M2.5 Flashcards
1
Q
- characterized by depressed mood
- at least 2 weeks
- loss of interest or pleausre, disturbances in sleep & appetie, deficits in cognition & energy, thoughts of guilt, worthlessness, and suicide
A
MAJOR DESPRESSIVE DISORDER
MDD
2
Q
PATHOPHYSIOLOGY OF MAJOR DEPRESSEION
- depression is related to a DEFICIENCY in the amount or function of cortical and limbic serotonin (5-HT), norepinephrine (NE), and dopamine (DA)
A
MONOAMINE HYPOTHESIS
2
Q
PATHOPHYSIOLOGY OF MAJOR DEPRESSEION
- depression is associated with the loss of neurotrophic support, the BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF), which are critical in the regulation og neural plasticity, resilience, and neurogenesis
A
NEUROTROPHIC HYPOTHESIS
3
Q
PATHOPHYSIOLOGY OF MAJOR DEPRESSEION
a NEUROPATHIC SUPPORT that is critical in the regulation of nerual plasticity, resilience, and neurogenesis
A
BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF)
4
Q
PATHOPHYSIOLOGY OF MAJOR DEPRESSEION
____ glutamate in the CEREBROSPINAL fluid of depressed patients
A
ELEVATED
5
Q
PATHOPHYSIOLOGY OF MAJOR DEPRESSEION
____ glutamate/glutamine ratios in the PLASMA has been considered as possible cause of MDD
A
DECREASED
6
Q
NEUROENDOCRINE FACTORS
MDD is associated with elevated ____ levels
A
cortisol
7
Q
NEUROENDOCRINE FACTORS
MDD is associated with nonsuppression of ____ hormone release in the dexamethasone suppresion test
A
adrenocorticotropic hormone (ACTH)
8
Q
NEUROENDOCRINE FACTORS
MDD is associated with chronically elevated levels of ____ hormone
A
corticotropin-releasing
9
Q
NEUROENDOCRINE FACTORS
MDD factors
A
elevated cortisol levels
thyroid disregulation
estrogen deficiency
10
Q
NEUROENDOCRINE FACTORS
type of THYROID disregulation that is more associated with MDD
A
hypothyrodism
11
Q
NEUROENDOCRINE FACTORS
- ____ are thought to play a role in the etiology of depression in some WOMEN
- this occur in the postpartum and postmenopausal periods
A
ESTROGEN DEFICIENCY
12
Q
NEUROENDOCRINE FACTORS
severe ____ in MEN is sometimes associated with depressive symptoms
A
TESTOSTERONE DEFICIENCY
13
Q
DRUG THERAPY FOR MAJOR DEPRESSION
Drugs for MAJOR depression
A
SSRI
SNRI
Uni, Tri, Tetra cyclic
MAOI
14
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
enhance serotonin
A
Selective Serotonin Reupatake Inhibitors
SSRI
15
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
SNRIs and TCAs
A
Serotonin-Norepinephrine Reuptake Inhibitors
SNRI
16
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
an AUTORECEPTOR
A
5-HT2
17
Q
SEROTONIN-SPECIFIC REUPTAKE INHIBITOR (SSRI)
prototype
A
Fluoxetine
18
Q
SEROTONIN-SPECIFIC REUPTAKE INHIBITOR (SSRI)
S-enantiomer of citalopram
A
Escitalopram
19
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
- first line of treatment for MDD
- increase serotonin
- as effective as TCA in the treatment of depression
- Fewer sedative, autonomic, and cardiovascular side effects than TCAs
- Safer than TCAs following an overdose
A
SEROTONIN-SPECIFIC REUPTAKE INHIBITOR
SSRI
20
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
a POTENT INHIBITOR of hepatic CYP-450 isoenzyme
inhibit enzyme = enhance another drug
A
Fluoxetine
21
Q
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)
active metabolite of VENLAFAXINE
A
DESVENLAFAXINE
22
Q
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)
active enantiomer of MILNACIPRAM
A
LEVOMILNACIPRAM
23
Q
MAJOR CATEGORIES OF ANTIDEPRESSANTS
- bind both the SEROTONIN (SERT) and NE (NET) transporters
- they LACK;
* antihistamine
* alpha-adrenergic blockade
* anticholinergic effects - NO Anti-HAM effect
- favored over TCAs in the treatment of MDD nad pain syndromes
A
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR
SNRI
24
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **NE** and **SEROTONIN** reuptake inhibitor
* **Tertiary** and **Secondary** amine
* potent **antagonists** of **H1 receptor**
* possess **ANTIMUSCARINIC effects**: dry mouth, constipation
* block **ALPHA-ADRENERGIC** receptor
TRICYCLIC ANTIDEPRESSANTS
25
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
* **Ami**triptyline
* **Imip**ramine
* **Tri**mipramine
* **Clo**mipramine
* **Dox**epin
TERTIARY AMINE
| Ami Imip Tri Clo Dox
26
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
* **Pro**triptyline
* **Desi**pramine
* **Nort**riptyline
SECONDARY AMINE
| Pro si Desi sa North
26
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
TERTIARY AMINE:
**prototype** drug
Imipramine
27
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
* block **NE reuptake** more than serotonin reuptake (**increases NE**)
* are **LESS likely** to cause **sedation**, **hypotension**, and **anticholinergic** effects
* are **MORE likely** to **induce psychosis**
SECONDARY AMINES
28
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
**SECONDARY** AMINES:
block ____ reuptake **more**
NE reuptake
29
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
**SECONDARY** AMINES:
are ____ likely to cause **sedation**, **hypotension**, and **anticholinergic** effects
LESS
30
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
**SECONDARY** AMINES:
are **MORE likely** to ____
induce psychosis
31
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
**primarily** block **SEROTONIN** uptake
TERTIARY AMINES
32
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
**potent ANTAGONISTS** of ____ receptor
H1
33
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
posses ____ effects; **dry mouth**, **constipation**
antimuscarinic
34
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TCA**
block ____ receptor
alpha-adrenergic
35
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **Dulo**xetine
* **Ven**lafaxine
* **Desven**lafaxine
* **Milna**cipran
* **Levo**milnacipran
SNRI
| sa DULO sina VEN at DESVEN, pati na rin si MILA at LEVO
36
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **Ser**traline
* **Fluo**xetine
* **Cital**opram
* **Escital**opram
* **Paro**xetine
* **Fluvo**xamine
SSRI
| SER sa FLUOr na lang ako mag reCITAL ng PARO-paro sa FLUVO
37
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **Nefa**zadone
* **Traz**odone
5-HT2 antagonists
38
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **block** 5-HT2A receptor associated with **antianxiety**, **antipsychotic**, and **antidepressant** effects
5-HT2 antagonists
39
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | 5-HT2**
a **weak INHIBITOR** of **both** **SERT** and **NET**
NEFAZODONE
40
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | 5-HT2**
a weak but **SELECTIVE inhibitor** of **SERT**
TRAZODONE
41
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
* in animal studies, it is a **modest-to-moderate inhibitors** of **NE** and **DOPAMINE reuptake**
* causes **presynaptic release** of **CATECHOLAMINES**
* used for **SMOKING CESSATION**
BUPROPION
42
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **Amo**xapine
* **Bup**ropion
* **Map**rotiline
* **Mirta**zapine
TETRACYLIC & UNICYCLIC ANTIDEPRESSANTS
| ang AMO ni BUP at MAP ay si MIRTA
43
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
**Buproprion** is modest-to-moderate inhibitors of ____ and ____ reuptake
NE and DA
44
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
**Bupropion** causes **presynaptic release** of ____
catecholamines
45
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
used for **SMOKING CESSATION**
Bupropion
46
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
* has a **complex pharmacology**
* an **antagonist** of **ALPHA-AUTORECEPTOR** and **enhances** the **release** of both **NE** and **5-HT**
* an **antagonist** of **5-HT2** and **5-HT3** receptors and a potent **H1 antagonist**
MIRTAZAPINE
47
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
**Mirtazapine** is an **antag**onist of
| (3)
alpha-autoreceptor
5-HT2
5-HT3
48
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
**Mirtazapine** **enhances** the **release** of ____ and ____
NE and 5-HT
49
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
**Mirtazapine** is a **potent antagonist** of ____
H1
50
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | TETRAcyclic & UNIcyclic**
same as TCAs
Amoxapine & Maprotiline
51
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS**
* **Hydralazine**
* **Non**-hydrazine
* MAO **A** selective
* MAO **B** selective
* **Nonselective**
MONOAMINE OXIDASE INHIBITORS
MAOIs
52
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
Classes based on **STRUCTURE**
Hydralazine
Non-hydrazine
53
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
Class based on **SELECTIVITY**
MAO A selective
MAO B selective
NONselective
54
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
* **reversible**
* **LESS** toxic
Moclobemide
MAO A selective
55
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
* **IRrevesible**
* **MORE** toxic
Selegiline
MAO B selective
56
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
MAO **A** selective
Moclobemide
57
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
MAO **B** selective
Selegiline
58
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
**NON**seelctive
Phenelzine
Isocarboxazid
Tranylcylpromine
59
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
tx for **depression**
MPIT
60
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
tx for **Parkinson's**
PITS
61
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
resposible for the **inactivation** of any **SEROTONIN** or **NE** that may leak out presynaptic storage vesicles
MAO A
62
# **MAJOR CATEGORIES OF ANTIDEPRESSANTS | MAOIs**
responsible for the **metabolism** of **DOPAMINE**
MAO B
63
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
**most** antidepressants are **approved** for both ____ and ____ treatment of **major depression**
acute and long-term
64
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
goal of **ACUTE** treatment of MDD
remission of all symptoms
65
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
**SSRIs** and **SNRIs** have been approved for all the **major** ____ **disorders**
anxiety
66
# **ANXIETY DISORDERS**
* is manifested when a **TRAUMATIC** or **LIFE THREATENING event** results in **INTRUSIVE anxiety** **provoking thoughts** or **imagery**, **hypervigilance**, **nightmares**, and **avoidance** of **situations** that **remind** the patient of the trauma
* other treatments: **psychotherapeutic interventions** in addition to antidepressants
PTSD (Post-Traumatic Stress Disorder)
67
# **ANXIETY DISORDERS**
considered **FIRST-LINE** treatment for **PTSD**
SSRI
68
# **ANXIETY DISORDERS**
* characterized by **REPETITIVE anxiety-rpovoking thoughts** (***obsessions***) or **REPETITIVE behaviors** aimed at reducing anxiety (***compulsions***)
* **Behavior therapy** is usually combined with the antidepressant for additional benefits
OCD
Obsessive-Compulsive Disorder
69
# **ANXIETY DISORDERS**
____ and several of the **SSRIs** are approved for the treatment for **OCD**, and they are **moderately effective**
CLOMIPRAMINE
70
# **ANXIETY DISORDERS**
* patients experience **SEVERE anxiety** in **SOCIAL INTERACTIONS**
* **limit** the **ability to function** adequately in their **jobs** or **interpersonal relationships**
SOCIAL ANXIETY DISORDER
71
# **ANXIETY DISORDERS**
several **SSRIs** and ____ are approved ofr the treatment of **SOCIAL ANXIETY DISORDER**
VENLAFAXINE
72
efficacy of the ____ in the treament of **social anxiety** is **GREATER** in some studies than their efficacy in the treatment of **MDD**
SSRIs
73
# **ANXIETY DISORDERS**
* characterized by a **CHRONIC**, **free-floating anxiety** and **undue worry** that tends to be chronic in nature
GAD
Generalized Anxiety Disorder
74
# **ANXIETY DISORDERS**
* characterized by **RECURRENT episodes** of **BRIEF overwhelming anxiety**, which often occur **without precipitant**
PANIC DISORDERS
75
# **ANXIETY DISORDERS**
drugs used for **GAD** and **PANIC disorders**
SSRI
SNRI
BZD
76
# **ANXIETY DISORDERS**
**MORE** used drugs for **GAD** and **PANIC disorders**
SSRI & SNRI
77
# **ANXIETY DISORDERS**
**GAD** & **PANIC DISORDERS**:
____ and ____ have largely **replaced** sedative-hypnotics and older antidepressants
SSRI and SNRI
78
# **ANXIETY DISORDERS**
**GAD** & **PANIC DISORDERS**:
____ provide **much more rapid relief** of both GAD and panic disorder
BZD
79
# **ANXIETY DISORDERS**
**GAD** & **PANIC DISORDER**:
____ appear as to be **as effective** or **more effective** than ____ in the **LONG-TERM** treatment of **GAD**
Antidepressants; BZDs
80
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
**antidepressants** possess ____ properties **independent** of their mood effects
analgesic
81
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
____ have been used in the treatment of **NEUROPATHIC** and other **pain conditions**
Tricyclic antidepressant
TCA
82
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
medications that posses both ____ and ____ properties are often useful in treating **PAIN disorders**
**NE** and **5HT** reuptake blockers
83
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | PAIN DISORDER**
was approved for the treatment of **CHRONIC JOINT** and **MUSCLE PAIN**
DULOXETINE
84
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | PAIN DISORDER**
is approved for the treatment of **FIBROMYALGIA** - widespread muscle pain
MILNACIPRAN
85
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | PAIN DISORDER**
is being investigated for a variety of pain conditions from **POSTHERPETIC NEURALGIA** to **chronic back pain**
DESVENLAFAXINE
86
lasting pain due to **shingles** (HSV4) caused by **herpes**
postherpetic neuralgia
87
herpes: **oral** infections
HSV1
88
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
* prominent **mood** and **physical symptoms** during the **LATE LUTEAL PHASE** of almost every cycle
* may include **anxiety**, **depressed** mood, **irritability**, **insomnia**, **fatigue**, and a variety of other physical symptoms
* symptoms are **more severe** than those typically seen in **premenstrual syndrome** (PMS) and can be quite **disruptive** to **vocational** and **interpesonal** activities
PREMENSTRUAL DYSPHORIC DISORDER
(PMDD)
89
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
drugs for **PREMENSTRUAL DYSPHORIC DISORDER** (PMDD)
Fluoxetine
Sertraline
90
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
* Bulimia Nervosa
* Anorexia Nervosa
eating disorders
91
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
* characterized by **EPISODIC INTAKE** of **LARGE** **amounts of food** (**binges**) followed by **ritualistic PURGING** through **EMESIS**, the use of **laxatives**, or other methods
BULIMIA NERVOSA
92
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
* is a disorder in which **REDUCED food intake** results in a **LOSS OF WEIGHT** of 15% or more of ideal body weight
* the person has a **MORBID FEAR** of **gaining weight** and a **highly DISTORTED body image**
ANOREXIA NERVOSA
93
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
**antidepressants** appear to be helpful in the treatment of ____ but **NOT** ____
helpful in **bulimia** but NOT in **anorexia**
94
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
drug approved for the treatment of **BULIMIA NERVOSA**
fluoxetine
95
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
**primary** treatment for **ANOREXIA**
refeeding, family therapy, conitive & behavioral therapy
96
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS | EATING DISORDERS**
may have some benefits in treating **OBESITY**
Bupropion
97
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
* was approved as a treatment for **SMOKING CESSATION**
* experience **fewer mood symptoms** and possible **less weight gain** while withdrawing from nicotine dependence
* as effeective as **nicotine patches**
BUPROPION
98
# **CLINICAL INDICATIONS OF ANTIDEPRESSANTS**
* has been shown to be helpful in **smoking cessation**
* the effects have **NOT** been as **consistent** as those seen with Buproprion
NOTRYPTYLINE
99
# **OTHER USES OF ANTIDEPRESSANTS**
used for ____ in **children**
enuresis
| **bed wetting**
100
# **OTHER USES OF ANTIDEPRESSANTS**
**less** commonly used now because of their side effects
TCAs (Imipramine)
**COMMONLY USED NOW**: Desmopressin - vasopressin agonist (anti ADH, anti ihi)
101
# **OTHER USES OF ANTIDEPRESSANTS**
* treatment for **URINARY STRESS INCONTINENCE**
* aproved in **Europe**
Duloxetine
102
# **OTHER USES OF ANTIDEPRESSANTS**
treatment of **VASOMOTOR** symptoms in **PERIMENOPAUSE**
**Serotonergic** antidepressants
Desvenlafaxine - under consideration
SSRIs, Venlafaxine, Nefazodone
103
# **OTHER USES OF ANTIDEPRESSANTS**
**SEXUAL DISORDERS**:
are sometimes used to treat **PREMATURE EJACULATION**
SSRIs
104
# **OTHER USES OF ANTIDEPRESSANTS**
**SEXUAL DISORDERS**:
has been used to treat **sexual ADVERSE EFFECTS** associated with **SSRI use**
bupropion
105
* **Depression**
* Effective in treating **Bulimia nervosa** and
* Obsessive-compulsive disorder (**OCD**)
* Also used in **Anorexia nervosa**
* **Panic** disorders
* Pain associated with **diabetic neuropathy**
* **Premenstrual Dysphoric Disorder** (PDD)
SSRIs
106
* Mood disorders (in **MDD**)
* **Panic** disorders
* Generalized anxiety disorder (**GAD**)
* Post-traumatic stress disorder (**PTSD**)
* Obsessive-compulsive disorder (**OCD**)
* Used to control **enuresis** in children (Imipramine)
* **Pain** disorders
* ability to **elevate mood**
TCA
107
**TCA**'s ability to **elevate mood** may require ____ weeks to become apparent
2-8 weeks
108
* **Depression**
* **Phobia**
* **Enuresis** – constriction
* **Chronic Pain**
* **Dilation**
IMIPRAMINE
109
* indicated for **depressed patients** who are **UNRESPONSIVE** or **ALLERGIC** to **TCA**
* used in patients with **LOW psychomotor activity**
* used in **ATYPICAL depression**: ***phobia***, ***psychotic*** features
MAOI
110
TCA is **stronger** in what type
tertiary amines
111
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
sustained erection
priapism
112
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS**
**sexual dysfunctions** such as **impotence**, **PRIAPISM**, **anorgasmia**, and **delayed ejaculation** are side effects that are associated with what drug
SSRIs
113
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
which RECEPTOR:
* **akathisia** - uncontrollable movement in the LOWER part of the body
* **psychomotor retardation**
* **parkinsonism**
* **dystonic movements** - involuntary muscle CONTRACTION
5HT**2A**
114
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
which RECEPTOR:
* **acute** stimulation (***days***), **chronic** administration (***2-3 weeks***)
* **mental agitation**
* **anxiety**
* **panic attacks**
5HT**2A**
5HT**2C**
115
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
**5HT3** antagonists
setrons
116
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
which RECEPTOR:
* **N&V**
* stimulation of **5HT3R** and **5HT4R**
* in **GI motility**, **GI cramps**
* **Diarrhea**
5HT3: Hypothalamus Brainstem (CTZ)
117
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
**WEIGHT GAIN** is particulary seen with what drug
PAROXETINE
118
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
* develops with SSRIs having **SHORT HALF-LIVES** such as **paroxetine** and **sertraline** (***frequent administration***)
* characterized by **dizziness**, **paresthesias** (tingling sensations), and other symptoms beginning **1 or 2 days after stopping** the drug and **persisting for 1 week or longer**
DISCONTINUATION SYNDROME
119
SSRIs with **short half-lives**
paroxetine
sertraline
120
most **SSRI** are what **FDA Pregnancy category**
CATEGORY C
121
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SSRIs**
____ is associated with **cardiac septal defects** in the **first trimester** exposures, thus is classified as category **D**
Paroxetine
122
# **SSRI**
**Paroxetine** is what FDA pregnancy category
CATEGORY **D**
123
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SNRIs**
**SNRIs** have many of the ____ adverse effects asspciated with **SSRIs**
serotonergic adveerse effects
124
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SNRIs**
**SNRIs** may also have ____ effects, including:
* **increased blood pressure** and **heart rate**
* CNS activation: **insomnia**, **anxiety**, **agitation**
noradrenergic effects
125
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SNRIs**
**DOSE-related** INCREASE in **BLOOD PRESSURE** is more commonly seen with the **immediate-release form** of ____
Venlafaxine
126
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | SNRIs**
**cardiac toxicity** is associated with ____
Venlafaxine overdose
127
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
* **dry mouth**, **constipation**, **urinary retention**, **blurred vision**, and **confusion**
* more common with tertiary amine TCAs such as **amitriptyline** and **imipramine** than with the secondary amine TCAs despiramine and nortriptyline
ANTICHOLINERGIC EFFECTS
128
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
* due to potent **α-blocking property** (α-1)
orthostatic hypotensions
129
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
____ at **higher doses**
arrhythmogenic
130
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
**sexual effects** are common particulary with **HIGHLY SEROTONERGIC TCAs** such as ____
CLOMIPRAMINE
131
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
**discontinuation syndrome** is characterized by ____ and ____ symptoms
Cholinergic rebound and Flulike symptoms
132
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TCAs**
coma, arrythmias, seizures
imipramine overdose
133
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
particularly with **TRAZODONE**
sedation
134
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
* **dose**-related
* **less pronounced** than those seen with SNRIs or SSRIs
gastrointestinal disturbances
135
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
* **uncommon** with **Nefazodone** or **Trazodone**
* **Trazodone** is **rarely** associated with **priapism**
sexual effects
136
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
**Trazodone** is **rarely** associated with ____
priapism
137
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
**sexual effects** is uncommon with ____ or ____
Nefadozone
Trazodone
138
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
**ORTHOSTATIC HYPOTENSION** is seen with what drugs
| 2
Nefadozone
Trazodone
139
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | 5HT RECEPTORS MODULATORS**
**HEPATOTOXICITY** including **rare fatalities** and cases of **fulminant hepatic failure** requiring transplantation is associated with ____
NEFADOZONE
| has a **black box warning**: HEPATOTOXIC
140
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TETRACYCLIC & UNICYCLIC**
**PARKINSONIAN** syndrome
Amoxapine
141
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TETRACYCLIC & UNICYCLIC**
**SEDATIVE** effect
Mirtazapine
142
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TETRACYCLIC & UNICYCLIC**
**TCA-like** adverse effects and, rarely, seiures
Maprotiline
143
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TETRACYCLIC & UNICYCLIC**
**agitation**, **insomnia**, and **anorexia**
Bupropion
144
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | TETRACYCLIC & UNICYCLIC**
**Gastrointestinal upset**, including diarrhea and nausea, than the SSRIs
Vilazodone
145
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
**most common** adverse effects of the **MAOIs** leading to **discontinuation** of these drugs
Weight gain & Orthostatic hypotension
146
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
**highest rates** of **sexual effects** are associated with ____
IRREVERSIBLE NONselective MAOIs
147
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
**activation**, **insomnia**, and **restlessness** are associated with the ____ properties of some MAOIs
amphetamine-like properties
148
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
____ tends to be **MORE SEDATING** than either **selegiline** or **trancylpromine**
Phenelzine
149
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
____ is also sometimes associated with **HIGHER DOSES** of MAOIs
Confusion
150
# **ADVERSE EFFECTS OF ANTIDEPRESSANTS | MAOIs**
MAOIs have been associated with a **sudden discontinuation syndrome** manifested in a ____ presentation with **psychosis**, **excitement**, and **confusion**
DELIRIUM-LIKE
151
# **DRUG INTERACTIONS | MAOIs**
SHOULD **NOT** BE ADMINISTERED FOR **AT LEAST**:
____ **after** discontinuing the use of most **SSRIs**
2 weeks
152
# **DRUG INTERACTIONS | MAOIs**
SHOULD **NOT** BE ADMINISTERED FOR **AT LEAST**:
____ **after** discontinuing the use of most **FLUOXETINE**
5 weeks
153
# **DRUG INTERACTIONS**
* **DO NOT USE TOGETHER** because both **increases SEROTONIN levels** in the brain that may result in **"serotonin syndrome"**
* **hyperthermia**
* **muscle rigidity**
* **myclonus** (seizures)
SSRIs and MAOIs
154
# **DRUG INTERACTIONS | MAOIs**
this will result to **increased** levels of **tyramine** which will **release catecholamines** from storage vesicles and therefore will act as a **PRESSOR AGENT**
sympathomimetic agents + foods&bevs containing amines (**tyramine**)
| tyramine - enhance exocytosis, increase neurotransmitter release
155
# **DRUG INTERACTIONS | MAOIs**
Foods & beverages that should **NOT** be taken with **sympathomimetic amines**
cheese
chicken liver
beer
red wine
156
# **BIOSYNTHESIS OF TYRAMINE**
inhibit **tyrosine hydroxylase**
metyrosine
157
# **BIOSYNTHESIS OF TYRAMINE**
inhibit **acetylcholine storage**
vesamicol
158
* characterized by **pathological MOOD SWINGS** from **mania** to **depression**
MANIC-DEPRESSIVE (**BIPOLAR**) DISORDER
159
* characterized by **elevated**, **expansive** or **irritable** mood, accompanied by **increased activity**, **pressure of speech**, **flight of ideas**, **grandiosity**, **decrease need for sleep**, **distractability**, or involvement of activities that have **high potential for painful consequences**
MANIA
160
# **DRRUGS FOR BIPOLAR DISORDER**
* inhibit **PHOSPHOINOSITIDE recycling**
* **interferes** with **nerve conduction**
* **increases** the **reuptake of NE** into adrenergic nerve endings and **decrease** the **release of NE**
* use: **primary** management of **mania** and **hypomania**
* limitation: **not** as effective for **rapid recyclers**
LITHIUM CARBONATE
161
# **DRRUGS FOR BIPOLAR DISORDER**
**primary** management of **MANIA** and **HYPOMANIA**
LITHIUM CARBONATE
162
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
conditions that **increase** **Li**
decrease Na
| **↑Li, ↓Na**
163
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
what CONDITION:
* **sodium LOSS**
* **Thiazides**: **ACEI**
* **NSAIDs**
decrease Na = increase Li
164
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
decrease **renal excretion** of LITHIUM
NSAIDs
165
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
what CONDITION:
* **Acetazolamide**
* **Xanthine diuretics**
* **Osmotic diuretics**
* **Na supplementation**
decrease Li = increase Na
166
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
most common **osmotic diuretic**
Mannitol
167
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
**AE/SE** occur at ____:
* **fine tremors**
* **polyuria**, and **polydipsia**
* **N&V**
therapeutic doses
168
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
* **coarse tremor**
* **neuromuscular excitability** - seizure, hypereflexxia
toxicities
169
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
* **thyroid enlargement**
idiosyncratic reaction
170
# **DRRUGS FOR BIPOLAR DISORDER | LITHIUM CARBONATE**
TERATOGENICITY
| abnormality in the **tricuspid valve**
EBSTEIN ANOMALY
171
# **DRRUGS FOR BIPOLAR DISORDER**
**better** than Li for **rapid recyclers**
Valproic acid
172
# **DRRUGS FOR BIPOLAR DISORDER**
**prophylaxis** treatment of **mania** (**combined** with **antidepressant** to **prevent bouncing**)
Carbamazepine
173
# **DRRUGS FOR BIPOLAR DISORDER**
* for **atypical** depression
* less EPS
2nd gen antipsychotics
