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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
Q

type of paroxteine that has less GI side effects

A

paroxetine CR

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26
Q

SSRI that may cause GI distress, insomnia or activation

A

Sertraline

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27
Q

does any one SSRI have more propensity to cause sexual dysfunction than another SSSRI?

A

No

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28
Q

which SSRI has the shortest 1/2 life meaning it need to be tapered

A

paroxetine

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29
Q

Antidepressant discontinuation syndrome

A 
flu/ malaise
dizziness, GI ADRs
transient changes in modd, affect, appetite, sleep
"shock-like" in upper extremities
vivid dreams/ nightmares
poor concentration
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30
Q

MOA of TCAs

A

Block the reuptake of NE and 5-HT (NE > 5-HT)

also block Ach and histamine at bit

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31
Q

dosing for TCAs

A

once daily dosing (1/2 life is ~24 hours)

32
Q

how are TCAs metabolized?

A

P450 (potential for drug interactions)

33
Q

what are the secondary amines (TCAs)

A

notriptyline
despramine
protriptyline
amoxapine

34
Q

What are the tertiary amines

A

Amitriptyline
imipramine
clomipramine
doxepin

35
Q

what TCAs may need levels monitored?

A

nortriptyline
despramine
(draw blood sample 12 hours past last dose)

36
Q

ADRs of TCAs

A 
Tachycardia
orthostasis
weight gain
sedation
sexual dysfunction
ach effects (dry, urinary retention)
37
Q

Cardiac conduction of TCAs

A

prolongated of QRS, ST depression, flatttened or inverted T-waves

38
Q

what should you get on each patient before starting TCAs

A

baseline EKGs

39
Q

what TCAs have worse anticholingeric, antihistamine, hypotensive effects

A

tertiary amines

40
Q

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

A

Mirtazapine

41
Q

benefit of mirtazapine

A

less nausea and sexual dysfunction than SSRIs

42
Q

dosing for mirtazapine

A

once daily at bedtime due to sedation

43
Q

what is soltab?

A

Dissolvable tablet of mirtazapine

44
Q

ADRs of mirtazapine

A 
Somnolence (increased risk w/ lower dose)
dry mouth
constipation
orthostasis
increased appetite and weight gain
45
Q

Inhibits reuptake of NE and 5-HT

Also inhibits DA reuptake (to lesser extent)

A

Venlafaxine (Effexor)

46
Q

ADRs w/ venlafaxine

A 
Nausea
HA
somnolence
sexual dysfunction
Increase in DBP (dose dependent)
insomnia
agitation
47
Q

Active metabolite for venlafaxine
No mechanistic advantage
Wrong answer on exam… shouldn’t be prescribed

A

Desvenlafaxine

48
Q

Potent 5-HT NE reuptake inhibitor

Can be dosed 1-2 daily

A

duloxetine

49
Q

other uses of duloxetine

A

urinary incontinence

diabetic neuropathic pain

50
Q

ADRs of duloxetine

A 
nausea (most reported) 
diarrhea
insomnia/ sedation
urinary hesitancy 
hepatotoxicity
Increase in BP
51
Q

Believed to block reuptake of dopamine and norepinephrine
No clinically significant effect on 5-HT
considered a first line agent

A

Bupropion (Wellbutrin)

52
Q

ADRs w/ bupropion

A

increased risk of seizures as threshold reduced (dose related)
anxiety, sweating, HA
GI problems
weight loss

53
Q

Serotonin reuptake inhibitor plus potent 5-HT2 receptor antagonist
Enhanced 5-HT1
Hepatotoxicity risk

A

nefazodone (Serzone)

54
Q

ADRs w/ nefazodone

A 
Heptatotoxicity- need baseline levels
sedation, orthostasis
dry mouth, nausea
blurred vision 
(occur less commonly than w/ SSRIs)
55
Q

Blocks 5-HT2A receptors (potently); Blocks 5-HT reuptake less potently
Also has antihistaminic properties → Sedation

A

Trazodone

56
Q

Block the break down of NE, 5-HT, DA, and epinephrine

A

monoamine oxidase inhibitors (MAOIs)

57
Q

2 indications for trazodone

A

depression

insomnia

58
Q

2 types of MAOIs

A

A- (EPI, NE, 5-HT, DA, tyramine)

B- (DA, tyramine, benzylamine, phenylethylamine)

59
Q

what type MAOI is used for parkinsons

A

MAOI-B

60
Q

what type MAOI is used for depression

A

mixed

61
Q

what are the irreversible mixed MAOIs

A

phenelzine

isocarboxazid

62
Q

what is the reversible MAOI inhibitor

A

tranylcypromine

63
Q

Irreversible inhibitor of MAO-B; inhibits A and B in higher doses (>10 mg/day)
available as a patch

A

Transdermal selegiline

64
Q

Drug food interaction w/ MAOIs

A

Aged, hard cheeses and strongly flavored cheeses contraindicated

65
Q

ADRs w/ AMOIs

A 
orthostasis
dizziness
mydraisis
piloerection
edema
sexual dysfunction
66
Q

what 2 things are there a high risk of w/ MAOIs

A

serotonin syndrome

hypertensive crisis

67
Q

Drug interactions w/ MAOIs

A 
other antidepressants including herbals
buspirone
meperidine
dextromethorphan
sympathomimetics (L-dopa, epinephrine, tyramine, ampetamines)
cocaine
68
Q

An adverse effect due to excessive serotonin in the periphery

A

Serotonin syndrome (toxicity)

69
Q

Symptoms of serotonin syndrome (sternbach criteria)

A

neuromuscular hyperactivity
autonomic hyperactivity
cognitive/ behavior changes

70
Q

when will most people have an onset of response w/ antidepressants

A

4 weeks

if no response up the dose and wait another 2-3 weeks

71
Q

a trial of an antidepressants shouldn’t last longer than how

A

8 weeks

72
Q

if an SSRI needs to be d/c what should happen

A

tapered down before d/c or class switch (except FLX due to long 1/2 life)

73
Q

patients who show a partial response to antidepressants can be treated for how long?

A

up to 12-16 weeks to see if there’s a response

74
Q

BBW for SSRIs

A

Suicide for children and adolescents

75
Q

first line antidepressants in geriatrics

A

SSRIs

76
Q

what drugs shouldn’t be used in geriatrics w/ depression

A

TCAs

77
Q

antidepressants to be used for pregnancy/ lactation

A

SSRIs or TCAs

FLX most studied

*Pharm III (8 decks)

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