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Psych-Unit 1 > Antidepressants & Mood stabilizers (Segars) > Flashcards

Antidepressants & Mood stabilizers (Segars) Flashcards

1
Q 
other 'antidepressant indications:
Nicotine withdrawal=\_\_\_
Enuresis=\_\_
Diabetic peripheral neuropathy, fibromyalgia, and chronic MSK pain=\_\_\_
stress incontinence=\_\_\_
**BIG STAR**
A

Bupropion - nicotine w/drawal
Imipramine - enuresis
Duloxetine - diabetic neuropathy…
Duloxetine - stress incontinence

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2
Q

Amitriptyline, Clomipramine, doxepin, and imipramine are __

A

TCAs –> 3 amines

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3
Q

amoxapine, desipramine, nortriptyline are __

A

TCAs –> 2 amines

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4
Q

All TCAs, desvenlafaxine, duloxetine, venlafaxine, and levomilnacipran are ___

A

SNRIs

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5
Q

Citalopram, escitalopram, fluoxetine, paroxetine, sertraline, vilazodone, vortioxetine are __

A

SSRIs

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6
Q

Amoxapine is a __

A

SNRI + DA

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7
Q

Bupropion is a __

A

NDRI

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8
Q

Mirtazapine, nefazadone, and trazodone are __

A

SARA

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9
Q

isocarboxazid, phenelzine, selegiline, and tranylcypromine are __

A

MAOIs

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10
Q

fluvoxamine is a __

A

SSRI only for OCD/SAD

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11
Q

Side effect with BIG STAR of SSRI’s? other SEs?

A

Acute w/drawal rxns –> flu-like symptoms (malaise, lethargy, generalized aches)
CNS –> sedation or insomnia/agitation/nervousness
Sexual dysfunction
weight gain or weight loss

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12
Q

Rare side effects of SSRIs BIG STAR?

A

Serious side effects include: SEROTONIN SYNDROME
–> sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors; increased risk when given concurrently with other serotonin-affecting agents

Suicidality (attempts/completions) –> highest risk in children/adolescents/young adults

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13
Q

distinct features of 5-HT syndrome?

A

HYPER-reflexia, clonus, dilated pupils, HYPER-active bowel sounds

Compare to neuroleptic malignant syndrome –> opposite of the above

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14
Q

which SSRI has highest risk of drug-drug interactions (CYP450)? Least risk?

A

most-Fluoxetine (broad and strong inhibitor)

Least-citalopram and sertraline (mild)

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15
Q

__ selectively inhibit the pre-synaptic reuptake of serotonin (via SERT) AND NE via NET

A

SNRI’s including TCAs

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16
Q

Only __ SNRI’s have impact on these 3 key non-efficacy-related receptors: H1, M, a1
BIG STAR

A

TCA-based SNRIs

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17
Q

Cardiovascular (alpha) SEs of TCAs?
Anticholinergic (muscarinic) SEs of TCAs?
CNS (histamine) SEs of TCAs?
BIG STAR

A

alpha-tachycardia, orthostatic hypotension, dysrhythmias
M-dry mouth, urine retention/constipation, blurred vision, increased IOP
H1-sedation/fatigue, dizziness/seizures

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18
Q

the 3 C’s of Toxic ingestion of TCAs?

A

Coma
Cardiotoxicity –> Quinidine-like effect conduction abnormality
Convulsions

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19
Q

Non-TCA SNRIs have SEs relatively similar to SSRIs with less risk (in general) of __ dysfunction (higher with venlafaxine)

A

sexual

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20
Q

which 2 SARAs act like SSRIs and also selectively block post-synaptic a1 receptors on NE neurons and post-synaptic 5-HT2a (& H1 blockade, sedation)?

A

trazodone and nefazodone

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21
Q

which SARA selectively blocks pre-synaptic a2 receptors on NE and 5-HT neurons?

A

Mirtazapine

blocks post-synaptic 5HT2a/2b/3 receptors
NO SERT/NET activity
H1 blokade (sedation)

22
Q

this drug/class selectively inhibits pre-synaptic reuptake of NE via NET and Dopamine via DAT

A

NDRIs –> Bupropion

23
Q

Side effects of NDRIs (bupropion) BIG STAR*?

A

Seizures (dose-dependent, or those at risk)

24
Q

which MAOI is B-selective?

A

Selegiline –> becomes non-selective at high doses

25
what is required if you have drug interactions with 5-HT/NE affecting drugs (while taking MAOIs), i.e., some anti-hypertensives, amphetamines, SSRIs/TCAs/SNRIs? **BIG STAR**
2 week washout period - Fluoxetine; 5 wks)
26
Major concern with MAOIs is risk of __ | **BIG STAR**
hypertensive crisis non-selective MAOIs inhibit MAO-A necessary in GI for tyramine metabolism --> increased tyramine --> significant catecholamine release --> hypertensive crisis Watch out for consuming aged cheeses, fava beans, processed/cured meats, wine/beer
27
S/S of HTN crisis with MAOIs? **BIG STAR**
``` Severe HA N/V Sweating/severe anxiety nosebleed tachy chest pain changes in vision SOB confusion ```
28
which antidepressant drug class should you choose to avoid anticholinergic SEs?
SSRIs --> Citalopram, Escitalopram, Fluoxetine, Sertraline Atypicals --> Bupropion SNRIs --> desvenlafaxine, duloxetine, levomilnacipran, venlafaxine Serotonin modulators --> trazodone, vilazodone
29
which antidepressant drug class that is most likely to cause anticholinergic SEs?
TCAs slight effect with MAOIs
30
which antidepressant drug class should you choose to avoid drowsiness?
SSRIs Atypicals (buporpion) SNRIs Serotonin modulator --> Just Vilazodone
31
which antidepressant drug class that is most likely to cause drowsiness?
TCAs Slight to low effect with most MAOIs
32
which antidepressant drug class should you choose to avoid orthostatic hypotension?
atypicals --> bupoprion and mirtazapine SNRIs 5-HT modulators --> Just vilazodone SSRIs have slight (+) effect
33
which antidepressant drug class that is most likely to cause orthostatic hypotension?
TCAs MAOIs 5-HT modulator --> Trazodone
34
which antidepressant drug class should you choose to avoid QTc prolongation?
Most of SSRIs SNRIs 5-HT modulators --> vilazodone and nefazodone MAOIs
35
which antidepressant drug class should you avoid d/t QTc prolongation SEs?
TCAs
36
which antidepressant drug class should you choose to avoid weight gain?
Atypical --> Bupoprion SNRIs 5-HT modulators
37
which antidepressant drug class should you avoid due to risk of weight gain?
TCAs | Atypical --> Mirtazapine
38
which antidepressant drug class should be selected to avoid sexual dysfunction?
Atypicals --> bupoprion and mirtazapine Nefazodone (5-HT modulator) Selegiline (MAOI)
39
which antidepressant drug class should you avoid d/t risk of sexual dysfunction?
SSRIs TCAs MAOIs except selegiline
40
the 5 R's for general antidepressant efficacy
1) Response=>50% reduction in symptoms from baseline 2) Remission=symptom-free 3) Recovery=2-6 months of ongoing Remission (not cured) 4) Relapse=return of symptoms AFTER Remission but before Recovery 5) Recurrence=return of symptoms AFTER Recovery
41
Since all antidepressants either are, or can be, associated with a withdrawal syndrome, what is recommended when getting a pt off of them? **BIG STAR**
slow titration downward is recommended for most agents (t1/2)
42
Classic SE of Lithium? **BIG STAR**
Polyuria (polydipsia) --> Clinical picture of Nephrogenic DI
43
what type of ion is Lithium? How is it handled by the kidneys?
Monovalent ion handled by kidneys similar to Na/K Li competes with Na for kidney reabsorption
44
Lithium drug interactions with other agents impaction Na/K? **BIG STAR**
Diuretics --> via preferential Na loss and Li reabsorption; Especially Thiazides (HCTZ) ACEi's--> Esp lisinopril NSAIDs
45
therapeutic window of lithium?
narrow therapeutic window --> 0.6-1.0 mEq/mL
46
indications for Lithium?
acute and maintenance tx of mania/bipolar I disorder augmentation in unipolar depressive pts w/inadequate response to antidepressant tx off-label: reduced risk of suicide and all-cause mortality in pts with mood disorders
47
List mood stabilizers that were initially developed as anti-seizure agents:
Carbamazepine Valproic acid Lamotrigine
48
Indications for Divalproex?
ACUTE Bipolar I (w/or w/out psychotic features)
49
Indications for Carbamazepine?
ACUTE and MAINTENANCE tx of acute mania and mixed episodes (Bipolar I)
50
Indications for Lamotrigine?
MAINTENANCE of Bipolar disorder (I and II)
51
Carbamazepine effect of CYP450? **BIG STAR**
Major CYP450 INHIBITOR

Psych-Unit 1 (14 decks)

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