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Pharmacology > Depression > Flashcards

Depression Flashcards

1
Q

Depression symptoms

A

Depressed mood
Anhedonia
Sad
Guilt
Hopeless (red flag)

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2
Q

Diagnosis
Depressive Disorder
Must meet 5

A

Weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation
Fatigue
Feelings of worthlessness
Dec concentration
Suicide thought

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3
Q

Monoamine oxidase

A

Metabolizes monoamines → dec NT
Inhibition of this enzyme → inc NT

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4
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A

Fluoxetine
Paroxetine “etine”
Citalopram
Escitalopram
Sertraline
Fluvoxamine

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5
Q

SSRIs
a) action
b) dose

A

a) Inhibit serotonin transporter
b) once a day in the morning

No data that SSRI is more effective
to other meds

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6
Q

SSRIs
ADRs

A

Serotonergic side effects
– Activation or sedation
– Nausea
– Sleep disturbances
– Sexual side effects
– Weight gain

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7
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
a) Medication name
b) Action

A

a)
Venlafaxine
Desvenlafaxine
Duloxetine
b)
Inhibit neuronal reuptake of 5HT and NE

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8
Q

Venlafaxine
a) action

A

5-HT reuptake inhibition across dosage range

We don’t see norepinephrine reuptake inhibition until doses >200 mg/day
Dose related increases in blood pressure

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9
Q

Venlafaxine
Two formulations
XR?IR?

A

XR
– dosed once daily
IR
– dosed two to three times daily

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10
Q

Venlafaxine
ADRs

A

Nausea, GI
Insomnia
Sexual side effects
Inc blood pressure
Sweating
Agitation

The same as Desvenlafaxine

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11
Q

Desvenlafaxine
a) action

A

Active metabolite of Venlafaxine (Venlafaxine is a prodrug converted in the body)

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12
Q

Duloxetine
a) action

A

Balanced NE and 5HT reuptake inhibition across dosage range

FDA approved for neuropathic pain associated with DM

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13
Q

Duloxetine
ADRs

A

Similar to venlafaxine
Significant rates of nausea (dose and schedule)

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14
Q

Bupropion
action?

A

Inhibition of DA and NE reuptake
Also FDA approved for smoking cessation
禁煙

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15
Q

Bupropion
ADRs?

A

Lowers seizure threshold
Already experience seizure
= increased incidence of seizure

Lower incidence of sexual side effects

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16
Q

Mirtazapine
a) action
b) characteristic

A

a)
Enhances NE and 5HT activity
Sedating antihistaminic effect
b)
Taken at bedtime
Low rate of sexual dysfunction

More side effect at lower doses!!!
-Inc NE activity at higher dose

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17
Q

Mirtazapine
ADRs

A

Significant weight gain

18
Q

Trazodone
a) action
b) characteristic

A

a)
enhances 5HT activity
b)
Very sedating – used to treat insomnia
Doses <300 mg used for insomnia

19
Q

Trazodone
ADRs

A

Antidepressant activity at higher doses
Sedation,
Nausea, GI upset
Priapism 持続勃起症

20
Q

Tricyclic Antidepressants
Medication name

A

Used for years but not using these days
Amitriptyline
Desipramine
Imipramine
Nortriptyline

21
Q

Tricyclic Antidepressants
a) action
b)characteristic

A

a)
inhibition of NE and 5HT reuptake
b)
Anticholinergic
dry mouth, dry eyes, constipation, blurred vision, urinary retention
Alpha-adrenergic
orthostasis
Very sedating

22
Q

Tricyclic Antidepressants
What is the most biggest waring sing?

A

Lethal in overdose (as little as 3x daily dose)!!!
Cardiac arrhythmia is cause of death

23
Q

Tricyclic Antidepressants
ADRs

A

Weight gain
Glucose dysregulation
Effects on cardiac conduction

24
Q

Monoamine Oxidase Inhibitors (MAOIs)
Medications name

A

Phenelzine
Selegiline
Tranylcypromine

25
Q

Monoamine Oxidase Inhibitors
a) action
b)characteristic

A

a)
Reserved for treatment of resistant depression.
b)
Drug food interactions: limit foods high in tyramine like aged cheese, cured meats, sauerkraut, beer

26
Q

Monoamine Oxidase Inhibitors
ADRs

A

Causes massive increase in BP
-Hypertensive crisis: risk for stroke and vascular damages
Tyramine increases norepinephrine + MAOIs increases NE 🡪 hypertensive crisis
Many ADRs

27
Q

Specialty Antidepressants
Agents

A

Brexanolone
Esketamine

28
Q

Brexanolone
a) action
b)characteristic

A

a)
Indicated for postpartum depression
Aqueous formulation of allopregnanolone
(active metabolite of progesterone).
b)
An IV infusion administered over 60 hrs with continuous monitoring
$34,000 very expensive! + may take mom away from baby for those 60 hrs. Not commonly given but still an option

29
Q

Esketamine
a) action
b)characteristic

A

a)
Indicated for treatment of resistant depression
b)
Nasal spray
Only available at treatment centers
Monitored for 2 hrs
Use associated with sedation, dissociation(disconnected from body), and abuse/misuse(people often abuse ketamine)

$20,800-$33,800/year very expensive!

30
Q

Treatment Stages
Significant reduction

A

Response
but not complete resolution

31
Q

Treatment Stages
Resolution symptoms

A

Remission
-The same level when it’s start

32
Q

Treatment Stages
Remission of at least 6 months
6 month

A

Recovery
The episode be treated was over!!

33
Q

Treatment Stages
Return of depressive symptoms within 6 months

A

Relapse
Happen BEFORE recovery
Effect goes down

34
Q

Treatment Stages
New episode of MDD after recovery from initial one

A

Recurrence
The episode was over, but new episode

35
Q

Phases of Treatment
a)Acute Phase
b) Continuation Phase

A

a)
Initial 6-12 weeks of treatment
b) reatment bridging remission to recovery
Typically 6-9 months
Continuation of antidepressant at full therapeutic dosage
Antidepressant may be discontinued at the conclusion of the continuation phase

36
Q

Phases of Treatment
Maintenance Phase

A

Continuation of an antidepressant at full therapeutic dosage
for extended periods of time, perhaps indefinitely

  • Not necessary for all patients
  • May be beneficial in patients at high risk of relapse or recurrence
37
Q

Choice of antidepressant based on?

A

Past history of response
Side effect profile
Comorbid psychiatric or medical conditions
Potential for drug interactions

Cost

38
Q

Treatment Goal

A

Remission
Improved overall functioning
Dec the risk of experiencing another
episode of depression
Inc amount of time until another episode in those who experience recurrence

39
Q

Managing ADRs
Insomnia

A

Caffeine?? dec more stimulants
Morning dosing
Reduce dose
Change antidepressant
Adjunct with a sleep medication

40
Q

Managing ADRs
Anxiety

A

inc with initiation of antidepressant treatment
Minimize or avoid caffeine intake
Reduce dose and titrate gradually
Beta-blocker or benzodiazepine
(to help with inc HR in anxiety)

41
Q

Managing ADRs
Nausea

A

Start low, titrate dosage up
Take with food
Decrease dose
Change antidepressant

42
Q

Managing ADRs
Sexual

A

Dec antidepressant dose
Switch to another antidepressant
– Bupropion
Add on a medication
– Sildenafil
Wait to see if the patient builds up a tolerance to the side effect

Pharmacology (34 decks)

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