dysfunction and weight gain

A

False — it does exert CNS activating effects, but it does NOT cause sexual dysfunction and is among the agents less likely to cause weight gain

35
Q

Besides being an atypical antidepressant, what else is buproprion indicated for?

A

Tobacco dependence/nicotine withdrawal

36
Q

Adverse effects and pt populations in which buproprion is contraindicated

A

Seizures — makes it a contraindication in anorexia nervosa and bulimia pts

37
Q

MAO inhibitors act on monoamine oxidase enzymes. What are the normal functions of these enzymes (A and B)?

A

MAO-A — breaks down serotonin, NE, and dopamine

MAO-B — breaks down dopamine

38
Q

MAOIs ________ (reversibly/irreversibly) inhibit monoamine oxidase enzymes

A

Irreversibly

39
Q

Indications for MAOIs

A

Depression (not first line!)

May be more useful in atypical and resistant depression

40
Q

Pts on MAOIs should avoid ______-containing foods like aged wine, cheese, and cured meats

A

Tyramine

[tyramine is normally broken down by MAO-A in GI tract. On MAOIs, tyramine enters circulation and acts as sympathomimetic agent —> hypertensive crisis]

41
Q

List 4 MAOIs

A

Isocarboxazid
Tranylcypromine
Phenelzine
Selegiline

42
Q

Which of the MAOIs is a selective MAO-B inhibitor making it a useful tx in Parkinsons?

A

Selegiline

43
Q

T/F: Maprotiline is an atypical tetracyclic antidepressant

A

True

44
Q

Mirtazapine is a tetracyclic atypical antidepressant. What is its MOA?

A

Blocks alpha-2 receptors —> increases presynaptic release of serotonin and NE

Blocks 5HT2 and 5HT3 receptors

Inhibits H1 histamine receptors

45
Q

T/F: Mirtazapine is associated with AE of sexual dysfunction

A

False

46
Q

Adverse effects of Mirtazapine

A

Sedation

Weight gain

47
Q

What are the two 5-HT2 receptor modulators?

A

Trazodone

Nefazodone

48
Q

MOA of trazodone

A

Antagonizes 5HT2 receptors and inhibits 5-HT reuptake (alpha-1 receptors)

Blocks H1 histamine receptors

49
Q

AEs of trazodone

A

Priapism
Orthostatic hypotension
Sexual dysfunction
Serotonin syndrome

50
Q

Weak inhibitor of both SERT and NET; potent antagonist of postsynaptic 5HT2A

Carries black box warning for hepatotoxicity — not commonly prescribed anymore

A

Nefazodone

51
Q

Although their MOA for bipolar is undelineated, what are 3 anti-seizure agents prescribed as mood stabilizers?

A

Carbamazepine
Lamotrigine
Divalproate/valproic acid

52
Q

Anti-seizure agent used for acute bipolar I (with or without psychotic features)

A

Divalproate/valproic acid

53
Q

Anti-seizure agent used for acute and maintenance treatment of acute mania and mixed episodes (bipolar I); major CYP450 inducer

A

Carbamazepine

54
Q

Anti-seizure agent used for maintenance therapy in bipolar I and II

A

Lamotrigine

55
Q

Indications for lithium therapy

A

Acute and maintenance tx of mania/bipolar I d/o

Augmentation in unipolar depressive pts with inadequate response to antidepressants

Off label — reduced risk of suicide and all-cause mortality in pts with mood disorders

56
Q

MOA of lithium therapy

A

Inhibits Ca-dependent and depolarization-provoked release of NE and DA

Inhibits receptor blockers and substances known to stimulate and inhibit G protein synthesis/actions [may reflect lithium’s ability to interfere with activity of both stimulatory and inhibitory G proteins by keeping them in an inactive state]

57
Q

AEs of lithium

A

Polyuria (polydipsia) — clinical picture of nephrogenic diabetes insipidus

Tremor

Mental confusion/dizziness/sedation (take at bedtime)

Thyroid goiter (hypothyroid) — inhibits iodination of thyroid hormone

Leukocytosis (stimulates MCSF — increasing granulocytes)

Seizures and serotonin syndrome

58
Q

Drug interactions with lithium

A

Diuretics — esp thiazides (d/t preferential Na+ loss)

ACEIs — esp lisinopril (renally eliminated)

NSAIDs - through alteration of renal perfusion

59
Q

All antidepressants either are, or can be, associated with a withdrawal syndrome, so slow titration downward is recommended. Symptoms include dizziness, HA, nervousness, nausea, insomnia, and flu-like aches. There is lower risk of this with what agents?

A

Long-acting agents (e.g., fluoxetine, amitriptyline)

[note that even long acting and XR agents can still cause this withdrawal, just less likely]

BSP Exam II (10 decks)

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