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Pharmacology > Exam 2: Antidepressants & Anxiolytics > Flashcards

Exam 2: Antidepressants & Anxiolytics Flashcards

1
Q

SSRIs: indications

A 
MDD
GAD
panic disorder
OCD
PMDD
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2
Q

SSRIs: adverse effects

A
  • sexual dysfunction
  • N/V/D/constipation
  • anxiety/jitteriness
  • sedation/drowsiness
  • switch to mania
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3
Q

Fluoxetine: drug interaction

A

CYP2C19 inhibitor

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4
Q

Paroxetine: drug interaction

A

CYP2D6 inhibitor

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5
Q

Fluoxetine: special considerations

A
  • most associated w/ jitteriness
  • give in AM
  • long T 1/2
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6
Q

Paroxetine: special considerations

A
  • most associated w/ constipation and sedation

- shortest T 1/2 (^ withdrawal)

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7
Q

Citalopram: special considerations

A
  • QTc prolongation

- dosage limits w/ CYP2C19 inhibitors

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8
Q

Escitalopram: special considerations

A

-QTc prolongation

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9
Q

Fluvoxamine: special considerations

A

best SSRI for OCD

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10
Q

Sertraline: special considerations

A

bad nausea and diarrhea

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11
Q

Vortioxetine: special considerations

A

bad nausea and diarrhea

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12
Q

SSRIs

A 
Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
Sertraline
Vortioxetine
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13
Q

SNRIs: describe how MOA varies based on dosing

A

low doses: bind to 5HT transporters

high doses: bind to NE transporters

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14
Q

SNRIs: indications

A

GAD
MDD
neuropathic pain

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15
Q

SNRIs: adverse effects

A
  • dizziness
  • insomnia
  • N/V/D/constipation
  • Xerostomia
  • Diaphoresis
  • HTN
  • Somnolence/fatigue
  • Sexual dysfunction
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16
Q

SNRIs: drug interactions

A

avoid use with:

-Sibutramine (5HT syndrome)

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17
Q

Duloxetine: drug interactions

A

CYP2D6 inhibitor

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18
Q

Velnafaxine: an SNRI w/ extra indications…

A

panic disorder

social anxiety disorder

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19
Q

Duloxetine: an SNRI w/ extra indications…

A

neuropathic pain (first line)
diabetic neuropathy
fibromyalgia

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20
Q

Milnacipran: an SNRI w/ an extra indication…

A

fibromyalgia

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21
Q

SNRIs

A 
Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran
Levomilnacipran
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22
Q

TCAs: secondary amines

A

desipramine*
nortriptyline*
protriptyline
amoxipine

23
Q

TCAs: tertiary amines

A 
amitriptyline*
clomipramine*
doxepin*
imipramine*
trimipramine
24
Q

TCAs: contraindications

A

elderly

suicidal pts

25
Q

TCAs: indications

A
  • insomnia, neuropathy

- (low doses, still may be hard to tolerate b/c of adverse effects)

26
Q

TCAs: adverse effects

A
  • switch to mania
  • CV*
  • anticholinergic*
  • antihistaminergic* (sedation, weight gain, confusion)
  • antiadrenergic (orthostasis, drowsiness dizziness)
27
Q

TCAs: drug interactions

A

avoid use with:

  • Antiarrythmics
  • Quinine
  • Ziprasidone
  • Metaclopramide
28
Q

TCAs: agents w/ less side effects

A

Desipramine

Nortriptyline

29
Q

Clomipramine: special consideration

A

best TCA for OCD

30
Q

Atypical antidepressants

A

buproprion
mirtazapine
trazodone

31
Q

Buproprion: MOA

A

associated w/ DA and NE

32
Q

Buproprion: indications

A

depression

smoking cessation

33
Q

Buproprion: special considerations

A
  • least amount of sexual dysfunction SE
  • very stimulating (good if pt needs energy)
  • good for obese pts (weight loss)
34
Q

Buproprion: contraindications

A

seizure disorders

35
Q

Buproprion: drug interactions

A 
avoid use with:
-MAOIs
-Tamoxifen
increased effects if combined w/ EtOH
strong CYP2D6 inhibitor
36
Q

Mirtazapine: MOA

A

central presynaptic a2-adrenergic antagonist: increased release of NE and 5HT

37
Q

Mirtazapine: indications

A
  • depression

- off label: appetite stimulant, sleep aid

38
Q

Mirtazapine: drug interactions

A

avoid use with:

  • MAOIs
  • Sibutramine (5HT syndrome)
39
Q

Trazodone: MOA

A

inhibits reuptake of 5HT and alters presynaptic 5HT receptors

40
Q

Trazodone: indications

A

MDD, but mostly used as hypnotic agent

41
Q

Trazodone: drug interactions

A
  • avoid use with sibutramine

- increased levels if combined w/ 3A4 inhibitors, alcohol, CNS depressants

42
Q

MAOIs

A

phenelzine
tranylcypromine
selegiline
isocarboxazid

43
Q

MAOIs

A

isocarboxazid
phenelzine
selegiline
tranylcypromine

44
Q

MAOIs: MOA

A

inhibit the degradation of 5HT by inhibiting deamination of monoamines»> increased 5HT and NE in cytoplasm of presynaptic neurons

45
Q

MAOIs: adverse effects

A

-tyramine toxicity (b/c MAO metabolize tyramine)»> hypertensive crisis

46
Q

Tyramine food sources

A

aged cheeses
processed meats
red wine
(soy products, caffeine, chocolate)

47
Q

MAOIs: indications

A

not 1st line therapy, used in refractory depression

48
Q

MAOIs: drug interactions

A

A LOT (these combined w/ adverse effects, dietary restrictions make MAOIs last line)

49
Q

Anxiolytics

A

antidepressants
benzos
buspirone

50
Q

Benzos: MOA

A
  • binds to GABA a receptors»> activates Cl- ion channels

- potentiates GABA (inhibitory)

51
Q

Benzos: indications

A

acute anxiety
acute alcohol withdrawal
insomnia
seizure disorders (used during seizure)

52
Q

Benzos: caution use in what pts?

A

elderly
substance abuse disorder
pregnancy

53
Q

Buspirone: MOA

A

partial agonist of 5-HT 1a

54
Q

Buspirone: indications

A

chronic anxiety (effect takes 2-6 weeks)

Pharmacology (6 decks)

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