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NMSP Exam III > Antidepressants & Mood Stabilizers (Segars) > Flashcards

Antidepressants & Mood Stabilizers (Segars) Flashcards

1
Q

What antidepressant drug is also used for nicotine withdrawal?

A

bupropion

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2
Q

What antidepressant drug is also used for enuresis?

A

imipramine

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3
Q

What antidepressant drug is also used for diabetic peripheral neuropathy, fibromyalgia and chronic musculoskeletal pain?

A

duloxetine

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4
Q

What antidepressant drug is also used for stress incontinence?

A

duloxetine

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5
Q

What is the first choice of treatment for depression?

A

psychotherapy

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6
Q

What are the 3 depression hypotheses?

A
  1. monoamine hypothesis***
  2. neurotrophic hypothesis
  3. steroids hypothesis
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7
Q

What are the 3 main neurotransmitters in the monoamine hypothesis?

A

norepinephrine (NE)
serotonin (5-HT)
dopamine (DA)

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8
Q

Which steroid in the steroid hypothesis may be used to supplement in low doses to treat patients with depression?

A

thyroid hormones (T3/T4)

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9
Q

What are the 5 R’s in antidepressant efficacy?

A
  1. Response = 50% reduction in symptoms from baseline (not enough)
  2. Remission = symptom free (the goal)
  3. Recovery = 6-12 months in ongoing remission
  4. Relapse = return of symptoms after remission
  5. Recurrence = return of symptoms after recovery
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10
Q

Which if the 5 R’s is the goal in general antidepressant efficacy?

A
  1. Remission = symptom free (the goal)
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11
Q

What is the typical timeframe that the patient tends to respond to the anti-depressant drug?

A

3-4 weeks

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12
Q

What are the SNRI’s ?

A

All the TCA’s and then:
Desvenlafaxine
Duloxetine
Venlafaxine
Levomilnacipran

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13
Q

What are the 7 SSRI’s?

A

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodone
Vortioxetine

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14
Q

What is the one NDRI?

A

Bupropion

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15
Q

What is the NDRI mixed with the MOA of NMDA antagonist?

A

Esketamine - treatment-resistant depression

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16
Q

What are the 3 SARA’s

A

Mirtazapine - watch for weight gain
Nefazodone - avoid due to hepatic toxicity
Trazodone - can aide as a good sleep agent

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17
Q

What is the one Neurosteroid/GABA Modulator?

A

Brexanolone - postpartem depression

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18
Q

What is the one SNRI + dopamine antagonist (DAn)?

A

Amoxapine

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19
Q

What are the 4 MAOI’s?

A

Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

20
Q

Which drug category is the drug of choice in depression?

A

the selectively serotonin reuptake inhibitors (SSRI’s) - Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

21
Q

Which two SSRI’s have an extra MOA on serotonin receptors?

A

Vilazodone - partial agonist on 5-HT1a
Vortioxetine - full agonist on 5-HT1a, full antagonist on 5 HT-1d,3,7 and partial agonist on 5-HT1b

22
Q

What is a concerning side effect of SSRI’s?

A

sexual dysfunction (a serotonin problem)

23
Q

What is a rare dose-dependent side effect of SSRI’s?

A

Serotonin syndrome (very unpleasant); abdominal pain, flushing, hyperreflexia, hyperthermia, mental status changes

24
Q

What are the typical symptoms seen in withdrawal syndrome?

A

FINISH
F - Flu-like symptoms
I - Insomnia
N - Nausea
I - Imbalance
S - Sensory disturbances
H - Hyperarousal

25
What is the Black Box Warning for ALL anti-depressant drugs?
suicidal ideation
26
What is the strongest CYP inducer in the SSRI family and should be avoided in patients who are on multiple medications?
fluoxetine
27
What are the 3 receptors that are modulated by SNRI's?
histamine (H1) - causes CNS probs (sedation, fatigue, dizziness, seizures) muscarinic (m3) - anticholinergic (dry mouth, urinary retention, blurred vision) adrenergic (a1) - CV )tachycardia, hypotension, dysrhythmias)
28
What are the 3 C's in TCA toxic ingestion?
Coma Cardiotoxicity (conduction abnormalities) Convulsions
29
Amoxapine
the one SNRI + dopamine antagonist (DAn);
30
Which one of the SARA's are to be avoided and why?
Nefazodone; hepatic toxicity
31
Mirtazapine
an adrenergic and serotonin blocker; watch for weight gain
32
Which SARA are you concerned with significant weight gain?
Mirtazapine
33
Bupropion
NE and DA reuptake inhibitor and also stimulates VMAT2 release of more neurotransmitters; side effects of stimulation and seizures at high doses
34
What is the only MAOI that is B-selective?
Selegiline
35
MOA of MAOI's?
irreversibly inhibits MAOI's
36
What is the major concern for MAOI's?
a hypertensive crisis; watch for tyramine containing foods/beverages (pt at a party night before and then crashes and ends up in the ER)
37
When is it ONLY clinically indicated to use Esketamine?
for treatment-resistant depression in conjunction with ongoing antidepressant therapy AND acute suicidal ideations/behaviors
38
Brexanolone
a Neurosteroid/GABA Modulator; indicated in postpartem depression; 60 hour IV infusion with q2h patient observation
39
Which drug is indicated for postpartem depression and treated with 60 hour IV infusion with q2h patient observation?
Brexanolone; a Neurosteroid/GABA Modulator
40
What are the 4 MOAs of Lithium?
1. inhibits dopamine transmission 2. down regulates the NMDA receptor 3. promotes GABAergic transmission 4. inhibits intraceullar enzymes
41
Lithium can cause what renal disorder?
Nephrogenic Diabetes Inspipidus (resistance to ADH)
42
What is the serum trough concentration of lithium?
0.6-1.5 mEq/L
43
What is the serum trough concentration of valproic acid/divalproex?
60-120 mcg/mL
44
What is the serum trough concentration of carbamazepine?
6-12 mcg/mL
45
What is the mood stabilizer drug used for maintenance of bipolar ONLY?
Lamotrigine

NMSP Exam III (6 decks)

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