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Behavioral Dynamicssss > Mood Med practice COPY > Flashcards

Mood Med practice COPY Flashcards

1
Q

SSRI MOA

A

decrease action of 5-HT reuptake pump which causes increased serotonin levels in the synapse

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2
Q

SSRI Dosing AND CLEARANCE

A

Typically QAM can be halved if SE are bad. Metabolized mostly by the liver so caution in hepatic impairement.

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3
Q

SSRI SE

A

GI (N/D/anorexia) sleep change, headaches, dizziness, decreased libido, anorgasmia, ED, anxiety, increased suicide risk, prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome

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4
Q

SSRI CI

A

allergy to SSRI, use of MAOI within 2 weeks. Fluoxetine must wait 5 weeks.

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5
Q

SSRI drugs

A

fluvoxamine
fluoxetine
sertraline
Citalopram/Escitalopram
Paroxetine

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6
Q

Fluvoxamine special notes

A

SSRI with shortest half life, increased somnolence, DDIs

The 3 S Sounds
“Short, Somnolence, Cytochrome inhib”

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7
Q

Fluoxetine special notes

A

SSRI with Longest halft life, increased insomnia, DO NOT TAKE w Tamoxifen

basically the opposite of fluvoxemine

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8
Q

sertraline special notes

A

SSRI with increased GI upset mostly diarrhea, increased insomnia, decreased QT prolongation

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9
Q

Citalopram/Escitalopram special notes

A

SSRI with MOST associated with QT prolongation, least impact on liver!

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10
Q

Paroxetine special notes

A

SSRI with Only one to cause anticholinergic SE, orthostatis hypotension, weight gain, sexual dysfuntion are all increased. DO NOT TAKE w tamoxifen.

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11
Q

SNRIs MOA

A

Blocks reuptake of 5-HT and NE, increasing their levels in synapse.

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12
Q

SNRI dosing AND CLEARANCE

A

takes a few weeks to see full effects. Typically taken QD. Cleared through liver and kidneys.

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13
Q

SNRI SE

A

N/V/D constipation, dry mouth. Sleep changes, HA, dizziness, anorgasmia, anxiety, suicide, diaphoresis, hypertension, serotonin syndrome.

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14
Q

SNRI CI

A

allergy to SNRIs; use within 2 weeks of an MAOI, caution if using other serotonergic drugs, caution with angle closure glaucoma.

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15
Q

SNRIs drugs

A

duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran/Levomilnacipran

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16
Q

Duloxetine Special notes

A

Only SNRI with hepatic cytochrome inhibitors which leads to DDIs, LEAST associated w HTN, indicated for chronic pain relief

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17
Q

Venlafaxine special notes

A

SNRI with higher risk of SE than others. MOST associated w HTN

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18
Q

Desvenlafaxine special notes

A

SNRI with synthetic of venlafaxine, Less risk of HTN and other general SE than venlafaxine

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19
Q

Milnacipran/Levomilnacipran special notes

A

SNRI with Greater effects on NE. most likely to have Psuedo anticholinergic SE (UR, const, dry mouth).

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20
Q

Bupropion MOA

A

acts as dopamine-NE reuptake inhibitor (also antagonizes nicotinic receptors)

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21
Q

patients with depression that may also want to quit smoking

A

bupropion

22
Q

Bupropion SE

A

Dry mouth
Insomnia
Nausea
Increased Seizure risk
SI

not associtated with weight gain or sesx dysf

cytochrome inhib!=DDI

23
Q

CI Bupropion

A

includes hepatic cytochrome inhibition causes DDIs
allergy
seizure disorder (HIGH RISK OF SEIZURE)
anorexia/bulemia ( causes weight loss and decreased appetite
use within 2 weeks of MAOI

24
Q

patients with depression who also have insomnia

A

mirtazapine

25
Q

Mirtazapine MOA

A

antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors which causes increased release of serotonin and NE.

26
Q

Mirtazapine SE

A

Dry mouth, increased appetite, weight gain (more than SSRI/SNRI), drowsiness, sedation, sexual dysfunction (less than SSRI).

LOWER HTN RISK
NO HEPATIC CYTOCHROME INHIB.= FEW DDIs

27
Q

Mirtazapine CI

A

Allergy
MAOI w/i 2 weeks.

28
Q

what are the atypical antidepressants

A

bupropion and mirtazapine

29
Q

Serotonin Modulators MOA

A

blocks the reuptake of 5-HT = increased serotonin
Nefazodone and trazodone also antagonize the 5-HT pump = increased serotonin
Vilazodone and Vortioxetine partially antagonize 5-HT pump = mimic serotonergic effects

30
Q

Serotonin Modulators Dosing AND CLEARANCE

A

QD or BID, Cleared through liver

31
Q

Serotonin Modulators SE

A

nausea, diarrhea, headache, suicide, serotonin syndrome.

32
Q

Serotonin Modulators CI

A

allergy
MAOI use W/I 2 weeks
caution with other serotonergic drugs

33
Q

What are the Serotonin Modulator medications

A

Nefazodone
Trazodone
Vilazodone
Vortioxetine

34
Q

SE: nefazadone

A

No sexual dysfunction, Less GI. increased Xerostomia, HA, Dizziness, insomnia or drowsiness, agitation, hypotension.
Hepatic Cytochrome enzyme inhibition = MOST DDI RISK OF ALL 5-HT inhib.
BBW = hepatotoxicity.

35
Q

Trazodone SE:

A

nausea, constipation, dry mouth, sedation, fatigue, sexual dysfunction (less than SSRIs or SNRIs.)
Rare: priapism and cardiac arrhythmias

36
Q

Vilazodone

A

SE: Nausea, Diarrhea, HA, sexual dysfunction (less than SSRIs or SNRIs)

37
Q

Ketamine/Esketamine MOA

A

opioid and glutamate agonist. NMDA antagonist. mechanism for antidepression is unknown

38
Q

Ketamine/Esketamine use

A

for severe, refractory depression w/o psychosis that is not respondant to ECT. short term use only!

39
Q

ketamine/esketamine Dosing

A

ketamine - IV
esketamine - Nasal
rapid effects but effects end in about 2 weeks.

40
Q

Ketamine/Esketamine SE

A

abuse potential becuase of euphoric/intoxicated effects
N/V, HA, dizziness, neurotoxicity, hepatotoxicity, bladder toxicity, tachycardia, HTN and abuse/addiction

41
Q

Ketamine/Esketamine CI

A

allergy
aneurysmal disease or AV malformation
hx of intracerebral hemorrhage
inability to tolerate increase in BP

42
Q

MAOIs Use

A

usually only for treatment-resistant or atypical depression. selegiline = low dose used for parkinsons

43
Q

MAOI MOA

A

MOAa breaks down serotonin and NE
MOAb works w MOAa to break down dopamine

44
Q

MAOI SE

A

hypotension, GI upset, urinary hesitancy, HA, myoclonic jerks, edema, suicidal ideation, hypertensive crisis w some foods (cheese, beer, tofu, cured meats)

45
Q

MAOI CI

A

includes allergy, CVD, pheochromocytoma (adrenal gland tumor), hepatic/renal impairment, use w serotonergic drugs. LOTS OF DDIs

46
Q

what medications are the MAOIs

A

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

47
Q

Tricyclic antidepressant MOA

A

inhibits reuptake of 5-HT and NE

48
Q

tricyclic antidepressants SE

A

includes: Anticholinergic, drowsiness, SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk

49
Q

this tricyclics antidepressants MOA includes more potent blocking of 5-HT reuptake rather than NE reuptake

A

tertiary amines
amitryptiline
doxepin
imipramine
clomipramine
trimipramine

50
Q

SE Tetra cyclic antidepressants

A

includes: Anticholinergic (less than TCAs), drowsiness (more than TCAs), SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk

51
Q

Maprotiline MAOI

A

this tetracyclic antidepressant blocks reuptake of NE and 5-HT

52
Q

Amoxapine MAOI

A

this tetracyclic antidepressant blocks reuptake of NE and blocks dopamine receptors

Behavioral Dynamicssss (21 decks)

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