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Pharm Block 2 > Anxiety and Depression Drugs > Flashcards

Anxiety and Depression Drugs Flashcards

1
Q

What do all anti-depressant drugs modulate?

A

All the antidepressant drugs now in use modulate monoamine neurotransmission

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2
Q

How long does it take for monoamines to exert their effects?

A

Monamines take six to eight weeks to exert their effects

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3
Q

What percentage of patients benefit from monamines?

A

60-70%

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4
Q

What neurological activities are monoamines active in?

A

Synaptic plasticity
Dendritic morphology
Neurogenesis

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5
Q

What is the mechanism of SSRIs (selective serotonin reuptake inhibitors)?

A

Blocks the serotonin reuptake molecule => keeping more of the serotonin monoamine in the synapse.

  • Because of similar molecular form, can also block norepinephrine and dopamine uptake => leads to side effects
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6
Q

Where are cells located that use serotonin as the primary signaling messenger?

A

Raphe Nucleus (brainstem/midbrain)

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7
Q

What is Citalopram (Celexa)?

A

Citalopram is an SSRI used for depression and acts on the Raphe Nucleus

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8
Q

What are the major side effects of citalopram?

A

Weight gain, GI, loss of libido, sleep, sweating, hyponatremia, mania.

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9
Q

What is the major risk of citalopram?

A

Increase suicidal thinking in individuals 25yo and younger

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10
Q

What are the major interactions of citalopram?

A
  • Weak 2D6 inhibition

- Can increase MAO-I’s and TCA levels (watch for synergistic effects)

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11
Q

What is the major cardiac precaution with citalopram?

A

QTc prolongation average 18msec at 60mg/day => can lead to Torsade’s

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12
Q

Where are norepinephrine dominant cells located?

A

Locus Coeruleus

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13
Q

What is Venlafaxine/ ER (Effexor/XR)?

A

Venlafaxine is an SNRI used for depression that acts on the locus ceruleus

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14
Q

What are the side effects of Venlafaxine?

A
  • GI, sexual, sleep, sweating, hyponatremia, mania

- Diastolic blood pressure increase

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15
Q

What is the major risk of Venlafaxine for patients under 25?

A

Increased suicidal thoughts

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16
Q

What are the major interactions of Venlafaxine?

A
  • Very weak 2D6 inhibition

- Can increase MAO-I’s and TCA levels (watch for synergistic effects)

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17
Q

What do TCA or tricyclic drugs do?

A

Modulate norepinephrine, but largely dual action drugs

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18
Q

What are the two types of TCAs (SNRIs)?

A

1) Tertiary Amines – having all three hydrogen replaced by other subgroups
2) Secondary Amines – where one of the 3 side groups is cleaved off and H again in its place
- Secondary Amines are metabolites of Tertiary Amines

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19
Q

What is Nortriptyline (Pamelor)?

A

A TCA used for depression

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20
Q

What are the major side effects of nortriptyline?

A

wt gain, sedation, ACh, hypotension, arrhythmia, sexual, sweating

21
Q

What are the major interactions with nortriptyline?

A
  • 2D6 inhibition

- MAO-I, TCA’s, tramadol

22
Q

Why is it easier to overdose on nortriptyline?

A

The dose for nortriptyline is 75-150mg/day

Lethal in overdose (LD50 is 2000-3000mg) => easier to OD with a month supply of the drug

23
Q

What is Bupropion (Wellbutrin/SR/XL, Zyban)?

A

Bupropion is an NDRI used for depression
[ Norepinephrine and dopamine reuptake inhibitor–mainly dopamine]

  • Zyban is used for smoking cessation
24
Q

What are the major side effects of bupropion?

A

Insomnia, tremor, tinnitus, seizures, restlessness, rare rash
* May reduce sexual side effects of anti-depressants because it doesn’t affect serotonin

25
Q

What are the major interactions with bupropion?

A

2D6 -, MAO-I, TCA, tramadol, levodopa

26
Q

Bupropion should be avoided in which patients?

A

Avoid in patients with eating disorders and seizure disorders

27
Q

Why is bupropion a better anti-depressant in bipolar patients?

A

least likely to cause mania

28
Q

How do MAO-Is work?

A

MAO inhibitors inhibit the activity of the monoamine oxidase enzyme family. They will affect serotonin, norepinephrine, and dopamine => broad spectrum drugs

29
Q

What are the main adverse reactions with MAO-I?

A

1) Serotonin syndrome:
MS changes
Autonomic instability
Neuromuscular signs

2) Hypertensive crisis:
Especially when dietary tyramine is added (cheese syndrome)
- Excess Dopamine and NE because tyramine is a precursor – cause high blood pressure, headaches, seizures, stroke and death

30
Q

What should be avoided in serotonin syndrome?

A 
SSRI, SNRI, TCA
Tramadol
meperidine (dilaudid)
Dextromethorphan
Amphetamines
31
Q

What is Mirtazapine (Remeron)?

A

A NaSSA (block reuptake of norepinephrine and serotonin) for depression

32
Q

What is the major side effect of mirtazapine?

A

Sedating
Wt gain => especially beneficial in elderly populations
Sexual side effects

33
Q

What are the major interactions of mirtazapine?

A

No P450 interactions

Do not combine w/ MAO-I

34
Q

What are the major uses of benzodiazepines?

A
  • Sedative – hypnotic
  • Anxiolytic
  • Seizure control
  • Muscle relaxant
  • Anterograde amnesia
35
Q

Which receptors are benzodiazepine sensitive?

A

Receptors containing the α1, α2, α3or α5subunit are benzodiazepine sensitive

36
Q

What are the major side effects of benzodizepine?

A

sedation, depression, amnesia, ataxia, dependence, withdrawal

37
Q

What interactions should be noted with benzodiazepine?

A

CNS depressants, (opiates), cimetidine.

38
Q

Describe the metabolism of benzodiazepine?

A
  • Hepatically cleared ( watch for EtOH abuse/hepatic impairment)
  • Active metabolites
  • flumazenil reverses
39
Q

What are the Z drugs?

A

Sedative hypnotics with preferential affinity for α1receptors

  • zolpidem
  • zalaplon
  • eszopiclone
  • NO anxiety reducing or muscle relaxing properties
40
Q

What is buspirone/BuSpar?

A

It is an anti-anxiety drug that is a 5HT-1A partial agonist used for General Anxiety Disorder

  • Acts on the hippocampus and cortex
  • Will augment MDD
41
Q

What are the major side effects of BuSpar?

A

Dizziness, HA, sedation, nervous/restless

42
Q

What are major interactions with BuSpar?

A

Do not take with MAO-I

43
Q

What are other interactions for BuSpar?

A

No sexual SE, No dependence, No withdrawal

Takes 4 weeks + to work

44
Q

What are the indications for citalopram?

A
  • Antidepressant
  • Anxiolytic
  • Panic
  • PTSD
  • Pain
  • OCD
45
Q

To what therapeutic class does Venlafaxine belong?

A
  • Anxiety and depression

- Neuropathic pain

46
Q

To what therapeutic class does Nortryptyline belong?

A
  • Severe depression
  • Anxiety
  • ADHD
  • Pain
47
Q

What is the mechanism of action of nortryptyline?

A

Blocks the uptake of all monoamines, especially NE and serotonin

48
Q

What cardiac risks are associated with nortryptyline?

A

Overdose of nortryptyline is lethal because it blocks the cardiac Na channels, leads to AV conduction block, causing sudden death

49
Q

To what therapeutic class does buproprion belong (i.e. indications)?

A
  • Depression without anxiety
  • ADHD
  • Nicotine cessation
  • Bipolar disorder

Pharm Block 2 (15 decks)

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