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*Pharm III > Depressive Spectrum > Flashcards

Depressive Spectrum Flashcards

1
Q

Mneumonic for symptoms of depression

A 
S leep disturbance
I nterest loss
G uilt
E nergy loss
C oncentration difficulties
A ppetite disturbance
P sychomotor retardation/ agitation
S uicidality
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2
Q

Meds than can cause depression

A 
Clonidine
Methyldopa
Propranolol
Prazosin
Alcohol
Alpha interferson
Corticosteroids
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3
Q

what endocrine condition is a big cause of depression

A

hypothyroidism

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4
Q

depression results from dysregulation of what 3 NTs?

A

Norepinephrine (NE)
Serotonin (5-HT)
Dopamine (DA)

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5
Q

What happens to post-synaptic 5-HT, DA, and NE receptors when the amount of these neurotransmitters is decreased?

A

Up-regulation of post-synaptic receptors
Decreased receptor sensitivity
Altered genetic expression

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6
Q

how does reserpine induce depression?

A

depletion of monoamines

depression reverse by 5-HT precursor

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7
Q

with loss of serotonin what happens

A

loss of impulse control

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8
Q

with loss of dopamine what do you lose?

A

drive

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9
Q

with loss of norepi what do you loss?

A

energy/ interest

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10
Q

Increased glucocorticoids may result from what?

A

severe stress

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11
Q

Hippocampus has negative feedback on the _______ _________

Glucocorticoids trigger this negative feedback

A

HPA loop

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12
Q

Potent regulator of plasticity of adult neurons and glia

Important for survival of neurons

A

BDNF- Brain Derived Neurotrophic Factor

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13
Q

where in the brain is the dopaminergic pathway

A

nucleus accumbens

amygdala

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14
Q

Mediates numerous functions ie., sleep, appetite, circadian rhythms, interest in sex

A

Hypothalamus

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15
Q

primary medication of choice for depression

A

SSRI

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16
Q

What are MAOIs reserved for now?

A

Parkinsons

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17
Q

TCAs have what type side effects

A

anticholinergic

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18
Q

what are the SSRIs (6)

A 
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine
Citalpram
Escitalopram
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19
Q

MOA of SSRIs

A

block reuptake of serotonin

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20
Q

are SSRIs titrated?

A

No

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21
Q

how are SSRIs dosed

A

once in the morning

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22
Q

common ADRs of SSRIs

A

Nausea
HA
sleep disturbances (not as common if take in am)
agitation/ increased anxiety (initially)

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23
Q

what SSRI has a very long 1/2 life

you could possibly abruptly stop because it could self taper

A

fluoxetine

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24
Q

SSRI more likely to cause sedation, constipation, dry mouth

A

paroxetine

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25
type of paroxteine that has less GI side effects
paroxetine CR
26
SSRI that may cause GI distress, insomnia or activation
Sertraline
27
does any one SSRI have more propensity to cause sexual dysfunction than another SSSRI?
No
28
which SSRI has the shortest 1/2 life meaning it need to be tapered
paroxetine
29
Antidepressant discontinuation syndrome
``` flu/ malaise dizziness, GI ADRs transient changes in modd, affect, appetite, sleep "shock-like" in upper extremities vivid dreams/ nightmares poor concentration ```
30
MOA of TCAs
Block the reuptake of NE and 5-HT (NE > 5-HT) | also block Ach and histamine at bit
31
dosing for TCAs
once daily dosing (1/2 life is ~24 hours)
32
how are TCAs metabolized?
P450 (potential for drug interactions)
33
what are the secondary amines (TCAs)
notriptyline despramine protriptyline amoxapine
34
What are the tertiary amines
Amitriptyline imipramine clomipramine doxepin
35
what TCAs may need levels monitored?
nortriptyline despramine (draw blood sample 12 hours past last dose)
36
ADRs of TCAs
``` Tachycardia orthostasis weight gain sedation sexual dysfunction ach effects (dry, urinary retention) ```
37
Cardiac conduction of TCAs
prolongated of QRS, ST depression, flatttened or inverted T-waves
38
what should you get on each patient before starting TCAs
baseline EKGs
39
what TCAs have worse anticholingeric, antihistamine, hypotensive effects
tertiary amines
40
Drug that is a potent and direct alpha-2 receptor antagonist Enhances 5-HT and NE transmission Blocks 5-HT2 and 3 receptors Results in enhances 5-HT1 reception
Mirtazapine
41
benefit of mirtazapine
less nausea and sexual dysfunction than SSRIs
42
dosing for mirtazapine
once daily at bedtime due to sedation
43
what is soltab?
Dissolvable tablet of mirtazapine
44
ADRs of mirtazapine
``` Somnolence (increased risk w/ lower dose) dry mouth constipation orthostasis increased appetite and weight gain ```
45
Inhibits reuptake of NE and 5-HT | Also inhibits DA reuptake (to lesser extent)
Venlafaxine (Effexor)
46
ADRs w/ venlafaxine
``` Nausea HA somnolence sexual dysfunction Increase in DBP (dose dependent) insomnia agitation ```
47
Active metabolite for venlafaxine No mechanistic advantage Wrong answer on exam... shouldn't be prescribed
Desvenlafaxine
48
Potent 5-HT NE reuptake inhibitor | Can be dosed 1-2 daily
duloxetine
49
other uses of duloxetine
urinary incontinence | diabetic neuropathic pain
50
ADRs of duloxetine
``` nausea (most reported) diarrhea insomnia/ sedation urinary hesitancy hepatotoxicity Increase in BP ```
51
Believed to block reuptake of dopamine and norepinephrine No clinically significant effect on 5-HT considered a first line agent
Bupropion (Wellbutrin)
52
ADRs w/ bupropion
increased risk of seizures as threshold reduced (dose related) anxiety, sweating, HA GI problems weight loss
53
Serotonin reuptake inhibitor plus potent 5-HT2 receptor antagonist Enhanced 5-HT1 Hepatotoxicity risk
nefazodone (Serzone)
54
ADRs w/ nefazodone
``` Heptatotoxicity- need baseline levels sedation, orthostasis dry mouth, nausea blurred vision (occur less commonly than w/ SSRIs) ```
55
Blocks 5-HT2A receptors (potently); Blocks 5-HT reuptake less potently Also has antihistaminic properties → Sedation
Trazodone
56
Block the break down of NE, 5-HT, DA, and epinephrine
monoamine oxidase inhibitors (MAOIs)
57
2 indications for trazodone
depression | insomnia
58
2 types of MAOIs
A- (EPI, NE, 5-HT, DA, tyramine) | B- (DA, tyramine, benzylamine, phenylethylamine)
59
what type MAOI is used for parkinsons
MAOI-B
60
what type MAOI is used for depression
mixed
61
what are the irreversible mixed MAOIs
phenelzine | isocarboxazid
62
what is the reversible MAOI inhibitor
tranylcypromine
63
Irreversible inhibitor of MAO-B; inhibits A and B in higher doses (>10 mg/day) available as a patch
Transdermal selegiline
64
Drug food interaction w/ MAOIs
Aged, hard cheeses and strongly flavored cheeses contraindicated
65
ADRs w/ AMOIs
``` orthostasis dizziness mydraisis piloerection edema sexual dysfunction ```
66
what 2 things are there a high risk of w/ MAOIs
serotonin syndrome | hypertensive crisis
67
Drug interactions w/ MAOIs
``` other antidepressants including herbals buspirone meperidine dextromethorphan sympathomimetics (L-dopa, epinephrine, tyramine, ampetamines) cocaine ```
68
An adverse effect due to excessive serotonin in the periphery
Serotonin syndrome (toxicity)
69
Symptoms of serotonin syndrome (sternbach criteria)
neuromuscular hyperactivity autonomic hyperactivity cognitive/ behavior changes
70
when will most people have an onset of response w/ antidepressants
4 weeks | if no response up the dose and wait another 2-3 weeks
71
a trial of an antidepressants shouldn't last longer than how
8 weeks
72
if an SSRI needs to be d/c what should happen
tapered down before d/c or class switch (except FLX due to long 1/2 life)
73
patients who show a partial response to antidepressants can be treated for how long?
up to 12-16 weeks to see if there's a response
74
BBW for SSRIs
Suicide for children and adolescents
75
first line antidepressants in geriatrics
SSRIs
76
what drugs shouldn't be used in geriatrics w/ depression
TCAs
77
antidepressants to be used for pregnancy/ lactation
SSRIs or TCAs | FLX most studied

*Pharm III (8 decks)

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