Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > Depression > Flashcards

Depression Flashcards

1
Q

What are the 5 SSRI medications?

A

Sertraline
Escitalopram
Citalopram
Fluoxetine
Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 SNRI medicaitons?

A

Duloxetine
Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the NDRI?

A

bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 1 A2 agonist 5ht2 antagonist?

A

Mirtazipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the MOA of SSRI

A

Inhibition of presynaptic 5-HT reuptake by inhibition of the 5Ht transporter CNS Neurons
Increased 5Ht is then present in the synaptic cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens the 1st few days of SSRI?

A

Decreased agitation and anxiety

Improved sleep and appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is important when someone first starts and SSRI

A

Higher incidence of energy may make someone more inclined to act upon their suicide ideation thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens the first 1-3 weeks of SSRI medication start?

A

Increased activity and sex drive

Improved self care and concentration memory thinking and movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens the first 2-4 weeks of starting an SSRI?

A

Relief of depressed mood, return or experiencing pleasure, fewer hopeless feelings, subsiding suicidial thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the adverse reaction of SSRI?

A

Aconym HANDS
Headache
Anxiety
Nausea
Diarrhea and GI pset
Sleep disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the acronym HANDS and what does it relate to?

A

Headache
Anxiety
Nausea
Diarrhea
Sleep disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are other AE of SSRIs?

A

Male/Female sexual/dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we deal with the adverse reactions of SSRI?

A

dose adjustment usually decreased

For Sexual dysfunction we may need to consider PDE5 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is emotional blunting/detachment?

A

Reported phenomenon in SSRI but hard to study accurately

We can switch to antidepressant with increase NE/DA activity such as bupropion or decrease the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the warnings of SSRI?

A

similar to all antidepressant where their is increased usage in children. adolescents and young adults

Increased fracture risk and decreased bone mineral density

QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an especially important note that we need to be aware of with respect to Citalopram and escitalopram?

A

Dose dependant QTc prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which SSRI usually are the most sedating (Still low)?

A

sertraline, citalopram, but paroxetine has the most sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which SSRI has been associated with weight gain?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What SSRI leads to more sweating and sedation?

A

paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which SSRS is most stimulating and have a long 1/2 life

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which SSRI has the most GI side effects?

A

Fluvoxamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which SSRI generally has the best tolerability?

A

Escitalopram and sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which SSRI has the least tolerability?

A

Fluvoxamine which can lead to nausea, sedation, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which enzyme is inhibited by fluvoxamine***

A

1A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Enzyme 1A2 is inhibited by?

A

Which enzyme is inhibited by fluvoxamine***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which enzyme is inhibited by fluoxetine and paroxetine?

A

2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Enzyme 2D6 is inhibited by

A

Which enzyme is inhibited by fluoxetine and paroxetine?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What happens when you increase NSAID usage with SSRI usage?

A

Increases risk of bleeding and decreases platelet aggregation effects of SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What risk increases when taking an SSRI

A

Serotonergic agents increase risk of serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the relevant PK of SSRIs (AM)

A

A= adequate with or without food,
Metabolism: Hepatically metabolized by CYP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which SSRI drug increases in absorption with food?

A

Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which SSRI form active metabolites?

A

Fluoxetine, Citalopram, Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How often is an SSRI taken?

A

Once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is Vortioxetine?

A

It is an SSRI that has mixed receptor effects, and ahas been shown to have a reduced side effect profile as comparred to other SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the two SNRIS

A

Duloxetine
Venlafaxine

Desvenlafaxine (Pristiq)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the MOA of SNRI

A

Inhibits the presynaptic 5-HT and NE reuptake by inhibiting 5-HT and NE transporters in CNS neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a possible MOA of SNRI as comparred to SSRI

A

It may be effective for the treatment of neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which SNRI is dose dependant for the amount of binding capacity to 5-HT

A

Venlafaxine
<150mg/dau binds to 5-HT
>150 binds to NE and 5HT

Weakly inhibits DA transporter A 450mg/dayu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which SNRI have about equal affinity for NE and 5HT trasnporters?

A

Duloxetine and desvenlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the onset of action for SSRI

A

SAME AS SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the anticholinergic-life effects of SNRIs?

A

Increase NE/anticholinergic effect. hence possible increase in dry mouth constipation sedation and urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which SNRI has lower sexual dysfunction as comparred to SSRI

A

Desvenlafaxine, duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which SNRI has similar rates of sexual dysfunction comparred to SSRI?

A

Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which SNRI can cause hyponatremia

A

Venlafaxine is the highest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the adverse drug effects of SNRI?

A

Dose related BP/HR and sweating

Dont appear to be associated with increased risk of fractures
May less emotional blunting than SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

SNRIs relevant PK

A

No effects from food

Dose adjustment for renal impairment
Venlafaxine and duloxetine are hepatically metabolized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which drug interaction should know for duloxetine?

A

Moderate inhibitor and substrate for Cyp2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is Duloxetine CI with?

A

Narrow Angle Glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the black box warning for SNRI?

A

Increase suicide if age is below 24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What should be monitored while on an SSRI?

A

Blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Should you stop SNRIs immediately?

A

No They need to be tapered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which disease states should you avoid taking duloxetine in?

A

Hepatic impairment or risk of urinary retention due to anticholingeric effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which SNRI is more serotonergic effect?

A

Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the NDRI ( Norepinephrine and dopamine reuptake inhibitors) we should know?

A

Buproprion

55
Q

What is the MOA of buproprion?

56
Q

What is buproprion useful in?

57
Q

What can bupropion augment?

58
Q

What does risk of sexual dysfunction do in relation to bupropion?

A

Less risk and may alleviate the actually alleviate the sx

59
Q

What is the onset of bupropion?

A

Similar to SSRIs and SNRIs

60
Q

Which liver enzyme is bupropion metabolized by?

61
Q

Where is bupropion primarily eliminated?

A

Kidneys, hence renal dosing adjustments are recommended

62
Q

Can Zyban be used concurrently for MDD and smoking cessation?

63
Q

What drug class is contraindicated with buproprion?

A

MAOI therapy

64
Q

Which Cyp enzyme does bupropion inhibit?

65
Q

What is the usual dose of Buproprion?

66
Q

What is the two formulations for bupropion?

67
Q

What medical conditions is Bupropion contraindicated for?

A

Seizure
Eating disorder
Abrupt discontinuation of alcohol or sedatives

68
Q

What are the black box warnings of bupropion?

A

Increase risk of suicide if less then 24 years old (as with all ADs)

69
Q

What is the ⍺2-antagonist 5-HT2antagonist we should know?

A

Mirtazipine

70
Q

What is the mechanism of Mirtazipine?

A

antagonism at: 5HT2A, 5HT2C, 5HT3, α2-adrenergic, H1

71
Q

What occurs at low doses of mirtazipine <30mg

A

HI receptor blocking

72
Q

What happens at dose of >15mg with mirtazipine?

A

increased release of NE and 5HT

73
Q

What is Mirtazipine especially considered for? Patients with?

A

insomnia, anxiety, reduced appetite

74
Q

Is mirtazipine usually dosed together or separetley?

A

Both mono and adjunctive

75
Q

Mirtazipine compared to other meds is it safer in overdose?

76
Q

What are the three AD effects of mirtazipine?

A

Sedation
Increased Triglycerides and weight gain due to increased appetite

Less sexual dysfunction as compared to ssri/snri

77
Q

Where is mirtazipine generally excreted?

A

Kidneys and liver, but no renal/hepatic adjustment required

78
Q

When should mirtazapine be taken?

A

Night because of sedation

79
Q

The sedation effect is typically lost (or at least much less pronounced) with doses starting at ___ (Mirtazapine)

80
Q

What are the black box warnings for mirtazapine?

A

Increased suicide risk if <24

81
Q

What are the second line TCAs?

A

Tertiary amines
* Amitriptyline (Elavil)
* Clomipramine
* Doxepin
* Imipramine
Secondary amines
* Nortriptyline (Aventyl)
* Desipramine

82
Q

What are the MOA of TCAs?

A

Inhibit presynaptic 5-HT and NE reuptake by inhibiting 5-HT and NE transporters in CNS neurons

DIRTY ANTIDEPRESSANTS

83
Q

What activity does tertiary amines have?

A

more 5-HT activity

84
Q

What activity does Secondary amines have?

A

More NE activity and better tolerated

85
Q

What are the Secondary amines? TCAs

A
  • Nortriptyline (Aventyl)
  • Desipramine
86
Q

What are the teriary amines TCAs?

A
  • Amitriptyline (Elavil)
  • Clomipramine
  • Doxepin
  • Imipramine
87
Q

What places for therapy does TCAs have?

A

MDD with additonal disease states such as
* Insomnia
* Anxiety
* Chronic, non-cancer pain (low back pain, neuropathic) * Migraines/headaches
* OCD (clomipramine)

88
Q

What are TCAs contraindicated in?

A
  • Acute MI, heart block, CHF * Severe liver impairment
89
Q

What are the adverse drug effects of TCAs?

A

Sedation
Anticholinergic effects
Cardiovascular effects

90
Q

What is the cardiovascular effects of TCAs?

A

Lethal in overdose
QT prolongation

91
Q

What dose range are TCAs lethal?

A

only 3x the therapeutic dose

92
Q

What are the additional ADEs with TCAS? (Not as major)

93
Q

What is trazodone?

A

Serotonin reuptake inhibitor/
5-HT2 antagonist

94
Q

What is the MOA of trazodone?

A

Weak inhibition of SERT and NET

95
Q

At doses of greater then 200mg what is the MOA of trazodone?

A

5-HT2A and 5-HT2C receptor antagonism

96
Q

At doses of 25-200mg what is the MOA of trazodone?

A

Antagonist at alpha-1 adrenergic receptors and H1 histamine receptors

97
Q

At doses of alpha-1 adrengergic receptors and H1 histamine receptors with respect to trazodone what are the common S/E

A

Sedation
Not as well tolerated

98
Q

What are the ADEs of trazodone?

A

dizziness, sedation, headache, nausea, constipation, drymouth

99
Q

What is the usual dose range of trazodone for depression?

A

200-400mg/dau

100
Q

What is the usualy dosage for sedative for trazodone?

A

50mg-200mg

101
Q

What does food do to trazodone?

A

Food enhances, although delays peak concentration

102
Q

Which CYP enzyme metabolizes trazodone?

103
Q

Where is trazodone primarily excreeted?

104
Q

Which drugs does trazodone have?

A

Dyp3A4 inducers and inhibitors

Antihypertensives (Since trazodone has alpha-1 antagonism

105
Q

What is the atypical antipsychotic?

A

Quetiapine (Seroquel)

106
Q

What is the MOA of Quetiapine

A

Antagonist at 5HT-1 & 2, D1 & 2, H1, alpha-1 & 2

107
Q

What is the usual dosage of quetiapine

A

150-300mg/day, requires a gradual increase in dosage

108
Q

What are doses of 300-600 generally reserved for with quetiapine?

A

Psychotic depression

109
Q

What dosage forms of Quetiapine are there?

A

IR or XR(ER)

110
Q

What is the usual dosage range of quetiapine?

A

150-300mg/day

111
Q

What is moclobemine?

A

Reversible MAOI

112
Q

What is the MOA of moclobemine?

A

Short- acting reversible inhibitor of MAO-A to ↓ metabolism of 5-HT, NE, DA

113
Q

What is the dosage regimen of Moclobemide?

A

300mg/day in 2 divided doses

114
Q

What is the issue with higher doses of Moclobemide

A

Specificity for MAO-A is list hence, caution regarding tyramine is required

115
Q

What is the tyramine reaction?

A

Where food containing tyramine increases the levels of norepinephrine

116
Q

Which enzymes metabolize Moclobemide?

A

CYP2C19, CYP2D6, most of the urine contains metabolites

117
Q

What are the DI with Moclobemide?

A

Serotonergic drugs need to be stopped 2 weeks before starting MAOI to avoid precipitating a hypertensive reaction or serotonin syndrome

118
Q

Which SSRI specifically needs to be stopped before starting a MAOI?

A

Stop Fluoxetine 5 weeks prior to starting MAOI

119
Q

If stopping MAOI how long do you need to wait before starting another antidepressant?

120
Q

Stop MAOI at least _______ prior to local or general anesthesia

121
Q

What ADE is there with MAOI/Moclobemide?

A
  • Tachycardia
  • Hypotension
  • Sleep disturbance, agitation, nervousness, anxiety
  • Less frequent than SSRI, SNRI * N/V/D
  • Sexual dysfunction (low incidence compared to SSRI) * Anticholinergic effects
122
Q

What is phenelzine and tranylcypromine?

A

Irreversible MOAI

123
Q

What is the MOA of phenelzine

A

Irreversibly bind and inhibit MAO-A and MAO-B non-selectively increasing 5-HT, NE, DA

124
Q

What is the MOA of Tranylcypromine

A
  • Irreversibly binds and inhibits MAO-A and MAO-B
  • Additional action similar to amphetamines:
    • Increased 5-HT, DA, NE release in
      synapse
    • Inhibits DA and NE transporters
125
Q

What is the duration of action with I-MAOI?

A

Duration of Action: matches timeframe to synthesize new MAO enzymes (2-3 weeks)

126
Q

What is CO with I-MAOI

A
  • Concurrent use of serotonergic or sympathomimetic agents

Tyramine containing foods

127
Q

Which medication counselling points are important with MOAI?

A

Adherence to diet and medication restrictions

Disclose MAOI use to all HCPS

128
Q

What are the 5 first line SSRI?

A

Sertraline Escitalopram Citalopram Fluoxetine Paroxetine

129
Q

What are the 2 first line SNRIs?

A

Duloxetine Venlafaxine

130
Q

What is the 5ht Modulator?

A

Vortioxetine

131
Q

What is the first line 1 NDRI?

132
Q

What is the first line 1 A2-agonist 5-ht2 antagonist

A

Mirtazapine

133
Q

What are the odds of remittance with antidepressant treatment?

A

1/3 remit after first treatment, 1/3 after second, and 2/3 after four treatment steps

Therapeutics (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions