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Pharmacology > Exam 10: Antidepressants > Flashcards

Exam 10: Antidepressants Flashcards

1
Q

What are two Tricyclic Antidepressants?

A

Imipramine

Amitriptyline

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2
Q

What are Imipramine and Amitriptyline?

A

Tricyclic Antidepressants

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3
Q

Name 6 SSRIs

A 
Fluoxetine
Fluvoxamine
Sertraline
Paroxetine
Citalopram
Escitalopram
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4
Q

Name 2 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

A

Venlafaxine

Duloxetine

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5
Q

Name 4 second generation (atypical) antidepressants

A

Trazodone
Nefazodone
Bupropion
Mirtazepine

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6
Q

Name 1 Selective Norepinephrine Reuptake Inhibitor

A

Atomoxetine

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7
Q

Name 3 MAO Inhibitors

A

Phenelzine
Tranylcypromine
Selegiline

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8
Q

Name 4 Mood Stabilizers

A

Lithium carbonate
Valproic Acid analogs
Carbamazepine
Clonazepam

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9
Q

Fluoxetine category

A

SSRI

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10
Q

Fluvoxamine category

A

SSRI

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11
Q

Sertraline category

A

SSRI

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12
Q

Paroxetine category

A

SSRI

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13
Q

Citalopram category

A

SSRI

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14
Q

Escitalopram category

A

SSRI

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15
Q

Venlafaxine category

A

SNRI

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16
Q

Duloxetine category

A

SNRI

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17
Q

Atomoxetine category

A

Selective Norepinephrine reuptake inhibitor

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18
Q

Phenelzine category

A

MAO Inhibitor

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19
Q

Tranylcypromide category

A

MAO Inhibitor

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20
Q

Selegiline category

A

MAO Inhibitor

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21
Q

Lithium category

A

Mood stabilizer

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22
Q

Valproic acid analog category

A

Mood stabilizer

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23
Q

Carbamazepine category

A

Mood stabilizer

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24
Q

Clonazepam category

A

Mood stabilizer

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25
Q

What are three first line drug categories for depression?

A

Tricyclics
SSRIs
Miscellaneous Second gen antidepressants (Atypical)

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26
Q

What is a second line category of drug for depression?

A

MAO Inhibitors

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27
Q

What is an anti anxiety drug that is thought to have antidepressant activity?

A

Alprazolam (Xanax)

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28
Q

What is a problem with the use of antidepressants in Manic Depressive Disorders?

A

They can help with depression, but may trigger a switch to the manic phase

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29
Q

What is the main benefit of SSRIs over Tricyclics?

A

They are safer, not really more efficacious.

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30
Q

What can’t you eat if you’re on MAO inhibitor?

A

foods that contain Tyramine will cause a massive release of catecholamines

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31
Q

What is a side effect that is pronounced in Trazodone and Nefazodone?

A

Very sedating

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32
Q

Imipramine Pharmacological Effects (5) (prototype for antidepressants)

A
  1. Sedation
  2. Antidepressant effects develops slowly over 2-4 weeks
  3. Can also treat OCD, panic attacks, generalized anxiety disorder, social phobias
  4. CNS Stimulation (usually at higher doses)
  5. Decreased seizure threshold
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33
Q

Imipramine mechanism of action (2) (other antidepressants)

A
  1. Inhibits reuptake of NE, 5-HT and/or DA

2. Adaptive changes in receptors and signaling pathways

34
Q

What is special about Bupropion?

A

It has the most major effect on DA reuptake inhibition (most others barely affect this or don’t at all)

35
Q

What side effects are not seen in SSRIs?

A

Cardiovascular side effects because they don’t affect NE and don’t have anticholinergic activity

36
Q

What is an additional mechanism seen in second gen antidepressants (not SSRIs or Tricyclics)?

A

Blockage of alpha 2 receptors

Can affect the cardiovascular system

37
Q

Which of the first line antidepressants has the worst anticholinergic effect? the least?

A

Amitriptyline is the worst

SSRIs have the least effect

38
Q

What are cardiovascular effects of antidepressants? Why?

A

Postural hypotension due to alpha blockade
Tachycardia (NE, anticholinergic)
Arrhythmias

39
Q

CNS side effects of antidepressants

A 
Tremor
Agitation, anxiety, irritability 
switch to manic phase
parkinsonism
increased risk of seizures
40
Q

What antidepressants are most/least likely to cause weight gain?

A 
Most = tricyclics
Least = SSRIs
41
Q

What is a potentially fatal side effect of antidepressants?

A

blood dyscrasias

42
Q

How can antidepressants affect sex?

A

Impotence or delay of orgasm in males due to alpha blockade (very common)
retrograde ejaculation can occur

43
Q

What is the traditional antidote to tricyclic toxicity?

A

Bicarb (alkalinize the urine)

44
Q

What is a major consideration when prescribing drugs to a depressed person?

A

They may be suicidal. The drugs you give them may be used to commit suicide

45
Q

What is a potential interaction of MAO inhibitors?

A

Serotonin syndrome can happen if switch patients between MAOIs and tricyclics/SSRIs too quickly

46
Q

What are some other uses of antidepressants?

A 
Enuresis (imipramine)
intractable pain from neuropathies
chronic pain
cocaine/amphetamine dependence
Anxiety/panic disorders
OCD
47
Q

What is a consideration when prescribing antidepressants to children?

A

May increase suicidal ideation, especially shortly after drug therapy is initiated.

48
Q

What effects are different about Amitryptiline vs Imipramine

A

Amitriptyline has more sedative and anticholinergic activity than imipramine

49
Q

Fluoxetine

A

Prototype SSRI
Treats depression, OCD, GAD, PMMD, eating disorders
Long acting, takes a while to work
Liver metabolism- drug interactions (CYP)

50
Q

sertraline

A

SSRI

Less drug interactions than Fluoxetine

51
Q

Paroxetine

A

SSRI
SHORTER ACTING than Fluoxetine and Sertraline
More weight gain than other SSRIs

52
Q

Citelopram and Escitalopram

A

Newest SSRIs

Similar to Sertraline (fewer drug interactions than Fluoxetine)

53
Q

What is an advantage of Fluoxetine?

A

Longer acting, protects against discontinuation symptoms

54
Q

Fluvoxamine uses (2)

A
  1. Antidepressant used in foreign countries

2. Used of Obsessive Compulsive disorder in the USA

55
Q

Bupropion mechanism

A

Selectively blocks DA reuptake

56
Q

Bupropion effects

A

“Psychic energizer” with mild stimulant activity

57
Q

Disadvantage of Bupropion

A

More likely to cause seizures than other antidepressants

58
Q

Bupropion use

A

Treatment of nicotine, cocaine, amphetamine dependence

59
Q

Bupropion advantage

A

Less likely to cause sexual side effects than other antidepressants

60
Q

Uses of Venlafaxine (2)

A
  1. Depression

2. Generalized anxiety disorder

61
Q

Venlafaxine effects

A

Improve mood, energize depressed patients

May work in patients who do not respond to SSRIs

62
Q

Venlafaxine side effects

A

Stimulant-like effects (sweating, nausea, anxiety, nervousness)

63
Q

Duloxetine uses

A

Musculoskeletal and neuropathic pain as well as depression/anxiety

64
Q

Trazodone/Nefazadone mechanism

A

Serotonin reuptake inhibitor that also blocks 5-HT receptors (idk how this makes sense)

65
Q

Trazodone/Nefazadone side effects (2)

A
  1. Priapism/sexual dysfunction in males

2. highly sedating

66
Q

Mirtazapine mechanism

A

Blocks alpha-2 receptors, enhancing serotonin and NE release

Also blocks some types of serotonin receptors

67
Q

Mirtazapine side effects

A

Anticholinergic, hypotension, tachycardia (similar to tricyclics)

68
Q

In whom is Mirtazapine especially effective

A

Depression with high levels of anxiety

69
Q

Atomoxatine use

A

ADHD in children and adults

70
Q

Atomoxatine side effects

A

Appetite suppression, increased BP, tachycardia, sexual dysfunction in adult males

71
Q

How do MAO inhibitors take effect?

A

Slowly, take weeks to develop

72
Q

MAO inhibitors side effects

A

Orthostatic hypotension, hypertension, GI effects, CNS stimulation, liver damage

73
Q

What is a severe problem with MAO inhibitors?

A

If taken with foods containing lots of Tyramine can cause hypertension, fever, convulsions.
Same can happen if the patient has a pheochromocytoma or is on sympathomimetics

74
Q

MAO inhibitor uses (3)

A
  1. Depression (second line)
  2. Bulimia, OCD, PTSD
  3. Narcolepsy
75
Q

Lithium effects on the CNS

A

On most people it has no affect

On people with bipolar disorder it is a mood stabilizer

76
Q

Lithium Mechanism

A

May alter metabolism of phospholipids that are involved in the phospholipid signaling pathway
May also affect distribution of ions or the release of neurotransmitters

77
Q

Pharmacokinetic consideration of Lithium

A

Excreted by kidney, use with caution in patients with impaired renal function

78
Q

What can early lithium toxicity mimic?

A

Alcohol intoxication

79
Q

What are 4 patents who shouldn’t get Lithium?

A
  1. Pregnancy
  2. Renal impairment
  3. CV disease
  4. thyroid disease
80
Q

What are 4 drugs used to treat manic depression?

A
  1. Lithium
  2. Carbamazepine
  3. Valproic Acid
  4. Clonazepam
81
Q

What do you need to do before giving an MAO inhibitor?

A

Make sure that they’ve stopped taking tricyclics long enough

82
Q

What drug is preferred for MILD depression with anxiety?

A

Alprazolam (Xanax)

Pharmacology (34 decks)

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