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Exam 6 > Depression > Flashcards

Depression Flashcards

1
Q

What the 5 most popular SSRIs

A 
Citalopram (celesta)
Escitalopram (lexapro)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
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2
Q

Which is the worse SSRI?

A

Paroxetine

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3
Q

What is the mechanism of SSRIs? How much activity inhibited at clinical doses? Why isn’t effect immediate?

A

Allosteric 5-HT inhibition.
80% inhibited
Clinical effect probably from overtime desensitization and down regulation of 5HT R’s

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4
Q

SSRIs have little affinity for ___, ____, or ____ receptors. Except for _____

A

histamine, α, or muscarinic

paroxetine (hits hist and muscarinic)

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5
Q

Fluoxetine is FDA approved for _____

A

bulimia

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6
Q

_______ is an SSRI that is safe to use in patients with CV disease

A

sertraline

SAD-HART trial

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7
Q

How long do Adverse effects from SSRIs last

A

1-2 weeks

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8
Q

What are some adverse effects from SSRIs

A

Nausea, GI upset, diarrhea (increase 5ht stimulation everywhere)
Headaches, insomnia
Sexual dysfunction

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9
Q

Paroxetine inhibits ________ which leads to even more sexual dysfunction than other SSRIs might cause

A

nitric oxide synthase

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10
Q

An AE of SSRIs that’s a concern for geriatric patients is ____________ due to __________

A

syndrome of inappropriate antidiuretic hormone secretion/hyponatremia
stimulation of arginine vasopressin from posterior pituitary

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11
Q

Paroxetine specifically has adverse effects of

A

increased weight gain, sexual dysfunction, sedation, anticholinergic adverse effects

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12
Q

Citalopram has the specific adverse effect _______.
What is the max dose that can be used in adults vs geriatrics?
What drug drug interaction does someone NEED to look for?

A 
QTc prolongation
40mg adults, 20mg geriatrics
CYP2C19 inhibitors (omeprazole PPI-> max 20mg)
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13
Q

Are SSRIs fatal in overdose?

A

no

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14
Q

What can happen if someone suddenly discontinues their SSRI?

A

dreams, paresthesias, flu like symptoms,

paroxetine specific-> cholinergic rebound

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15
Q

Which SSRI has a lower risk of withdrawal symptoms and why?

A

fluoxetine bc long half life and active metabolite

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16
Q

Which SSRIs are potent inhibitors of CYP2D6?

A

fluoxetine and paroxetine

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17
Q

What’s the deal with NSAIDs and SSRIs?

A

SSRIs prevent 5ht from being taken up into platelets and released for aggregation-> increase GI bleed risk

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18
Q

Some groups of things that might cause serotonin syndrome?

A

MAOIs, linezolid, triptans, tramadol

19
Q

What are 4 commonly used SNRIs?

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq) (metabolite of venlafaxine)
levomilnacipran (fetzima)

20
Q

What is the MOA for SNRIs?

A

inhibit 5ht and NE reuptake transporters

21
Q

What is special about the MOA of Venlafaxine? (what dose do you need)

A

weak inhibitor of NE reuptake due to low affinity

Need dose greater than 150mg for SNRI. otherwise its just an SSRI

22
Q

What is special about duloxetine MOA?

A

inhibits 5ht and NE at low doses

23
Q

Do SNRIs have affinity for histamine, α, or muscarinic receptors?

A

not really

24
Q

SNRIs are useful in depression with _____ because ______

A

lethargy

increase in NE

25
Q

SNRIs can also be used in _______

A

anxiety, peripheral neuropathy, fibromyalgia

26
Q

What are NE related AEs from SNRIs?

A

increased BP, HR, sweating

caution in patients with CV disease

27
Q

What is the MOA of bupropion?

A

Inhibition of NE and DA. no effect at 5HT, muscarinic, α, or histamine

28
Q

Bupropion can be used with another antidepressant for __________ and _______

A

anhedonia, low mood

decreased sexual dysfunction compared to other antidepressants

29
Q

________ is the antidepressant of choice for depression with lethargy, lack of energy, sexual dysfunction and low mood

A

Bupropion

also helpful in smoking cessation, ADHD, and weight loss

30
Q

Bupropion is not good when depression is comorbid with ____, _____, or _____

A

anxiety, irritability, insomnia

31
Q

Bupropion _______ at really high doses. Where should you exhibit caution?

A

lower seizure threshold. Eds, epilepsy, alcoholism, CNS tumor

32
Q

What are some adverse effects of bupropion?

A

nausea, agitation, tremor, insomnia, decreased appetite

33
Q

What is the mechanism of action for MIrtazapine (remeron)

A

Antagonist at presynaptic auto and hetero α 2 and 5ht receptors -> increase release NE and 5HT
NOT an reuptake inhibitor

34
Q

What is Mirtazapine an antagonist at?

A

5ht2a, 5ht2c, 5ht3
Histamine 1 (good for insomnia)
no activity at α 1 or muscarinic

35
Q

Miratazapine will have an _____ in sexual dysfunction vs other antidepressants, useful in depression with __________

A

decrease

insomnia, weight loss, anxiety, N/V, failure to thrive

36
Q

Do not use Mirtazapine in depression with __________

A

sedation, hypersonic, weight gain

37
Q

What is the mechanism of tricyclic antidepressants?

A

Inhibit 5ht and NE reuptake transporters

high affinity for histamine, α 1, or muscarinic

38
Q

When would you whip out the tricyclic antidepressants?

A

later stage. its as effective but less tolerated becasue more AEs and DDIs

39
Q

Are tricyclic antidepressants lethal in overdose? if so, how?

A

Yes
Inhibit Na channels->longer ventricular depolarization->QRS widen->arrhythmia
Treat with sodium bicarb (displaces TCA)

40
Q

What are TCA specific AEs and what population should they be avoided using in

A

anticholinergic (dry mouth, blurry vision, urinary retention, constipation)
avoid in geriatric patients

41
Q

What is the dietary restriction for MAO-Is?

A

don’t eat tyramine rich foods -> increase in peripheral NE -> hypertensive crisis.

42
Q

Are MAO I’s fatal in OD?

A

yes

43
Q

What is esketamine used for?

A

treatment resistant depression, rapid antisuicidal properties

44
Q

What is brexanolone used for?

A

treatment for post partum depression

Exam 6 (14 decks)

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