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PHRM 845: Therapeutics III > Antidepressants: Ott > Flashcards

Antidepressants: Ott Flashcards

1
Q

What is Depression?

A
  • SUSTAINED/PERSISTANT feeling of sadness/decreased interest in all or most activities
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2
Q

Who are more likely to have a major depressive episode?

A
  • Women 2-3x more likely than men
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3
Q

What is the Biogenic Amine Hypothesis in Depression?

A
  • A decrease/desensitization in neurotransmitters [Norepinephrine, Dopamine, Serotonin, Acetylcholine, Eprinephrine]
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4
Q

What are some of the risk factors for Depression?

A
  • Guilt, Fatigue, Sleep issues, decrease sex drive, agitation, anxiety, hopelessness
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5
Q

What does SIGECAPS means in depression?

A
  • S: sleep
  • I: interest
  • G: guilt
  • E: energy
  • C: concentration
  • A: appetite
  • P: psychmotor
  • S: suicide
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6
Q

What are the risk factors for suicide?

A
  • Plan, Loss, widowed/Unmarried, Increasing Age, Prior Attempts…
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7
Q

What are some of the specifiers for Major Depressive Disorder?

A
  • Psychosis, Catatonia, Peripartum Onset [During Pregnancy], Seasonal Patterns, Distress, Melancholic nature..
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8
Q

What is Substance/Medication Induced depressive disorder?

A
  • Disturbance in mood in the clinical sense
  • Symptoms develop after intoxication or withdrawal & involve substance cause symptoms
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9
Q

What are some medications that can cause Substance/Medication Induced Depressive Disorder?

A
  • Beta-Blockers, Hormonal Therarpy, Isotretinoin, CNS Depressants, Interferon-Beta, Levetiracetam, Indomethacin
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10
Q

What is depressive disorder due to another medical condition?

A
  • Period of depressed mood or decreased interest in all, or almost all, activities
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11
Q

What are some of the examples that relate to depressive disorder due to another medical condition?

A
  • Bereavement, Life circumstances, stroke, Parkinson’s dementia, MS, Hypothyroidism, Low vit D, Hypercalcemia, Malignancy, Overactive bladder, Infectious disease…
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12
Q

What are the treatment goals of Depression?

A
  • Eliminate or Reduce acute symptoms
  • Minimize adverse drug effects
  • Ensure adhernce
  • Facilitate return to baseline
  • Prevention
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13
Q

What are some of the non-pharmacological therapies for depression?

A
  • Psychotherapy, Mindfulness, Spirituality, Relationship building, Physical activity
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14
Q

What is Electroconvulsive Therapy in Depression?

A
  • Shocks the brain in a specific part to like “reset” it and hopefully decrease brain issues [release monoamines and increases neruonal formation]
  • LAST LINE and difficult to get
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15
Q

What are some of the Natural Products used in Depression?

A
  • St. Johns Wart [3A4 Inducer]*
  • SAMe, Valerian Root, L-Methylfolate, Omega-3
  • *INCREASED risk of serotonin syndrome [Nausea, Dizziness, Headache, Diarrhea, Agitation, Tachycardia, Hallucinations]
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16
Q

What is the way we should treat someone that is new to antidepressants?

A
  • STEP-WISE treatment: Takes about 4-6 weeks
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17
Q

What are the important features that occur during the step-wise treatment for Antidepressants?

A
  • Week 1: Better Appetite*
  • Week 2: Better Sleep*
  • Week 4: Better Mood
  • Week 6: Goal is absence of symptoms
  • Months 2-3: Goal is absence of symptoms
  • Months 4-6: Goal is Eliminate symptoms
  • Month 12-36: Prevent of depression

*Anxiety is INCREASED

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18
Q

What are some other important things to think about for the treatment of depression?

A
  • INCREASED risk of suicidal thinking for ages <24
  • PROTECTIVE factor for ages >65
  • Medguides are REQUIRED for ALL antidepressants
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19
Q

What are the Selective Serotonin reuptake Inhibitors used?

A
  • Citalopram [Celexa]
  • Excitalopram [Lexapro]
  • Fluocetine [Prozac]
  • Fluvoxamine [Luvox]
  • Paroxetine [Paxil]
  • Sertialine [Zoloft]
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20
Q

What are the side effects for Citalopram [Celexa]?

A
  • Nausea, Vomiting, Fatigue [take PM], Insomnia [Take AM] = Patient specific dosing
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21
Q

What are some of the clinical pearls for Citalopram [Celexa]?

A
  • Dosed QAM
  • High QTc Prolongation risk [Dosed adjustment in elderly]
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22
Q

What is the CYP interaction in Citalopram [Celexa]?

A
  • 2C19, 3A4
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23
Q

What are some of the side effects for Escitalopram [Lexapro]?

A
  • Nausea, Diarrhea, Sexual Dysfunction
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24
Q

What are some of the clinical pearls Escitalopram [Lexapro]?

A
  • Has less QTc Prolongation
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25
Q

What is the CYP interaction of Escitalopram [Lexapro]?

A
  • 2C19
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26
Q

What are the side effects of Fluxoetine [Prozac]?

A
  • Sexual dysfunction, Weight loss, Insomnia, Resting Tremor
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27
Q

What are the clinical pearls of Fluxoetine [Prozac]?

A
  • ACTIVATING
  • Suppresses appetite
  • QTc Prolongation
  • Sarafem is for PMDD
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28
Q

What is the CYP interaction for Fluxoetine [Prozac]?

A
  • 2D6, 2C19
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29
Q

What are the side effects for Fluvoxamine [Luvox]?

A
  • Anorexia, Sexual Dysfunction
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30
Q

What are the clinical pearls Fluvoxamine [Luvox]?

A
  • ONLY really used for OCD
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31
Q

What are the CYP interaction for Fluvoxamine [Luvox]?

A
  • 1A2, 2D6, 2C19, 3A
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32
Q

What are the side effect for Paroxetine [Paxil]?

A
  • Nausea, Vomiting, Diarrhea, Insomnia, Tremor, Sedation, Weight Gain
33
Q

What are some of the clinical pearls for Paroxetine [Paxil]?

A
  • H1 Blockade & M1 activation =SEDATION
  • Most potent SSRI
  • Brisdelle is for moderate severe vasomotor symptoms with menopause
  • ALWAYS tapered
34
Q

What are the CYP interactions for Paroxetine [Paxil]?

A
  • 2D6
35
Q

What are the side effects for Sertaline [Zoloft]?

A
  • Nausea, Vomiting, Diarrhea, Nightmares
36
Q

What are some of the clinical pearls for Sertaline [Zoloft]?

A
  • QAM for nightmares
  • Best tolerated
  • PREFERRED for patients with Cardiac Risk
37
Q

When should you disconitinue a SSRI?

A

FLUSH
- Flu-like symptoms
- Lightheadedness
- Uneasiness
- Sleep Disturbance
- Headache

38
Q

What are the Selective Norepinephrine Reuptake Inhibitors?

A
  • Duloxetine [Cymbalta]
  • Levomilnacipran [Fetzima]
39
Q

What are the side effects for Duloxetine [Cymbalta]?

A
  • Liver injury
  • CANNOT used in glaucoma
  • Sweating
40
Q

What are some of the clinical pearls for Duloxetine [Cymbalta]?

A
  • Dose >60 NOT beneficial for Depression
  • Used for Musculosketetal diagnoses
41
Q

What are the CYP interactions for Duloxetine [Cymbalta]?

A
  • 2D6, 1A2
42
Q

What are the side effects for Levomilnacipran [Fetzima]?

A
  • Nausea, Vomiting, Diarrhea
43
Q

What are some of the clinical pearls for Levomilnaripram [Fetzima]?

A
  • Stronger toward NE than 5HT = Helps sexual dysfunction
  • INCREASED seizure risk, urinary retention, NMDA antagonism
44
Q

What are the CYP interactions for Levomilnacipram [Fetzima]?

A
  • 3A4
45
Q

What is the one Dopamine Norephinephrine reuptake inhibitor [DNRI]?

A
  • Bupropion [Wellbutrin]
46
Q

What are the side effects for Bupropion [Wellbutrin]?

A
  • Weight loss, Decrease Seizure therhold, Insomnia
47
Q

What are some fo the clinical pearls for Bupropion [Wellburtin]?

A
  • CONTRAINDATED: history of serizures, eating disorders, alcohol or sedative withdrawal
  • “poor mans cocaine” = abuse
  • Contrave: Weight loss
  • Zyban: smoking cessation
48
Q

What is the CYP interactions for Bupropion [Wellburtin]?

A
  • 2D6
49
Q

What is the dosing for Bupropion [Wellbutrin]?

A
  • Daily: 450 mg IR/XL & 400 mg SR
  • Single Dose: 150 mg IR, 200 mg SR, 450 mg XL
50
Q

What are some of the Serotonin Antagonist Reuptake inhibitors [SARIs] used?

A
  • Trazodone [Desyrel]
  • Nefazodone [Serzone]
51
Q

What are some of the side effects for Trazodone [Desyrel]?

A
  • Praipism [Painful erection], QTc Prolongation, Sedation
52
Q

What are some of the clinical pearls for Trazodone [Desyrel]?

A
  • Used for sleep
  • 300-600mg to get antidepressant activity
53
Q

What are the CYP interactions for Trazodone [Desyrel]?

A
  • 2D6
54
Q

What are the side effects for Nefazodone [Serzone]?

A
  • Liver failure
55
Q

What are some of the clinical pearls for Nefazodone [Serzone]?

A
  • BOXED WARNING: Liver failure
  • NO LONGER USED
56
Q

What is the CYP interaction for Nefazodone [Serzone]?

A
  • 5HT2A, 3A4, 2D6
57
Q

What are the Multi-modal medication used?

A
  • Mirtazapine [Remeron]
  • Valazodone [Viibryd]
  • Voritoxetine [Trintellix]
58
Q

What are the side effects for Vilazodone [Viivryd]?

A
  • NAUSEA
59
Q

What are some of the clinical pearls for Vilazodone [Viidryd]?

A
  • Less sexual dysfunction
  • TAKE WITH FOOD
60
Q

What are the CYP interactions for Vilazodone [Viivbryd]?

A
  • 3A4
61
Q

What are the side effects for Mirtazapine [Remeron]?

A
  • QTc Prolongation
  • SOMNOLENCE [Sleepy]
  • WEIGHT GAIN
62
Q

What are some of the clinical pearls for Mirtazapine [Remeron]?

A
  • 7.5mg works on H1 = SEDATION
  • 15mg works on 5HT = ANTIDEPRESSANT
  • > 30mg = INCREASED APPETITE
63
Q

What are the CYP interactions for Mirtazapine [Remeron]?

A
  • 3A4
64
Q

What are the side effects for Voritoxetine [Trintellix]?

A
  • Nausea, Vomiting, Diarrhea, Abnormal Dreams
65
Q

What are some of the clinical pearls for Voritoxetine [Trintellix]?

A
  • Less sexual dysfunction
66
Q

What are the CYP interactions for Voritoxetine [Trintellix[?

A
  • 2D6
67
Q

What are some of the Tricyclic - Tertiary Amines used?

A
  • Amitriptyline [Elavil]
  • Imipramine [Tofranil] (WEIGHT GAIN)
  • Doxepin [Sinequan]
68
Q

What is important to know for the Tricyclic - Tertiary Amines?

A
  • START with 25mg qhs and INCREASE by 25-50 mg q3-4d until response
  • 1G can be fatal
  • Taper over 1-2 weeks
69
Q

What are some of the side effects for the Tricyclic -Tertiary Amines?

A
  • Sedation, weight gain, Orthostatsis, Anticholinergic effects, CARDIAC TOXICITY [Overdose]
70
Q

What are the Monoamine Oxidase Inhibitors used?

A
  • Phenelzine [Nardil]
  • Tranylcypromine [Parnate]
  • Isocarboxazid [Marplan]
  • Selegiline [Emsam]
71
Q

What is important to note about the MAO-Is?

A
  • 14 day wash period between serotonin agents
72
Q

What are some of the side effects for the MAO-Is?

A
  • Hypertensive Crisis [Tyramine restriction], SEROTONIN SYNDROME
73
Q

What is Serotonin Syndrome?

A
  • MEDICAL EMERGENCY: too much serotonin
  • Treat with stopping the agent and supportive care
74
Q

What are some of the alternative therapies used?

A
  • Esketamine [Spravato]
  • Brexanolone [Zulresso]
75
Q

What are the side effects for Esketamine [Spravato]?

A
  • Increased BP, Sedation, Bad Taste
76
Q

What are some of the clinical pearls for Esketamine [Spravato]?

A
  • Add on therapy
  • Active metabolite for ketamine
  • Used for treatment-resistant depression AND acute suicidality
77
Q

What are the side effects of Brexanolone [Zulresso]?

A
  • Fatigue, Flushing, Sedation
78
Q

What are some of the clinical pearls for Brexanolone [Zulresso]?

A
  • REMS = EXCESSIVE SEDATION
  • 60 hour infusion
  • Used for Post-partum depression
79
Q

What are some of the things that we should do for someone with Treatment resistant depression?

A
  • Increase the dose
  • Augment with buspirone
  • Augment with lithium

PHRM 845: Therapeutics III (25 decks)

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