Depression

Question 1

Black Box for all Antidepressants

Answer 1

Increased risk of suicidal thoughts and behaviors
Closely monitor for emerging or worsening
Early s/s resolution with more energy and motivation to accomplish tasks coupled with delayed resolution of s/s such as worthlessness or helplessness = worsening thoughts and behaviors

Question 2

Tricyclic Antidepressants

Answer 2

IND: Depression
MOA: Inhibits NE reuptake
BOX: Antidepressants
CON: Use with MAOIs
ADR: Ortho hypotension, sedation, anticholinergic effects, cardiac toxicity, seizures

Question 3

Amitriptyline

Answer 3

IND: Depression. Helpful in anxiety-related IBS
MOA: TCA
BOX: Antidepressants
CON: MAOI
ADR: Sedation, constipation, cardiotoxicity

Question 4

Nortriptyline

Answer 4

IND: Depression
MOA: TCA
BOX: Antidepressants
CON: Use in recovery phase of MI, MAOIs
ADR: Sedation, drowsy, cardiotoxic, constipation, xero

Question 5

SSRI’s

Answer 5

IND: Depression. Most common, 1st line
MOA: Inhibits neural serotonin reuptake. Acutely increases serotonin in synapse = activation of 5HT receptors. Long term clinical response is d/t down-regulation of 5HT receptors = decreased serotonin release. SSRI disinhibit(activate) the neuron = more serotonin in synapse.
BOX: Antidepressants
CON: MAOI’s,
ADR: NAUSEA AND DIARRHEA. Agitation/insomnia. Sexual dysfunction. Weight gain. Hyponatremia

Question 6

Sertraline

Answer 6

Zoloft
IND: Depression. Preferred agent in pregnancy
MOA: SSRI. More “activating” for energy loss, hypersomnia, concentration
BOX: Antidepressants
CON: MAOIs
ADR: N/D, xerostomia, insomnia

Question 7

Citalopram and Escitalopram

Answer 7

Celexa or Lexapro
IND: Depression. Pregnancy category C.
MOA: Sedating SSRI, good for use in insomnia
BOX: Antidepressants
CON: MAOIs
ADR: N/D, QT prolongation, xerostomia, somnolence, diaphoresis

Question 8

Fluoxetine

Answer 8

Prozaac
IND: Depression
MOA: SSRI, activating. Long half life, good for non-compliance
BOX: Antidepressants
CON: MAOIs
ADR: N/D, xerostomia, insomnia, sexual dysfunction

Question 9

Paroxetine

Answer 9

Paxil
IND: Depression. Pregnancy category D/X
MOA: SSRI, sedating. Terrible for non-compliance
BOX: Antidepressants
CON: MAOIs
ADR: N/D, xerostomia, somnolence, drowsy, QT prolongation. Withdrawals
Renal adjustment required

Question 10

SNRI

Answer 10

Inhibit neuronal serotonin and NE reuptake.
CON: MAOIs
Similar efficacy to SSRI but are 2nd line

Question 11

Venlafaxine and Desvenlafaxine

Answer 11

IND: Depression
MOA: SNRI
BOX: Antidepressants
CON: MAOIs
ADR: Weight loss/anorexia. HTN. INTENSE WITHDRAWAL SYNDROME with abrupt d/c, must taper over 2-4 weeks

Question 12

Duloxetine

Answer 12

IND: Depression and anxiety
MOA: SNRI
BOX: Antidepressants
CON: MAOIs
ADR: Weight loss/anorexia. HTN
INTENSE WITHDRAWAL SYNDROME with abrupt d/c.

Question 13

Milnacipran

Answer 13

IND: Depression
MOA: SNRI
BOX: Antidepressants
CON: MAOIs
ADR: HA, insomnia, hot flashes, ortho hypotension

Question 14

Mirtazapine

Answer 14

IND: Depression
MOA: The only TetraCA for depression. Alpha 2 antagonism. Increases release of Serotonin and NE. Also blocks 5HT2 and 3
BOX: Antidepressants
CON: MAOIs
ADR: Weight gain and increased cholesterol. Increased appetite. Incredibly sedating. Constipation, xero.

Question 15

Vilazodone

Answer 15

IND: Depression
MOA: SSRI and 5HT1A partial agonist (anxiolytic) (SPARI). Equally efficacious as Fluoxetine and Citalopram w/slightly more GI side effects
BOX: Antidepressants
CON: MAOIs
ADR: N/D, HA

Question 16

Vortioxetine

Answer 16

IND: Depression
MOA: SSRI and 5HT1A partial agonist (anxiolytic) AND 5HT3 antagonist
BOX: Antidepressants
CON: MAOIs
ADR: N/D (5HT3 didn’t work), Sex dysfunction

Question 17

NE Dopmaine Reuptake Inhibitor (NDRI); Bupropion

Answer 17

Wellbutrin
IND: Depression, smoking cessation, SAD
MOA: NDRI. Similar to amphetamines, stimulant actions and appetite suppression
BOX: Antidepressants
CON: SEIZURE DISORDERS
ADR: Tachycardia, weight loss, GI, agitation and insomnia (take earlier in the day. 9am/3pm)
DON’T cause sex dysfunction, may even increase

Question 18

Esketamine

Answer 18

IND: Depression
MOA: NDMA antagonist
BOX: Sedation and dissociation, monitor for 2 hours after each treatment
Misuse and abuse, controlled substance
Spravato REMS d/t sedation, dissociation, misuse and abuse
Suicidal thoughts and behaviors
CON: Hx of intracerebral hemorrhage, aneurysmal vascular dz
ADR: HTN, N/V/loss of taste, anxiety, depersonalization

Question 19

Nefazodone

Answer 19

IND: Depression
MOA: SNRI and 5HT2 and alpha2 antagonist
BOX: Hepatotoxicity; life threatening
STRONG CYP INHIBITOR
CON: MAOIs
ADR: HA, drowsy, N/constipation

Question 20

Trazodone

Answer 20

IND: Depression
MOA: SNRI and 5HT2 antagonist
BOX: Antidepressants
CON: MAOIs
ADR: HA, dizzy/drowsy, N/V, Xero

Question 21

MAOIs

Answer 21

LINEZOLID and Methylene Blue
Last line. High concern for fatal HTN crisis, tons of drug and food interactions.
ADR: hypotension, anxiety, insomnia, agitation, mania

Question 22

Olanzapine-Fluoxetine

Answer 22

IND: Depression, BPD
MOA: SGA + SSRI
BOX: Antidepressants and SGA
CON: MAOIs
ADR: n/a

Question 23

Serotonin Syndrome

Answer 23

Potentially fatal. Usually presents within 3 days.
Manage by d/c serotonergic agents, support, and control hyperthermia.
Benzos for sedation and relaxing.
Serotonin antagonist; Cyproheptadine
Bromocriptine is used in NMS and CAN WORSEN SS