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Behavioral Health > Behavioral Health Meds 1 > Flashcards

Behavioral Health Meds 1 Flashcards

1
Q

What are the SSRIs? (6)

A
  1. Sertraline
  2. Fluoxetine
  3. Citalopram
  4. Escitalopram
  5. Paroxetine
  6. Fluoxetine
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2
Q

What is the MOA for SSRIs?

A

Selective serotonin reuptake in the CNS

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3
Q

SSRIs are usually first line for what 5 conditions?

A
  1. Depression
  2. PTSD
  3. Panic Disorder
  4. PMDD
  5. Anxiety disorder
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4
Q

What are the main benefits of SSRIs?

A

-Relatively few AEs
-Less toxic in overdose

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5
Q

Why are SSRIs lower risk (pathophys)?

A

-No effects on norepinephrine, acetylcholine, histamine or dopamine

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6
Q

What antidepressant is approved for treatment of bulimia?

A

Fluoxetine

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7
Q

What is unique about Fluoxetine (why is it approved for Bulimia)

A

-Longer half life (2-4 days instead of 1-2), longer washout period for switching to MAOIs

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8
Q

How long is the washout period for switching off fluoxetine?

A

5 weeks

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9
Q

What is the washout period for switching off of SSRIS besides fluoxetine?

A

At least 2 weeks

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10
Q

On average, how long do SSRIs take to reach maximum efficacy?

A

4-6 weeks

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11
Q

What is the first response to non-efficacy to an SSRI?

A

Try a different SSRI before moving to second line

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12
Q

What are the main 3 adverse effects of SSRIs?

A
  1. GI
  2. Sexual dysfunction
  3. Weight changes
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13
Q

What are constitutional side effects of SSRIs? (3)

A

-GI
-Headaches
-Energy changes (fatigue or restlessness)

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14
Q

What are mental adverse effects of SSRIs? (2)

A

-Anxiety
-Insomnia

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15
Q

What are chemical side effects of SSRIs? (2)

A

-SIADH
-Serotonin syndrome

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16
Q

What is the black box warning for SSRIs?

A

Increased suicidality in children / young adults

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17
Q

What is a specific side effect of Citalopram?

A

QT prolongation

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18
Q

What are the SNRIs? (3)

A
  1. Duloxetine
  2. Venlafaxine
  3. Desvenlafaxine
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19
Q

What is the MOA of SNRIs?

A

Inhibits neuronal uptake of serotonin, norepinephrine and dopamine

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20
Q

Duloxetine can be used as first line especially in patients with ____ and ____

A

Fatigue / neuropathy pain, depression

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21
Q

_____(SNRI) is good for depression and anxiety disorder

A

Venlafaxine

22
Q

What is the general side effect profile of SNRIs?

A

Similar to SSRIs plus hyponatremia

23
Q

What are the side effects of SNRIs specific to norepinephrine?

A

Hypertension
Sweating
Dizziness
Dry mouth
Constipation

24
Q

What are contraindications to SNRIs? (4)

A
  1. MAOI use
  2. Renal impairment
  3. Hepatic impairment
  4. Seizures
25
Q

Be careful with SNRIs in pts with ____

A

HTN

26
Q

SNRIs + (herbal) can cause serotonin syndrome

A

St. Johns Wort

27
Q

What is mirtazapine?

A

Tetracyclic antidepressent

28
Q

Mirtazapine MOA

A

Increases norepinephrine and serotonin release via central presynaptic alpha-2 adrenergic receptor antagonism

and

Postsynaptic 5-HT2 and 5-HT3 receptor antagonist, increases neurotransmission via 5-HT1 receptors

29
Q

Why is mirtazapine sedating?

A

High affinity for H1 receptors

30
Q

What is mirtazapine indicated for?

A

Depression and anxiety

31
Q

When is mirtazipine a good choice in depression?

A

-Insomnia
-Significant weight loss (appetite stimulating)

32
Q

Mirtazapine has fewer ____ side effects than SSRIs

A

Sexual

33
Q

What are the top side effects of mirtazapine?

A

Sedation and weight gain

34
Q

What are other AEs of mirtazipine?

A

(Sedation and weight gain)
-Dry mouth
-Constipation
-Tremor
-Dizziness
-Agranulocytosis

35
Q

What is the contraindication of mirtazipine?

A

MAOI inhibitors

36
Q

What are the tertiary tricyclic antidepressants? (4)

A
  1. Amitriptyline
  2. Clomipramine
  3. Imipramine
  4. Doxepin
37
Q

What are the secondary TCAS? (2)

A
  1. Desipramine
  2. Nortriptyline
38
Q

What are the indications for TCAs?

A
  1. Depression
  2. Insomnia
  3. Neuropathies
  4. Migraines
  5. Urge incontinence
39
Q

Why are TCAs used less frequently than other options?

A

High AE profile, severe overdose potential

40
Q

What are the main AEs of TCAs?

A
  1. Anticholinergic effects
  2. Weight gain
  3. Prolonged QT interval
  4. Sedation
  5. Lower seizure threshold
  6. SIADH
41
Q

What are the anticholinergic effects of TCAs?

A

-Dry mouth
-Constipation
-Urinary retention
-Tachycardia
-Orthostatic hypotension
-Confusion/hallucinations (elderly)

42
Q

What does TCA overdose look like?

A

The three C’s:

Cardiotoxicity
Convulsions
Coma

43
Q

What does the cardiotoxicity of TCA overdose look like?

A

Wide complex tachycardia due to Na+ channel blocking effect

44
Q

What do the convulsions of TCA entail?

A

Seizures or other neuro symptoms (like respiratory depression)

45
Q

How do you manage TCA overdose?

A

Sodium bicarb for cardiotoxicity

46
Q

When are TCAs contraindicated?

A

Use of MAOI
Recent MI
Seizure history

47
Q

Which TCAs are the most anticholinergic/antihistiminic and antiadrenergic?

A

Tertiary amines (higher toxicity with overdose)

48
Q

Which TCA is most useful in neuropathies, insomnia and chronic pain?

A

Amitriptyline (due to Na channel blocking properties)

49
Q

Which TCA is most useful in OCD?

A

Clomipramine (most serotonin specific)

50
Q

Doexpin is good for ____

A

chronic pain

Behavioral Health (19 decks)

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