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PC 707 Pharmacology > Module 7 Unit B Antidepressants > Flashcards

Module 7 Unit B Antidepressants Flashcards

1
Q

What are examples of SSRIs?

A

paroxetine (Paxil)
citalopram (Celexa)
fluoxetine (Prozac)
sertraline (Zoloft)

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2
Q

What are the indications for SSRIs?

A

Depression

Anxiety

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3
Q

What is the MOA of SSRIs?

A

SSRIs block the reuptake of serotonin, resulting in an increased concentration of serotonin in the synapse and increased activation of postsynaptic serotonin receptors.

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4
Q

What is a rare but serious complication of SSRIs?

A

Serotonin syndrome is a rare but serious complication.

Symptoms: 
Agitation or restlessness.
Insomnia.
Confusion.
Rapid heart rate and high blood pressure.
Dilated pupils.
Loss of muscle coordination or twitching muscles.
High blood pressure.
Muscle rigidity.
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5
Q

What should we monitor for in the first few weeks of a patient taking an SSRI?

A

Increased suicidal ideation the first 2-3 weeks.

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6
Q

What side effects are seen with SSRIs?

A

May cause n/v, insomnia, weight gain, and sexual dysfunction.

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7
Q

When should SSRIs be used cautiously?

A

Use caution with elderly. Start low and go slow.

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8
Q

What is the BBW associated with SSRIs?

A

Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.

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9
Q

Which SSRI should be avoided in pregnancy?

A

Paxil

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10
Q

Which SSRI is the most studied in children?

A

Prozac

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11
Q

What are examples of SNRIs?

A

venlafaxine (Effexor)
desvenlafaxine SR (Pristiq)
duloxetine (Cymbalta)

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12
Q

What are the indications for SNRIs?

A

Depression

Anxiety

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13
Q

What is the MOA of SNRIs?

A

Boost serotonin and norepinephrine

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14
Q

When should the SNRI Venlafaxine be avoided?

A

Venlafaxine may cause HTN and must be avoided with MAOI.

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15
Q

What is the BBW associated with SNRIs?

A

Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.

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16
Q

What is another indication for Venlafaxine (effexor) outside of A/D?

A

Venlafaxine can be used for post-menopausal hot flashes.

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17
Q

What are some examples of TCAs?

A

Amitriptyline (elavil)
Clomipramine (Anafranil)
Doxepin (Silenor)
Imipramine (Tofranil)

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18
Q

What is the indication for TCAs?

A

Depression

Can be helpful for those with sleep issues.

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19
Q

What is the MOA of TCAs?

A

Block reuptake of norepinephrine and serotonin.

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20
Q

When should TCAs be used cautiously and why?

A

Elderly-anticholinergic

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21
Q

What condition is TCAs contraindicated with?

A

Cardiac issues due to cardiac toxicity

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22
Q

What adverse effect can TCAs cause?

A

It may lead to dysrhythmias and may be fatal with overdose.

QT prolong

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23
Q

What drugs have D2D interactions with TCAs?

A

MAOI, CNS depressants, sympathomimetics, anticholinergic drugs.

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24
Q

What is the BBW associated with TCAs?

A

Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.

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25
Q

What are examples of MAO inhibitors?

A

Isocarboxazid

Phenelzine

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26
Q

What is the MOA of MAOIs?

A

Increases the amount of norepinephrine and serotonin for release by inhibiting intraneuronal MAO-A.

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27
Q

When are MAOIs used? Who prescribes them?

A

It is reserved for patients who have not responded to SSRIs, TCAs, and other safer drugs.

Typically prescribed by psych.

28
Q

What adverse effect is associated with MAOIs?

A

Risk for hypertensive crisis.

29
Q

What education should be reviewed with a patient on MAOIs?

A

Avoid fermented or aged foods. Tyramine-rich foods.

30
Q

When are MAOIs contraindicated?

A

It is contraindicated in elderly.

31
Q

Why are MAOIs reserved for patients unresponsive to other drugs?

A

Higher risk and many D2D interactions

32
Q

What is the BBW associated with MAOIs?

A

Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.

33
Q

What is the indications for Bupropion (Wellbutrin)?

A

Depression,

Smoking cessation

34
Q

What is the MOA of Bupropion (Wellbutrin)?

A

Boosts norepinephrine and dopamine.

35
Q

What may we see in patient with seizures who are prescribed Bupropion (Wellbutrin)?

A

May increase the frequency and severity of seizures in those with a seizure disorder.

36
Q

What is the BBW for Bupropion (Wellbutrin)?

A

Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25 years old.

37
Q

What side effects may we see with Bupropion (Wellbutrin)?

A

Decreased appetite, increased libido.

Improved focus and concentration can be seen.

38
Q

Indication Triazolopyridine (Trazodone)

A

Depression

Sedative

39
Q

What is an example of N-Methyl-D-Aspartate (NMDA) Receptor Antagonist?

A

Ketamine

40
Q

What is the indication for N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine]?

A

Depression

41
Q

What is the MOA of N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine]?

A

Blocks NMDA receptor, decreasing glutamate binding.

42
Q

How is N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine] given and how long do the effects last?

A

Given intranasally. The effect lasts 1-2 weeks.

43
Q

What is the indication of Brexanolone (Zulresso)?

A

Depression (Used in postpartum people.)

44
Q

What is the MOA of Brexanolone (Zulresso)?

A

Modulates GABA

45
Q

Why don’t we use Brexanolone (Zulresso) often?

A

Very expensive.

Given IV.

46
Q

What are examples of stimulants?

A

Methylphenidate (Ritalin, Concerta)

Dextroamphetamine (Dexedrine)

47
Q

What are stimulants used for?

A

First-line treatment of ADHD

48
Q

What is the MOA of stimulats?

A

Amplify norepinephrine and dopamine signals that are low in ADHD.

49
Q

What side effects are seen with stimulants?

A

May cause insomnia and restlessness, suppress appetite leading to weight loss, a small increase in heart rate and blood pressure.

50
Q

What is the BBW associated with Methylphenidate (Ritalin, Concerta)?

A

Chronic abuse of methylphenidate can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior and possible frank psychotic episodes.

51
Q

What is the BBW associated with amphetamines -Dextroamphetamine (Dexedrine)?

A

Amphetamines have a high potential for abuse and dependence. In patients who use amphetamines chronically, withdrawal may occur if use of these medications is suddenly stopped.

52
Q

What are the second line drugs used for ADHD?

A

Non-Stimulants

Atomoxetine (Strattera)
Clonidine (Kapvay)

53
Q

What is the MOA of Atomoxetine (Strattera) & Clonidine (Kapvay)?

A

Inhibits norepinephrine reuptake, increasing NE

54
Q

What are the adverse effects associated with Atomoxetine (Strattera) & Clonidine (Kapvay)?

A

dyspepsia, n/v, decreased appetite, dizziness, somnolence, mood swings.

55
Q

What adverse effect is seen with Atomoxetine (Strattera) in children and adolescents?

A

*Atomoxetine may cause suicidal thinking in children and adolescents but not adults

56
Q

What adverse affect is associated with Atomoxetine (Strattera)?

A

Slight risk of severe liver injury.

57
Q

What monitoring do we need to do with SNRI’s?

A

BP initial and occassionally

58
Q

TCA monitoring

A

ECG baseline and plasma levels

59
Q

S/E of Zulresso

A

dizziness, sedation/somnolence, xerostomia, loss of consciousness, and hot flashes

60
Q

BBW Strattera

A

suicidal thinking in children and adolescents

61
Q

Are non-stimulants controlled substances?

A

No

62
Q

What schedule are our stimulants (rittalin, Adderal)?

A

Schedule II

63
Q

BBW Zulresso

A

Excessive sedation and loss of consciousness.

64
Q

MOA trazadone

A

reduces levels of neurotransmitters associated with arousal effects, such as serotonin, noradrenaline, dopamine, acetylcholine, and histamine

65
Q

RIsks and cautions with trazadone

A

Sleepiness, dizziness, weight loss,

Serotonin Syndrome.

Low BP.

66
Q

BBW trazadone

A

Suicide

PC 707 Pharmacology (39 decks)

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