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Clinical Prep > Anxiety and Depression > Flashcards

Anxiety and Depression Flashcards

1
Q

TCAs

A

Considered 2nd line for Anxiety, but not used often d/t SE and Overdose potential

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2
Q

Overdose of TCA

A

TORSADES de POINTE
Coma
Acidosis
Respiratory depression

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3
Q

TCA risk

A

Seretonin synd

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4
Q

TCAs act on what receptors

A

NE and Seretonin

also: histamine, a1, cholinergic (which causes the SE)

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5
Q

TCAs

A

2: Notriptyline, Desipramine
3: Amitriptyline, Imipramine

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6
Q

Indications for TCAs

A

Anxiety (2nd line)
Chronic pain
Fibro
Enuresis (bedwetting)

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7
Q

When using TCAs, since they act on Serotonin receptors, caution of

A

Seretonin syndrome

do NOT combine with MAOIs

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8
Q

Drugs that act on 5HT (Serotonin) receptors therefore we need to be cautious of Serotonin syndrome

A

TCA, SNRI, SSRI, MAOIs

Nortriptyline, Amitriptyline, Prozac, Zoloft, Paxil, Effexor, Cymbalta, etc.

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9
Q

Generic name: Fluoxetine

SSRI

A

Brand name: Prozac

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10
Q

Generic name: Sertraline

SSRI

A

Brand name: Zoloft

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11
Q

Generic name: Paroxetine

SSRI

A

Brand name: Paxil

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12
Q

Generic name: Citalopram

SSRI

A

Brand name: Celexa

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13
Q

Generic name: Escitalopram

SSRI

A

Brand name: Lexapro

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14
Q

Generic names:

Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram

are all

A

SSRIs

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15
Q

Brand names:

Prozac
Zoloft
Paxil
Celexa
Lexapro

are all

A

SSRIs

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16
Q

Fluoxetine, aka

A

Prozac

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17
Q

Sertraline, aka

A

Zoloft

“the S and Z at beg look the same”

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18
Q

Citalopram, aka

A

Celexa

“both have C at the beg”

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19
Q

Escitalopram, aka

A

Lexapro

“both have E towards the beg”

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20
Q

Unique uses of Paroxetine (Paxil)

A

Social anxiety

OCD

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21
Q

Disadv of Fluoxetine (Prozac)

A

More drug intxns than other SSRIs

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22
Q

Good thing about Sertraline (Zoloft)

A

Least likely for drug intxns

Preferred for Elderly

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23
Q

OLD PPL with depression

A

Zoloft/ Sertraline

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24
Q

DOC for Depression

A

Citalopram (Celexa)

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25
Q

Anxiety and Insomnia can occur as SE of

A

Fluoxetine (Prozac)

Sertraline (Zoloft)

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26
Q

Fluoxetine (Prozac)

A

more drug intxns

Can cause insomnia

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27
Q

Two meds to keep in mind, avoid using together

A

B- blockers “lol”
and
SSRIs (antidepressants)

Can cause Hypotension and Heart block

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28
Q

A ton of meds to be cautious of using with SSRI Antidepressants d/t caution of: SEROTONIN SYNDROME

A 
MAOIs
St Johns Wort
Amphetamines
Meperidine (opioid)
TCAs
SNRIs

Nortriptyline, Amitriptyline, Prozac, Zoloft, Paxil, Effexor, Cymbalta, etc.

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29
Q

If you are using SSRI: prozac, zoloft, paxil, celexa, etc…. keep in mind that _____ will not work as effectively

A

Codeine- its conversion to active compound is blocked

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30
Q

SNRIs

A

inhibit NE and Serotonin

31
Q

The two SNRIs

NE and Seretonin

A

Effexor

Cymbalta

32
Q

Venlaxafine, aka

SNRI

A

Effexor

33
Q

Duloxetine, aka

SNRI

A

Cymbalta

34
Q

Venlaxafine

Duloxetine

A

SNRIs

35
Q

SE of Venlaxafine (Effexor)

A

Increase BP

36
Q

SE of Duloxetine (Cymbalta)

A

Hepatotoxic (liver!)

Glaucoma (acute angle closure)

37
Q

When can you NOT use Bupropion (Wellbutrin)?

A

hx of Seizures

38
Q

What neurotransmitters are a/w Bupropion (Wellbutrin)

A

Mainly Dopamine (DA)

but minimally NE and 5HT (seretonin)

39
Q

When to use Wellbutrin (Bupropion)?

A

When others havent worked

When pt doesn’t want the loss of Libido SE

40
Q

St John Wort

A

for Mild depression
Mechanism unsure- may block reuptake or inhibit MAO

Photosensitivity

do NOT combine w other SSRI- risk of Serotonin synd

41
Q

SSRIs that are ok while breastfeeding

A

Sertraline (Zoloft)

Paroxetine (Paxil)

42
Q

Which of the two ok for breastfeeding is the DOC while breastfeeding?

SSRIs

A

Zoloft

aka Sertraline

43
Q

DOC for Acute Anxiety

short term, self limiting

A

Benzos

44
Q

DOC for GAD

A

1st line: SSRI, SNRI
2nd line: TCA
Abuse concern: Buspirone, Hydroxyzine

45
Q

Most useful for short term insomnia

A

Benzos

46
Q

GABA

CNS depresant

A

Major inhibitory neurotransmitter

Relives anxiety and promotes sedation

47
Q

Activation of GABA receptors

A

allows Cl- to enter cell, hyperpolarizing

causing depression of electrical activity

48
Q

Drugs that work independently of GABA

A

Buspirone

Ramelteon

49
Q

What is Hydroxyzine’s business in Anxiety?

A

It’s an Antihistamine used as anti-anxiety med

No abuse potential, good for recovering addicts

50
Q

DOC for Recovering Addicts suffering from Anxiety

A

Hydroxyzine
Buspirone

low abuse potential

51
Q

Hydrozyzine (Vistaril) is also used in _____ in addition to Anxiety

A

Parkinson

52
Q

Barbs

independent of GABA

A

Marked CNS depression, causes Euphoria

Drug of ABUSE!!

53
Q

CONTRA of Barb

A

Porphyria (abnormal heme synthesis)
Pulmonary insuff
Supra-additive effects when combined w other depressants (i.e. Alcohol)

54
Q

When to use Barbs?

A

Short acting: Induction of anesthesia
Long acting: Anticonvulsants

for SEIZURES

55
Q

Barbs

A

Thipental- induce anesthesia

Phenobarbitol- tx Seizure, it’s an Anti convulsant

56
Q

Why are Barbs so dangerous?

A

NO ceiling effect

Coma, resp depression, dec BP

DO NOT GIVE STIMULANT to combat these effects

57
Q

How to treat Barb OD?

A

Supportive

Diuretics, Alkalization of urine

58
Q

Benzos indication

A

Anxiety
Insomnia

but dec in Anxiety often accompanied by drowsiness

59
Q

Short acting Benzo

A

Midazolam

60
Q

Intmdt acting Benzo

A

Alprazolam
Oxazepam
Lorazepam

61
Q

Long acting Benzo

A

Diazepam

Flurazepam

62
Q

Do NOT use Benzos to treat Anxiety if any of these other things are present

A

OCD
Panic disorder
PTSD
Anxiety in child/teen

instead, use SSRI

63
Q

Benzo that’s used in prep for Anesthesia for Short surgical procedures

A

Midazolam

64
Q

Benzos DOC for Status Epilepticus

A

Diazepam

Lorazepam

65
Q

The Z drugs used just for Insomnia

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

strong and rapid sedative effects

66
Q

Which of the Z drugs have short duration of action, therefore NO DROWSY MORNING

A

Zolpidem (Ambien)

Zaleplon (Sonata)

67
Q

Which Z drug stands out for having drowsy morning effect bc it has a longer duration of action

A

Eszopiclone (lunesta)

68
Q

Overall, the safety of the Z drugs is

A

GOOD

high margin of safety

69
Q

Ramelteon (Rozerem)

A

Melatonin analogue, resets sleep wake cycle

Promotes sleepy w/ no GABA effect

70
Q

Buspirone

A

agonist for Seretonin

Indications: GAD or Anxiety w Depression
ADHD
PMS

Low addiction potential

71
Q

Buspirone and Breastfeeding

A

“Caution”

not enough data

72
Q

SSRI to reach for if you are breastfeeding

A

Zoloft (sertraline)

73
Q

SE of Effexor

aka Venlaxafine

A

Increase BP –> HTN

74
Q

SE of Cymbalta,

aka Duloxetine

A

Hepatotoxic

Glaucoma

Clinical Prep (41 decks)

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