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Section 15: Toxicology > Chapter 178: Atypical and Serotonergic Antidepressants > Flashcards

Chapter 178: Atypical and Serotonergic Antidepressants Flashcards

1
Q

Known as newer or second generation antidepressants

A

Atypical and Serotonergic antidepressants

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2
Q

Most popular form of psychopharmacologic therapy for the treatment of major depression, obsessive-compulsive disorder, panic disorders, and eating disorders

A

Atypical and Serotonergic antidepressants

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3
Q

How Atypical and Serotonergic antidepressants metabolized?

A

Hepatic

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4
Q

What example of atypical antidepressants

A
  • Bupropion
  • Mirtazapine
  • Nefazodone
  • Trazodone
  • Vilazodone
  • Vortioxetine
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5
Q

This atypical antidepressant primarily inhibition of neuronal reuptake of norepinephrine and dopamine with very minimal serotonergic activity

A

Buproprion

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6
Q

Metabolite of Buproprion that inhibits norepinephrine reuptake and may contribute to seizure development

A

Hydroxybupropion

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7
Q

At what dose youll see a Bupropion toxicity?

A

> 450mg

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8
Q

Most common ECG abnormality seen in Bupropion toxicity

A

Sinus tachycardia

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9
Q

More common tocxicity symptoms seen in Bupropion compare to other atypical antidepressants

A

Seizures

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10
Q

True or False

Ipecac syrup is the treatment of choice for Bupropion toxicity

A

False

Ipecac syrup is contraindicated due to the risk of seizures

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11
Q

Atypical antidepressants that blocks central presynaptic α2-adrenergic receptors and the postsynaptic serotonin 5-HT2 and 5-HT3 receptors

A

Mirtazapine

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12
Q

It is a rare but potentially serious complication of chronic mirtazapine use

A

Agranulocytosis is a rare but potentially serious complication of chronic mirtazapine use

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13
Q

The most common symptom Nefazodone toxicity

A

Drowsiness

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14
Q

Atypical antidepressant action believed to be due to a combination of serotonin reuptake inhibition and antagonism of postsynaptic serotonin 5-HT2 receptors

A

Trazodone

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15
Q

The most common side effect of Trazodone

A

Sedation

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16
Q

Trazodone is one of the most common causes of ____

A

Trazodone is one of the most common causes of drug-induced priapism

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17
Q

The most frequently reported cardiovascular abnormality noted in trazodone overdose

A

Orthostatic hypotension

18
Q

The most common ECG abnormality in Trazodone overdose is ____

A

The most common ECG abnormality is moderate prolongation of the QT interval

19
Q

This medication can worsen the hypotension in the presence of trazodone-induced a-adrenergic receptor antagonism

A

B-adrenergic receptor activity (Dopamine)

20
Q

Atypical antidepressant with selective serotonin reuptake inhibi- tion and partial serotonin 5-HT1A agonism

A

Vilazodone

21
Q

The most serious drug-related adverse effect of SSRI psychopharmacotherapy is?

A

Serotonin syndrome

22
Q

What SSRI has less likely to have withdrawal syndrome?

A

Fluoxetine because it may last up to 5 weeks after last dose

23
Q

Highest incident of seizure in SSRI?

A

Citalopram

24
Q

True or False

Sinus bradycardia is observed more frequently in fluvoxamine overdoses than in overdoses of other SSRIs

A

True

Sinus bradycardia is observed more frequently in fluvoxamine overdoses than in overdoses of other SSRIs

25
Q

Prolongation of the QRS complex and QT interval occurs in association with significant what SSRIs?

A

Citalopram and Escitalopram ingestions

26
Q

Treatment for prolonged QRS complex?

A

Sodium bicarbonate

27
Q

Treatment of choice for atypical antidepressants and SSRI management at ED?

A

Activated charcoal within 1 hours of ingestion

28
Q

True or False
The serotonin/norepinephrine reuptake inhibitors (SNRIs) are primarily nonselective inhibitors of serotonin and norepinephrine reuptake with a very small amount of dopamine reuptake inhibition

A

True
The serotonin/norepinephrine reuptake inhibitors (SNRIs) are primarily nonselective inhibitors of serotonin and norepinephrine reuptake with a very small amount of dopamine reuptake inhibition

29
Q

SNRI that absorbed fastest after ingestion

A

Venlafaxine

peak of 2 hours

30
Q

When to consider to give whole-bowel irrigation?

A

Venlafaxine overdose of >4000mg

31
Q

All SNRI have simlar side effect with SSRI, except?

A

Venlafaxine

32
Q

The most common ECG abnormality observed in SNRI overdose

A

Sinus tachycardia

33
Q

The stimulation of specific postsynaptic serotonin receptors is required for full expression of this syndrome, primarily the ____

A

The stimulation of specific postsynaptic serotonin receptors is required for full expression of this syndrome, primarily the serotonin 5-HT1A and 5-HT2A receptors

34
Q

What is the triad o serotonin syndrome?

A
  • Cognitive
  • Autonomic
  • Neuromuscular effect
35
Q

What time after ingestion will the patient will produce serotonin syndrome?

A

2-24 hours

36
Q

The most common symptoms seen in serotonin syndrome?

A
  • Altered mental status
  • Hyperthermia
  • increased muscle tone
37
Q

What signs/symptoms reported as marker of a poor prognosis?

A

The temperature of >41

38
Q

The most common cause of death in serotonin syndrome

A

Severe hyperthermia

39
Q

Treatment for serotonin syndrome that has antihistamine and serotonin antagonist with anticholinergic effects

A

Cyproheptidine with initial dose 12 mg, 2mg every 2 hours until clinical improvement

40
Q

An antagonist of 5-HT2A receptors and there are reports of successful treatment of serotonin syndrome

A

Chlorpromazine

41
Q

Nonspecific muscle relaxant that is used occasionally in the management of serotonin syndrome, but clinical benefit is unproven

A

Dantrolene

Section 15: Toxicology (5 decks)

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