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Pharmacology > Depression > Flashcards

Depression Flashcards

1
Q

Major depression symptoms

A

depressed most of day, most days; diminished interest in activities, dec weight/wt inc; insomnia, hypersomnia, fatigue; feeling worthless, guilty; dec ability to concentrate, recurrent thoughts of death

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2
Q

Subgroups of depression

A

psychotic, atypical, seasonal, postpartum, melancholia, catatonic

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3
Q

Pathophysiology of depression

A

reduced neurotransmitters: serotonin, norepi, DA, mostly invloving limbic and hypothalamus

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4
Q

Treatment options for depression

A

psychotherapy, electroconvulsive therapy, antidepressants

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5
Q

Electroconvulsive therapy

A

unilateral/ bilateral seizures that change level of neurotransmitters, response faster than drugs, may need 6-12 months of therapy, most pts respond, be careful w/ stoke or MI

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6
Q

Antidepressant treatment

A

onset requires weeks, appears to restore the neurotransmitter mediated balance in the brain between serotonin, norepi, and DA, 60-70% efficacy no matter the agent, don’t d/c abruptly, shouldn’t be on 2 from same class

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7
Q

SSRIs

A

paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitaloprom (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), vortioxetine (Brintellix)

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8
Q

SSRI MOA

A

inhibits the reuptake of serotonin at the pre-synaptic serotonin transporter pump, inc brain serotonin levels, not fatal if overdose

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9
Q

SSRI ADRs

A

CNS abnormalities, GI upset, st change, hyponatremia, decreased libido

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10
Q

Fluoxetine (Prozac)

A

Long T1/2- active metabolites, , activating, causes insomnia, wt loss, minor dopamine antagonist

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11
Q

Fluoxetine (Prozac) dosage

A

20 mg PO daily, only one available once a week option, 90 mg PO weekly, good for noncompliant pts, must adhere first 2 weeks

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12
Q

Parocetine (Paxil)

A

wt gain and sedation prominent, take at bedtime, 20-40 mg PO once daily

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13
Q

Sertraline (Zoloft)

A

25-100 mg PO once daily, middle of the road in terms of effects on sleep and appetite, DA agonist (Minor), good for parkinson’s

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14
Q

Citalopram (Celexa)

A

20-40 mg PO daily, only effects serotonin, not DA or Ach, fewest ADRs, better for mild to mod depression

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15
Q

Fluoxamine (Luvox)

A

50-100 PO daily, only indicated for OCD, can also be used to boost activity of antipsychotic agents

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16
Q

All SSRIs are

A

highly protein bound, inhibit P450 system, increase effects of TCAs, inc/dec lithium, dec clearance of trazodone and diazepam, inc toxicity of MAOIs, may displace protein bound drugs

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17
Q

SNRIs

A

Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafacine (Pristiq)

18
Q

SNRI MOA

A

inhibit neuronal serotonin and nor epi reuptake results in inc brain serotonin and norepi levels

19
Q

Venlafaxine (effexor)

A

take with food, may be effective for resistant depression, ADR exceptions, less sexual side effects, HTN

20
Q

Venlafaxine (effexor) dosage

A

75-150mg PO BID, used most frequently as XR formulation: 75-150 PO daily

21
Q

Desvenlafaxine sodium (Pristiq)

A

Longer T1/2 than venlafaxine,, requires adjustment for impaired renal function, ADR profile is very similar to venlafaxine

22
Q

Duloxetine (Cymbalta)

A

40-60 mg PO daily, quicker onset, effective in one week? used reg for diabetic peripheral neuropathy, hepatoxic

23
Q

Tricyclic antidepressants

A

Amitriptyline (Elavil), doxepin (sinequan), nortriptyline (Pamelor), imipramine (tofranil), clomipramine (Anafranil), desipramine (Norpamin)… and more

24
Q

MOA of TCA

A

inhibit the of reuptake of norepi and/or serotonin, causing a relative inc in [neurotransmitter], can be fatal in overdose

25
Q

TCA ADRs

A

most common: ach effects, sedation and orthostatic hypotension, TCAs lower the seizure threshold and may precipitate seizures, tachycardia, arrhythmias, elderly are at risk of sedation and hyTN

26
Q

Amitriptyline

A

10-100mg PO daily, generally at bedtime, used reg for insomnia in young pop

27
Q

Trazodone (Desyrel)

A

inhibit serotonin reuptake, 100 mg PO once daily at bedtime, often used in combo w/SSRIs for insomnia, no ACh ADRs, may cause priapism, take w/ food

28
Q

Bupropion (Wellbutrin) MOA

A

mild DA reuptake inhibitor, little effect on norepi, no effect on seritonin or monoamine oxidase

29
Q

Bupropion (Wellbutrin)

A

Contraindicated in pts w/ seizure disorders and psychosis, lack of cardiovascular, ACh, and sexual side effects, Wt loss, insomnia, agitation, HA, a DOC for smoking cessation, also available as wellbutrin SR/XL

30
Q

Mirtazapine (Remeron)

A

enhances central norep and serotonin activity by antagonizing central pre-synaptic a2 receptors, often as adjunct (30mg), monotherapy for insomnia, possibly faster onset

31
Q

Mirtazapine (Remeron) ADRs

A

somnolence, at low dose, dizziness, increased appetite/wt gain, orthostatic hyTN, and hallucinations

32
Q

MAOIs

A

Phenelzine (Nardil), Selegiline (Eldepryl, Zelapar), tranylcypromine (parnate)- none use very often, must have 2 week washout period when switching from other vice versa

33
Q

MAOI MOA

A

impair degradation of norepinephrine, serotonin, and dopamine leading to inc neurotransmitter conc; prevents metabolism of tyramine in GI and liver causing release of norepi and severe HTN, rarely use w/ another class

34
Q

MAOI ADRs

A

orthostatic hypotension, delayed ejaculation, wt gain, and edema, can switch bipolar pts into mania, liver toxic, lot of DIs

35
Q

Withdrawal of antidepressants

A

1-5 days after d/c, fatigue, insomnia, dizziness, tremor, confusion, agitation, memory probs

36
Q

Treatment of withdrawals

A

resume antidepressant if possible, reassurance and supportive care, not life threatening rxns, can be disturbing

37
Q

Serotonin syndrome

A

symptoms complex characterized by mental status changes, agitation, diaphoresis, diarrhea*, incoordination and tachy

38
Q

Cause of serotonin syndrome

A

believed to be from serotonergic hyperstimulation, can develop when taking a combo of serotonergic meds or when changing from one serotonergic drug to another, also from DI that applify the seroonergic effect of single drug

39
Q

Treatment serotonin syndrome

A

d/c all serotonergic meds, supportive care

40
Q

Suicide warning for antidepressants

A

boxed warning on most if not all agents, inc in suicide thinking and behavior, not completed attempts

41
Q

Treatment resistance

A

clinical trial have documented that most persons do not recover completely from depression w/ 1st drug therapy, many will require therapy w/ 2 or more concurrent agents, for recurrent disease, must treat x2years

Pharmacology (61 decks)

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