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Behavioral Dynamics > Mood disorders- PHARM- Exam 2 > Flashcards

Mood disorders- PHARM- Exam 2 Flashcards

1
Q

_____ Naturally occurs in the body; may raise dopamine levels
Can be used as an adjunctive option for mild to moderate.

A

S-Adenosylmethionine (SAMe)

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2
Q

S-Adenosylmethionine (SAMe) may trigger ____

A

manic episodes

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3
Q

____ Natural precursor to serotonin. What are the SE?

A

5-Hydroxytryptophan (5-HTP)

GI upset, serotonin syndrome, eosinophilic myalgia syndrome

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4
Q

_____ works better if combined with antidepressant, may increase risk of bleeding

A

Omega-3 Fatty Acids

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5
Q

_____ increases serotonin, and possibly norepinephrine and dopamine levels

A

St. Johns Wort

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6
Q

What are the SE of St. John’s Wort? Why do prescribers tend to dislike it?

A

GI upset, serotonin syndrome, photosensitivity

LOTS of drug-drug interactions

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7
Q

_____ may help with depression but risk of GI upset, mania, bleeding; can be fatal at high doses

A

Saffron

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8
Q

____ Improved mood in pts being treated for memory loss; may increase sensitivity to serotonin, may increase risk of bleeding

A

Ginkgo biloba

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9
Q

**What are the prescribing guidelines for oral antidepressants?

A

-Start low and go slow : titrate dose over 7-10 days

-trial of at least 4 weeks (usually 4-6 weeks)

-Rx should be continued for 6+ months after s/s improvement

-Gradual down titration is recommended when discontinuing antidepressants

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10
Q

**When can pts start to see an improvement once starting oral antidepressants?

A

Patients may see improvement as early as week 1, but it generally takes 4-6 weeks to see a response

May consider treatment modification if <25% improvement in baseline s/s after 4-6 weeks

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11
Q

What are the 3 classes of antidepressants that fall under the first generation?

A
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12
Q

What are the 5 classes of antidepressants that fall under the second generation?

A
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13
Q

______ selectively decreases the action of 5-HT reuptake pump, leading to increased serotonin levels in the synapse

A

SSRI

often takes several weeks to see the benefit

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14
Q

What are the drugs that fall into the SSRI category?

A

Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Fluvoxamine (Luvox)

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15
Q

When are SSRIs usually dosed? What is the 1/2 life?

A

Typically QAM (½ life approx. 24 hrs.)

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16
Q

SSRIs are metabolized in the ____

A

liver

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17
Q

**If your pt is on a SSRI and want to change to MAOI, how long do you need to wait?

A

2 weeks

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18
Q

**If your patient is on Fluoxetine and you want to start an MAOI, how long do you need to wait?

A

5 weeks

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19
Q

What are some common SE of SSRIs? What are the two major ones?

A

nausea, diarrhea, anorexia

insomnia or hypersomnia

headache, dizziness

↓libido, anorgasmia, ED

anxiety, ↑ risk of suicide**

prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome**

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20
Q

When does Serotonin syndrome typically occur?

A

within 24 hours (often within 6 hours) of starting/changing a medication or overdosing

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21
Q

What are some s/s of serotonin syndrome?

A

Diarrhea, increased bowel sounds, agitation, hyperreflexia, dry mucous membranes, autonomic instability, hyperthermia, HTN, tremor, clonus, seizure, death

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22
Q

True/False: If you are concerned about serotonin syndrome you can order a 5-HT level test

A

FALSE, 5-HT levels do not correspond

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23
Q

What is the treatment for serotonin syndrome?

A

Supportive care
D/C serotonergic medications
Sedation with benzodiazepines
Normalize vitals and hydration status

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24
Q

_____ is more likely to cause GI upset than others in the class, esp. diarrhea

A

Sertraline (Zoloft)

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25
Q

_____ has a slightly higher chance of insomnia so should be dosed in the morning

A

Sertraline (Zoloft)

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26
Q

_____ is most associated with prolonged QT and palpitations and has minimal SE profile otherwise

A

Citalopram (Celexa)

Escitalopram (Lexapro)

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27
Q

SSRI
____ has the least inhibition of hepatic cytochrome enzymes

A

Citalopram (Celexa)

Escitalopram (Lexapro)

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28
Q

_____ is a good choice for alcoholics

A

Citalopram (Celexa)

Escitalopram (Lexapro)

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29
Q

_____ is a bad choice for patients with heart problems

A

Citalopram (Celexa)

Escitalopram (Lexapro)

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30
Q

_____ has the shortest 1/2 life and frequently causes somnolence and should be taken at bedtime
SSRI

A

Fluvoxamine (Luvox)

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31
Q

SSRI
_____ and ____ are a potent inhibitor of 2 cytochrome systems, potential for DDIs

A

Fluvoxamine (Luvox)

Paroxetine (Paxil)

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32
Q

____ longest half-life of any in the class (up to 3 days)

A

Fluoxetine (Prozac)

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33
Q

_____ was the first SSRI on the market

A

Fluoxetine (Prozac)

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34
Q

_____ has a slightly higher risk of insomnia SE and can increase anxiety

A

Fluoxetine (Prozac)

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35
Q

Which two drugs should not be written with Tamoxifen?

A

Fluoxetine (Prozac)
and
Paroxetine (Paxil)

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36
Q

SSRI
_____ causes anticholinergic SE, unlike others in the class

A

Paroxetine (Paxil)

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37
Q

_____ slightly higher risk of orthostatic hypotension, weight gain, & sexual dysfunction than other SSRIs

A

Paroxetine (Paxil)

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38
Q

_____ are used for tx of other disorders, including anxiety disorders, fibromyalgia, neuropathy, menopausal s/s

A

SNRIs

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39
Q

_____ blocks reuptake of 5-HT and norepinephrine (NE), increasing their levels in the synapse

A

SNRIs

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40
Q

Which two SNRI has a greater effect on the NE?

A

Savella
and
Fetzima

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41
Q

Which SNRIs have a greater effect on 5-HT?

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

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42
Q

What are the 5 SNRIs?

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Milnacipran (Savella)
Levomilnacipran (Fetzima)

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43
Q

____ are cleared through the kidneys and liver

A

SNRIs

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44
Q

What are the CI to SNRIs?

A

-use within 2 weeks of an MAOI

-Caution if using with other serotonergic drugs

-Caution if angle closure glaucoma

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45
Q

(SSRIs/SNRIs) are more associated with weight gain

A

SSRIs

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46
Q

What are some common SE of SNRIs?

A

N/V/D, constipation, dry mouth

insomnia or hypersomnia

HA, dizziness

anorgasmia, ED may be less than SSRIs

anxiety, ↑ risk of suicide**

diaphoresis, hypertension, serotonin syndrome

47
Q

The sexual dysfunction side effects are more severe with SSRIs or SNRIs?

A

SSRIs

48
Q

_____ has a higher risk of SE than other SNRIs
More N/V than SSRIs as a class

A

Venlafaxine (Effexor)

49
Q

_____ is the SNRI most associated with an elevated BP

A

Venlafaxine (Effexor)

50
Q

____ is the synthetic form of the major metabolite of venlafaxine

Less risk of HTN, general SE than venlafaxine

A

Desvenlafaxine (Pristiq)

51
Q

____ is the only SNRI with hepatic cytochrome inhibition → most likely to have DDIs

A

Duloxetine (Cymbalta)

52
Q

____ least associated with elevated BP and
has an indication for chronic pain relief

A

Duloxetine (Cymbalta)

53
Q

_____ or ____ is the most likely SNRIs to have pseudo-anticholinergic SE
Urinary retention, constipation, dry mouth, etc.

A

Milnacipran (Savella)

Levomilnacipran (Fetzima)

54
Q

_____ is marketed as more for pain relief than for depression

A

Savella

55
Q

What drug class is often used as second-line therapy if pts fail SSRIs; may be first-line in special cases

A

Atypical Antidepressants

56
Q

What two drugs are considered atypical antidepressants?

A

Bupropion (Wellbutrin; Zyban)

Mirtazapine (Remeron)

57
Q

_____ acts as a dopamine-norepinephrine reuptake inhibitor

A

Bupropion

58
Q

____ MOA also antagonizes nicotinic receptors, and is sometimes used to help people quit smoking

A

Bupropion (Wellbutrin; Zyban)

59
Q

_____ antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors, which causes increased release of serotonin and norepinephrine

A

Mirtazapine (Remeron)

60
Q

What are the SE of Bupropion (Wellbutrin)? What is the major one?

A

Dry mouth, insomnia, nausea, risk of suicidal thoughts/ideation

**increased risk of seizures

Not associated with weight gain or sexual dysfunction

61
Q

Atypical
_____ does have hepatic cytochrome enzyme inhibition, so can cause DDIs

A

Bupropion (Wellbutrin)

62
Q

What are the CI of Bupropion (Wellbutrin)? What are the two major ones?

A

seizure disorder
**high seizure risk
**anorexia or bulimia hx
use within 2 weeks of an MAOI

63
Q

What are the SE of Mirtazapine (Remeron)?

A

Dry mouth, *drowsiness, sedation, increased appetite, *weight gain, sexual dysfunction, risk of suicidal thoughts/ideation

64
Q

_____ has more risk of weight gain than SSRIs, SNRIs and may have less sexual dysfunction than SSRIs

A

Mirtazapine (Remeron)

65
Q

____ has a lower risk of orthostatic hypotension than other antidepressants

A

Mirtazapine (Remeron)

66
Q

____ is helpful in patients with depressive symptoms who also are suffering from insomnia

A

Mirtazapine (Remeron)

67
Q

____ are often used as second-line therapy for patients who cannot tolerate SSRIs; may be first-line therapy

A

Serotonin Modulators

68
Q

_____ and ____ all block reuptake of 5-HT, also antagonize 5-HT receptors, causing increased release of serotonin

A

Nefazodone and trazodone

69
Q

____ and _____ all block reuptake of 5-HT, also partial agonist of 5-HT receptors, mimicking serotonergic effects

A

Vilazodone and vortioxetine

70
Q

What are the 4 serotonin modulators?

A

Nefazodone (Serzone)
Trazodone (Desyrel)
Vilazodone (Viibryd)
Vortioxetine (Brintellix/Trintellix)

71
Q

______ causes liver toxicity and not available anymore

A

Nefazodone (Serzone)

72
Q

What are the SE of serotonin modulators?

A

Headache, diarrhea, nausea are common
Increased suicide risk
Serotonin syndrome risk

73
Q

_____ hepatic cytochrome enzyme inhibition - most DDI risk among 5HT modulators

A

Nefazodone (Serzone)

74
Q

What is the BBW for Nefazodone (Serzone)?

A

hepatotoxicity

CI in patients with hx of liver disease, and elevated liver enzymes

75
Q

What are the SE of Nefazodone (Serzone)?

A

headache, agitation, dizziness, drowsiness or insomnia, xerostomia, hypotension

Not associated with sexual side effects
Less GI upset and weight gain than SSRIs

76
Q

What are the SE of Trazodone?

A

sedation, nausea, dry mouth, fatigue, constipation, sexual dysfunction

77
Q

What are the rare SE of Trazodone?

A

priapism, cardiac arrhythmias

78
Q

Does Trazodone have (more/less) sexual dysfunction that SSRIs and SNRIs

A

less sexual side effects

79
Q

What are the SE of Vilazodone (Viibryd)?

A

headache, diarrhea, nausea, sexual dysfunction

80
Q

Vilazodone (Viibryd) and Vortioxetine (Trintellix)
may have a (faster/slower) onset and (more/less) sexual dysfuntion than SSRI and SNRIs

A

faster onset

less sexual dysfunction

81
Q

What are the SE of Vortioxetine (Trintellix)?

A

dizziness, N/V/D/C, sexual dysfunction

82
Q

Ketamine/Esketamine is newly approved to treat severe, refractory depression without ____

A

psychosis

83
Q

(Ketamine/Esketamine) is usually given in IV formulation

(Ketamine/Esketamine) is given in a nasal spray

A

Ketamine

Esketamine

84
Q

Ketamine/Esketamine may have _____ in the long term setting and can cause _____ effects

A

neurotoxicity

psychotomimetic

85
Q

_____ opioid and AMPA (glutamate) agonist, NMDA antagonist

A

Ketamine/Esketamine

86
Q

May see fewer psychotomimetic effects with (Ketamine/Esketamine)

A

Esketamine

87
Q

_____ contraindications are aneurysmal disease or AV malformation; hx of ICH; inability to tolerate increase in BP

A

Ketamine/Esketamine

88
Q

____ breaks down serotonin and norepinephrine

A

MAOa

89
Q

_____ works with MAOa to break down dopamine

A

MOAb

90
Q

**_____ have extensive side effects, DDIs, and dietary restrictions. Usually only for treatment-resistant or atypical depression

A

MOAIs

91
Q

_____ used at low doses for Parkinson’s

A

Selegiline

92
Q

What are the drugs in the MAOIs?

A

Tranylcypromine (Parnate)
Phenelzine (Nardil)
Isocarboxazid (Marplan)
Selegiline (Eldepryl); available orally or transdermal

93
Q

_____ CIs are cardiovascular disease; pheochromocytoma; hepatic or renal impairment

A

MAOIs

94
Q

______ SE are hypotension, GI upset, urinary hesitancy, headache, myoclonic jerks, edema, suicidal ideation

A

MAOIs

95
Q

**_____ run the risk of hypertensive crisis when consuming foods with tyramine

A

MAOIs

96
Q

_____ Used as second-line treatment for depression due to side effects. Also treat anxiety disorder, pain disorders such as neuropathy and headaches. Low doses usually work well

A

TCAs: Tricyclic Antidepressants

97
Q

_____ MOA inhibits reuptake of 5-HT and norepinephrine (NE)

A

TCAs

98
Q

(Tertiary/Secondary) Amines: are more potent in blocking 5-HT reuptake than NE reuptake

A

tertiary amines

99
Q

(Tertiary/Secondary) Amines: are more potent in blocking NE reuptake than 5-HT reuptake

A

secondary amines

100
Q

What are the tertiary amines?

A

Amitriptyline (Elavil)**
Doxepin (Silenor)**
Imipramine (Tofranil), Clomipramine (Anafranil), Trimipramine (Surmontil)

101
Q

What are the secondary amines?

A

**Nortriptyline (Pamelor) - metabolite of amitriptyline

**Desipramine (Norpramin) - metabolite of imipramine

Protriptyline (Vivactil)

102
Q

_____ patients may respond to very low doses

A

TCAs

103
Q

_____ should not be used within 2 weeks of an MAOI; use in acute recovery phase of an MI

A

TCAs

104
Q

______ SEs are anticholinergic; drowsiness; sexual dysfunction; diaphoresis; tremor; weight gain; increased appetite

A

TCAs

105
Q

**_____ medication class is at risk of cardiotoxicity (prolonged QT) and high potential for fatality in overdoses

A

TCAs

106
Q

When are TeCAs typically used?

A

refractory or atypical depression

107
Q

How are TCAs and TeCAs different?

A

TeCAs have an extra ring when compared to TCAs

108
Q

What drugs are included in the TeCAs?

A

Maprotiline (Ludiomil)
Amoxapine (Asendin)

109
Q

_____ MOA blocks reuptake of NE and 5-HT (more potent for 5-HT)

A

Maprotiline (Ludiomil)

110
Q

_____ MOA blocks reuptake of NE; blocks dopamine receptors (antipsychotic). Sometimes classified as secondary amine TCA

A

Amoxapine (Asendin)

111
Q

TCAs vs TeCAs:

TeCAs have (more/less) anticholinergic SE and (more/less) antihistamine-like SE than TCAs.
Still have risk for suicidal ideation

A

less anticholinergic SE but more antihistamine SE

112
Q

_____ often used in bipolar; may also be helpful for unipolar depression. Why are people hesitant to prescribe it?

A

lithium

Numerous side effects, risk for toxicity

Not as efficacious as antidepressant drugs

113
Q

____ are typically used as an add-on to antidepressants. Name some drugs in the class?

A

Antipsychotics

Aripiprazole (Abilify)
brexpiprazole (Rexulti)
quetiapine (Seroquel)
Symbyax (fluoxetine + olanzapine)

114
Q
A

Behavioral Dynamics (16 decks)

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