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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 35 - Antidepressants > Flashcards

Chapter 35 - Antidepressants Flashcards

1
Q

What is the most common psychiatric disorder?

A

depression

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2
Q

What are the clinical features of depression?

A

-depressed mood
-loss of pleasure or interest
-insomnia
-anorexia
-loss of concentration
-feelings of guilt, worthlessness, helplessness
-suicidal thoughts

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3
Q

How long do symptoms need to last to be considered depression?

A

present most of the day, nearly every day, for at least 2 weeks

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4
Q

What are possible factors that contribute to depression?

A

-genetics
-childhood (ACEs)
-low self-esteem
-life stress

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5
Q

The monoamine hypothesis of depression says…

A

depression is thought to be caused by functional insufficiency of monoamine NTs

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6
Q

When we say depression is complex we mean…

A

there is likely no ‘one’ cause

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7
Q

Explain the association between inflammation and depression:

A

-activation of immune system and inflammation change BBB
-BBB allows entry of pro-inflammatory proteins that change brain and cause depression

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8
Q

When is electroconvulsive therapy used?

A

-when drugs and psychotherapy don’t work
-rapid response needed
-severe depression
-suicidal patients
-elderly patients at risk of starving

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9
Q

What is TMS?

A

transcranial magnetic stimulation

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10
Q

When do initial responses to antidepressants begin?

A

1-3 weeks after starting therapy

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11
Q

Maximal responses of antidepressants may not be seen for ___ weeks

A

12

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12
Q

What is considered a failed response to antidepressants?

A

drugs taken for 1 month with no success

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13
Q

How does efficacy of antidepressants vary?

A

it doesn’t they are nearly all equal

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14
Q

How do antidepressants affect suicidal tendencies?

A

-may increase them during early treatment
-especially in young adults

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15
Q

What changes should patients starting antidepressants be watched for?

A

-suicidal behaviour
-worsening mood
-behaviour changes

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16
Q

What does SSRI stand for?

A

selective serotonin reuptake inhibitor

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17
Q

When were SSRIs introduced?

A

1987

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18
Q

What is the most commonly prescribed antidepressant?

A

SSRIs

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19
Q

SSRIs are as effective as ________________ but don’t cause…

A

tricyclic antidepressants; SSRIs don’t cause hypotension, sedation, anticholinergic effects

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20
Q

Does overdose on SSRIs cause cardiac toxicity?

A

no

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21
Q

How common is death by SSRI overdose?

A

not common

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22
Q

How do SSRIs act?

A

blocking neuronal 5-HT reuptake

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23
Q

What was once the most widely prescribed SSRI in the world?

A

Fluoxetine (Prozac)

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24
Q

What is Fluoxetine (Prozac) used for?

A

-bipolar disorder
-OCD
-panic disorder
-bulimia nervosa
-premenstrual dysphoric disorder
-GAD
-PTSD
-social anxiety
-ADHD
-tourettes

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25
Q

What are the adverse effects of Fluoxetine (Prozac)?

A

-serotonin syndrome
-teratogenesis
-bleeding disorders
-sexual dysfunction
-weight gain
-hyponatremia (older adults)
-withdrawal syndrome

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26
Q

When does serotonin syndrome start?

A

2-72 hours after treatment

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27
Q

What does serotonin syndrome involve?

A

-agitation
-confusion
-disorientation
-anxiety
-hallucinations
-poor concentration
-incoordination
-myoclonus
-hyperreflexia
-excessive sweating
-tremor
-fever
-death

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28
Q

How do you stop serotonin syndrome?

A

discontinuation of the drug

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29
Q

What increases the risk of serotonin syndrome?

A

concurrent use of MAOIs and other drugs that affect 5-HT

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30
Q

What does fluoxetine (prozac) interact with?

A

-monoamine oxidase inhibitors (MAOIs)
-antiplatelets
-anticoagulants
-other drugs that work on 5-HT

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31
Q

What does SNRI stand for?

A

serotonin/norepinephrine reuptake inhibitor

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32
Q

What group of antidepressant is Venlafaxine (Effexor)?

A

SNRI

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33
Q

What are SNRIs used for?

A

-major depression
-GAD
-social anxiety disorder
-neuropathic pain

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34
Q

SNRIs block the reuptake of…

A

NE and 5-HT

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35
Q

What are the side effects of SNRIs?

A

-nausea
-headache
-anorexia
-nervousness
-sweating
-somnolence
-insomnia
-weight loss
-diastolic hypertension
-sexual dysfunction
-hyponatremia (older adults)
-neonatal withdrawal syndrome
-withdrawal syndrome

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36
Q

Desvenlafaxine, Duloxetine, Levomilnacipran, and Venlafaxine are all ________

A

SNRIs

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37
Q

What is a special consideration of the absorption of Duloxetine?

A

food reduces rate of absorption

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38
Q

How does Duloextine travel in the bloodstream?

A

bound to albumin

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39
Q

How is Venlafaxine administered?

A

XR capsules

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40
Q

With Venladaxine and Levomilnacipran, the dose must be decreased when…

A

the patient has liver or kidney dysfunction

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41
Q

What does SPARI stand for?

A

serotonin-1A partial agonist/serotonin reuptake inhibitor

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42
Q

What group of antidepressant is Vilazodone (Viibryd)?

A

SPARI

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43
Q

How does Vilazodone act?

A

ssri and partial agonist of 5-HT1A

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44
Q

What is Vilazodone used for?

A

manic depressive disorder and generalized anxiety disorder

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45
Q

Vilazodone should be administered with or without food?

A

with food

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46
Q

Vilazodone should not be administered with food or meds with _____________ properties such as…

A

anticoagulant; ginko, ginger, garlic, licorice

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47
Q

What are side effects of Vilazodone?

A

-headache
-diarrhea
-nausea

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48
Q

Do symptoms stop suddenly when Vilazodone is discontinued?

A

no

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49
Q

How long does it take for Vilazodone to take effect?

A

up to 28 days

50
Q

What does SARI stand for?

A

serotonin antagonist receptor inhibitor

51
Q

What drug class is Vortioxetine (Trintellix)?

A

SARI

52
Q

How does Vortioxetine work?

A

-inhibit 5-HT reuptake
-stimulate 5-HT1A receptors
-block 5-HT3, 5-HT1D, 5-HT7 receptors
-partial agonist of 5-HT1B receptors

53
Q

What is Vortioxetine used for?

A

major depression in adults

54
Q

When does Vortioxetine require a 50% dose reduction?

A

when taken with CYP2D6 inhibitors

55
Q

How is Vortioxetine transported in blood?

A

higly protein bound

56
Q

What are the adverse effects of Vortioxetine?

A

-nausea
-constipation
-suicide
-agitation
-NMS
-serotonin syndrome
-hyponatremia
-pregnancy
-bone fracture risk

57
Q

What antidepressant group is Trazodone?

A

SARI

58
Q

How does Trazodone act at high doses?

A

-bind to 5-HT2 receptors and acts as a 5-HT agonist

59
Q

How does Trazodone act at low doses?

A

-bind to 5-HT2 receptors and acts as a 5-HT antagonist, like SSRIs

60
Q

What receptor subtypes does SARI act on?

A

H1, A1, and A2

61
Q

What is Trazodone used for?

A

as a sedative, even in people without depression

62
Q

What are the adverse effects of Trazodone?

A

-anticholinergic
-priapism (erection)

63
Q

How do tricyclic antidepressants act?

A

by blocked reuptake of NE and 5-HT

64
Q

What is the most dangerous AE of TCAs?

A

cardiotoxic in OD

65
Q

Amitrityline along with Clomipramine, Doxepin, Imipramine, Nortriptyline are all…

A

TCAs

66
Q

What are TCAs used for?

A

-depression
-fibromyalgia syndrome
-neuropathic pain
-chronic insomnia
-ADHD
-panic disorder
-OCD
-nocturnal enuresis

67
Q

What are the adverse effects of TCAs?

A

-orthostatic hypotension
-anticholinergic effects!!
-diaphoresis (sweating)
-sedation
-cardiac toxicicty
-seizures

68
Q

TCA toxicity (anticholinergic and cardiotoxic) manifests as:

A

-dysrhythmias
-tachycardia
-intraventricular blocks
-complete AV block
-ventricular tachycardia
-V fib

69
Q

How is TCA toxicity treated?

A

-gastric lavage
-charcoal ingestion
-IV sodium bicarbonate (dysrhythmias)

70
Q

MAOIs are the ________ or ________ choice antidepressants for most patients.

A

second or third

71
Q

How do MAOIs compare to TCAs and SSRIs?

A

-equally effective
-MAOIs are more hazardous

72
Q

Eating foods rich in ___________ risk triggering hypertensive crisis in patients taking MAOIs.

A

tyramine

73
Q

MAOIs are the drug of choice for _________ depression

A

atypical

74
Q

Phenelzine (Nardil) is a _______

A

MAOI

75
Q

How do MAOIs act?

A

-convert monoamine NTs (NE, serotonin, and dopamine) into active products
-inactivate tyramine and biogenic amines

76
Q

What are the two forms of MAO in the body?

A

MAO-A
MAO-B

77
Q

Reversible MAOI action lasts ________

A

3-5 days

78
Q

Irreversible MAOI action lasts _________

A

~2 weeks

79
Q

What are MAOIs used for?

A

-depression
-bulimia nervosa
-agoraphobia
-ADHD
-OCD
-panic attacks

80
Q

What are the AEs of MAOIs?

A

-CNS stimulation
-orthostatic hypotension
-hypertensive crisis (via dietary tyramine)

81
Q

How does tyramine promote hypertensive crisis?

A

tyramine promotes the release of NE from sympathetic neurons

82
Q

What are the symptoms of a hypertensive crisis?

A

-headache
-tachycardia
-hypertension
-N&V
-confusion
-sweating
-stroke
-death

83
Q

What foods should not be eaten when taking MAOIs?

A

cheese, salami, wine, beer

84
Q

What is the treatment for hypertensive crisis?

A

-IV vasodilator
-sodium nitroprusside
-phentolamine (alpha antagonist)
-labetalol (A/B antagonist)

85
Q

What does RIMA stand for?

A

reversible inhibitor of monoamine oxidase

86
Q

What class of antidepressant is Moclobemide?

A

RIMA

87
Q

How does Moclobemide act?

A

by reversibly inhibiting monoamine oxidase

88
Q

What are the adverse effects of Moclobemide?

A

-dry mouth
-dizziness
-tremor
-headache
-restlessness

89
Q

What is Moclobemide used for?

A

-anxiety
-phobias
-atypical depression

90
Q

When is Moclobemide administered?

A

after meals

91
Q

Can people on Moclobemide eat tyramine?

A

yes but not in excessive amounts

92
Q

What does Moclobemide interact with?

A

-St. John’s wort
-many others

93
Q

What antidepressant class is Bupropion (Wellbutrin)?

A

norepinephrine and dopamine reuptake inhibitor

94
Q

In what cases should the dose of Bupropion be decreased?

A

renal dysfunction

95
Q

How does Bupropion differ from the rest of the drugs?

A

-no weight gain
-no sexual dysfunction
-increased seizure risk
-Zyban brand used for smoking cessation
-SR and XL tabs

96
Q

What are the adverse effects of Bupropion?

A

-seizures
-agitation
-tremor
-tachycardia
-blurred vision
-dizziness
-headache
-insomnia
-dry mouth
-GI upset

97
Q

What does Bupropion interact with?

A

MAOIs

98
Q

How does Mirtazapine (Remeron) act?

A

-block 5-HT2, 5-HT3 & H1 receptors
-moderate blockade of A1 and muscarinic receptors

99
Q

What are the adverse effects of Mirtazapine?

A

-anticholinergic (dry mouth, sedation)
-edema
-dizziness
-arthralgias (joint stiffness)
-nightmares
-weight gain
-increased QT interval

100
Q

What is Mirtazapine used for?

A

-anxiety
-somatization
-depression

101
Q

How does Mirtazapine differ from other drugs?

A

less sexual dysfunction

102
Q

What antidepressant class is Esketamine (Spravato)?

A

glutamate receptor modulator (NMDA receptor antagonist)

103
Q

How does Esketamine act?

A

non-selective, non-competitive blockade of NMDA (glutamate) receptors

104
Q

What is Esketamine used for?

A

-MDD
-combined with SSRI and SNRI when no response to 2 courses of current treatment

105
Q

WARNINGS of Esketamine:

A

-assess BP before and after (will peak 40min post dose, monitor till normal)
-dissociative sedation
-respiratory depress
-signs of abuse or misuse
-suicidal ideation
-CV risk (resuscitation equip avail!!!)

106
Q

How is esketamine given?

A

-2 sprays intranasally
-single use

107
Q

Esketamine isn’t used or people older than ______

A

age 65

108
Q

People of ___________ ancestry should have a reduced dose of Esketamine

A

Japanese

109
Q

What are the side effects of esketamine?

A

-increased BP
-sedation
-dissociation
-headache
-vertigo

110
Q

Esketamine administration requires:

A

-direct HCP supervision
-2 hr observation

111
Q

Electroconvulsive therapy is effective and ________

A

rapid

112
Q

What is an adverse effect of ECT?

A

memory loss of immediate events

113
Q

Where does transcranial magnetic therapy deliver magnetic fields?

A

left dorsolateral prefrontal cortex

114
Q

TMT lasts ____ sessions every ___ weeks

A

40 min; every 6 weeks

115
Q

What are the adverse effects of TMT?

A

-transient headaches
-scalp discomfort
-eye pain
-toothache
-muscle twitching
-seizures

116
Q

When is vagus nerve stimulation used?

A

long-term therapy of treatment-resistant depression - when at least 4 drugs have failed

117
Q

What is vagus nerve stimulation?

A

implanted device that delivers electrical pulses to the vagus nerve

118
Q

What are the side effects of vagus nerve stimulation?

A

-hoarseness
-voice alteration
-cough
-dyspnea

119
Q

What is light therapy used for?

A

treatment of seasonal affective disorder and nonseasonal major depression

120
Q

What is Psilocybin?

A

a 5-HT2A receptor agonist that is used for therapy in opioid addiction and mental heath conditions

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (18 decks)

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