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

Antidepressants & Mood stabilizers (Segars) Flashcards

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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
Q

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

A

2 week washout period - Fluoxetine; 5 wks)

26
Q

Major concern with MAOIs is risk of __

BIG STAR

A

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
Q

S/S of HTN crisis with MAOIs? BIG STAR

A 
Severe HA
N/V
Sweating/severe anxiety
nosebleed
tachy
chest pain
changes in vision
SOB
confusion
28
Q

which antidepressant drug class should you choose to avoid anticholinergic SEs?

A

SSRIs –> Citalopram, Escitalopram, Fluoxetine, Sertraline
Atypicals –> Bupropion
SNRIs –> desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
Serotonin modulators –> trazodone, vilazodone

29
Q

which antidepressant drug class that is most likely to cause anticholinergic SEs?

A

TCAs

slight effect with MAOIs

30
Q

which antidepressant drug class should you choose to avoid drowsiness?

A

SSRIs
Atypicals (buporpion)
SNRIs
Serotonin modulator –> Just Vilazodone

31
Q

which antidepressant drug class that is most likely to cause drowsiness?

A

TCAs

Slight to low effect with most MAOIs

32
Q

which antidepressant drug class should you choose to avoid orthostatic hypotension?

A

atypicals –> bupoprion and mirtazapine
SNRIs
5-HT modulators –> Just vilazodone

SSRIs have slight (+) effect

33
Q

which antidepressant drug class that is most likely to cause orthostatic hypotension?

A

TCAs
MAOIs
5-HT modulator –> Trazodone

34
Q

which antidepressant drug class should you choose to avoid QTc prolongation?

A

Most of SSRIs
SNRIs
5-HT modulators –> vilazodone and nefazodone
MAOIs

35
Q

which antidepressant drug class should you avoid d/t QTc prolongation SEs?

A

TCAs

36
Q

which antidepressant drug class should you choose to avoid weight gain?

A

Atypical –> Bupoprion
SNRIs
5-HT modulators

37
Q

which antidepressant drug class should you avoid due to risk of weight gain?

A

TCAs

Atypical –> Mirtazapine

38
Q

which antidepressant drug class should be selected to avoid sexual dysfunction?

A

Atypicals –> bupoprion and mirtazapine
Nefazodone (5-HT modulator)
Selegiline (MAOI)

39
Q

which antidepressant drug class should you avoid d/t risk of sexual dysfunction?

A

SSRIs
TCAs
MAOIs except selegiline

40
Q

the 5 R’s for general antidepressant efficacy

A

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
Q

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

A

slow titration downward is recommended for most agents (t1/2)

42
Q

Classic SE of Lithium? BIG STAR

A

Polyuria (polydipsia) –> Clinical picture of Nephrogenic DI

43
Q

what type of ion is Lithium? How is it handled by the kidneys?

A

Monovalent ion

handled by kidneys similar to Na/K
Li competes with Na for kidney reabsorption

44
Q

Lithium drug interactions with other agents impaction Na/K? BIG STAR

A

Diuretics –> via preferential Na loss and Li reabsorption; Especially Thiazides (HCTZ)
ACEi’s–> Esp lisinopril
NSAIDs

45
Q

therapeutic window of lithium?

A

narrow therapeutic window –> 0.6-1.0 mEq/mL

46
Q

indications for Lithium?

A

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
Q

List mood stabilizers that were initially developed as anti-seizure agents:

A

Carbamazepine
Valproic acid
Lamotrigine

48
Q

Indications for Divalproex?

A

ACUTE Bipolar I (w/or w/out psychotic features)

49
Q

Indications for Carbamazepine?

A

ACUTE and MAINTENANCE tx of acute mania and mixed episodes (Bipolar I)

50
Q

Indications for Lamotrigine?

A

MAINTENANCE of Bipolar disorder (I and II)

51
Q

Carbamazepine effect of CYP450? BIG STAR

A

Major CYP450 INHIBITOR

Psych-Unit 1 (14 decks)

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