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Fall Pharmacology > Depression > Flashcards

Depression Flashcards

1
Q

Dose a monoamine oxidase inhibitors

A

Phenelzine 15mg once daily

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2
Q

Dose a tricyclic antidepressant

A

Amitriptyline 150mg once a day at bedtime

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3
Q

Dose a selective serotonin reuptake inhibitor

A

Sertraline 100mg once daily

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4
Q

Dose a serotonin/norepinephrine reuptake inhibitor

A

Cymbalta 60mg once daily

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5
Q

If depression is left untreated, 15% of patients

A

commit suicide

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6
Q

Diagnosis of depression needs

A

depressed mood or loss of interest for at least 2 weeks + at least 4 of the following in the same period:
change in sleep pattern
change in appetite/weight
fatigue
psychomotor agitation or retardation
feelings of worthlessness/guilt
diff thinking/concentrating/ indecisiveness
recurrent thoughts of death, suicidal ideation, plans or attempts

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7
Q

What guidelines do we use to diagnose mental disorders

A

DSM-5

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8
Q

What monoamine oxidase inhibitors is available as a patch?

A

Selegeline

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9
Q

ADRs or monoamine oxidase inhibitors

A 
Suicidal thinking/behavior
Dizzy, lightheaded
Drowsy, fatigue, weakness
BP effects
Hypoglycemia possible
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10
Q

MOA of monoamine oxidase inhibitors

A

Monoamine levels rise in nerve endings, synapses, etc.

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11
Q

monoamine oxidase inhibitors include

A

Tranylcypormine
isocarboxazid
phenelzine
selegeline (targets MOA-B)

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12
Q

secondary amines of tricyclic antidepressants include

A

nortriptyline

desipramine

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13
Q

tertiary amines of tricyclic antidepressants include

A 
amitriptyline
clomipramine
doxepin
imipramine
trimipramine
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14
Q

tetracyclic amines of tricyclic antidepressants include

A

Maprotiline

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15
Q

How do you dose tricyclic antidepressants?

A

Based on observation, not plasma levels. So side effects and clinical response

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16
Q

ADRs of tricyclic antidepressants

A

Histamine receptor blockade= sedation
Alpha adrenergic blockade= postural hypotn
anticholinergic= clurred vision, dry mouth, constipation
cardiac= arrhythmias, sinus tachy, prolongation of conduction time

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17
Q

How often should tricyclic antidepressant be dosed?

A

Most effective once a day, single dose at bedtime

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18
Q

Differences for tricyclic antidepressants

A

Elderly don’t tolerate well, Nortriptyline is best. Younger pts it doesn’t matter

19
Q

MOA of tricyclic antidepressants

A

Block many receptor sites (leading to many side effects)

20
Q

Selective serotonin reuptake inhibitors include

A 
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
vilazodone
vortioxetine
21
Q

What would you not want to prescribe selective serotonin reuptake inhibitors with?

A

Monoamine oxidase inhibitors

Additive effect to result in serotonin syndrome (st johns wort, etc)

22
Q

MOA of SSRI

A

block reuptake of serotonin

23
Q

differences in SSRI categories

A

side effect profiles

paxil- decreased libido

24
Q

When do SSRIs need to be dose adjusted?

A

Not renally

maybe in severe liver impairment

25
Q

ADRs of SSRIs

A 
Increased fall risk
Lower bone mineral density
sexual dysfx
SIADH
Constipation, diarrhea, n, dizzy, HA, insomnia, etc etc
26
Q

serotonin/norepinephrine reuptake inhibitors include

A 
desvenlafaxine
duloxetine
levomilnacipran
milnacipran
venlafaxine
27
Q

Are SSRIs okay in pregnancy?

A

No reason to think unsafe

risk vs. benefits

28
Q

SNRIs MOA

A

serotonin and norepinephrine reuptake blockade, increasing levels of both

29
Q

What SNRI can be used for neuropathic pain?

A

Duloxetine

30
Q

What patient would Effexor be a poor choice?

A

HTN, can raise BP

31
Q

ADRs of venlafaxine

A 
raises BP
higher rate of emergent mania
dose dependent wt loss
insomnia
HA
32
Q

Highest risk of withdrawal issues for SSRIs and SNRIs

A

paroxetine and venlafaxine

33
Q

withdrawals symptoms of SSRI and SNRI include

A 
nausea
HA
dizziness
lethargy
flu-like symptoms
34
Q

ADRs of bupropion/ Wellbutrin

A

seizure lowering threshold (don’t use in bulimic pt)

anaphylactic reactions

35
Q

MOA of bupropion

A

norepi/dopamine reuptake inhibitor

36
Q

Benefit of bupropion

A

fast onset of action

37
Q

A serotonin antagonist is

A

Mirtazapine (Remeron)

38
Q

ADRs of mirtazapine

A

appetite increase (wt gain)
drowsiness
cholesterol increase

39
Q

Nefazodone can cause

A

hepatotoxicity

40
Q

ADRs to serotonin modulators

A

drowsiness
hypertension
weight gain

41
Q

Serotonin modulators include

A 
trazodone
vilazodone
nefazodone (don't write for)
42
Q

Overall efficacy of antidepressants

A

only 60-70% response rate, should see around 1-2 weeks with max effect seen in 4 to 6 weeks

43
Q

What age group is at an increased risk of suicide? decreased risk?

A

65 decreased risk of suicide

44
Q

Preferred agents for depression in elderly

A

Sertraline
Bupropion (extended release)
Citalopram (less drug interxns)

Fall Pharmacology (13 decks)

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