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Psychiatry > Neuropsychopharm Antidepressants > Flashcards

Neuropsychopharm Antidepressants Flashcards

1
Q

Why is mirtazapine sedating at low doses but not high doses?

A

At high doses, blocks alpha2 receptor, leading to increased NE release.

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2
Q

What drug effect is signified by widened QRS on EKG?How is this treated?

A

TCA overdose (also see long QT).Treatment: Sodium bicarbonate and magnesium

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3
Q

What is the mechanism of action of mirtazapine?

A

NaSSA: Noradrenergic and specific serotonin antagonistActivates 5-HT2, blocks 5-HT3.Alpha 2 blockage at higher doses (which is why higher doses less sedating)

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4
Q

What TCA is also used in treating OCD?

A

Clomipramine (Anafranil)(Incidentally, also most 5-HT specific)

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5
Q

What TCA is the most 5-HT specific?

A

Clomipramine (Anafranil)(Incidentally, also used in treating OCD)

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6
Q

What are common side effects of MAOIs?

A

Orthostatic hypotension, sleep disturbence, GI distress, dry mouth, headache

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7
Q

What antidepressants can be used as adjuncts on top of SSRIs?

A

Buproprion (NDRI)Buspirone

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8
Q

How do side effects of SNRIs compare to SSRIs, in general?

A

Similar. May be more activating than most SSRIs.

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9
Q

What are 4 SSRIs approved for depression?

A

Fluoxetine (Prozac)Paroxetine (Paxil)Sertraline (Zoloft)Citalopram (Celexa) / Escitalopram (Lexapro)(Fluvoxamine (Luvox) is not approved for depression, instead for OCD and social anxiety)

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10
Q

What are two SNRIs?

A

Venlafaxine (Effexor)Duloxetine (Cymbalta)

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11
Q

What MAOI is selective for MAO-B?What is the implication of this?

A

Selegiline.More specific for DA (does not break down 5HT, melatonin, Epi, or NE), so can be used in low dose to augment DA signaling in Parkinson’s with fewer side effects.At higher doses blockes MAO-A as well, so can still be used as an antidepressant with higher dose.

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12
Q

What TCA is approved for insomnia treatment?

A

Doxepin

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13
Q

What is the side effect profile of mirtazapine?

A

Appetite stimulation (weight gain) and, at low doses, sedation

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14
Q

What type of antidepressant has significant dietary restrictions?

A

MAOIs (due to tyramine hypertensive crisis)(Tyramine in aged cheese, Chanti, fava beans, liver, cured meats, soy sauce, sauerkraut)

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15
Q

What is the side effect profile of buproprion?

A

Similar to SSRIs, but rarely see sexual side effects

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16
Q

What SSRI(s) can be used in anxiety disorders?

A

Paroxetine (Paxil)Sertraline (Zoloft)

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17
Q

What SSRI has an extremely long half-life and therefore has no need to taper before stopping?

A

Fluoxetine (Prozac)

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18
Q

What SSRI can lead to QT prolongation?

A

Citalopram (Celexa)(Otherwise few side effects)

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19
Q

Other than antidepressants, what are 4 serotonergic drugs that can contribute to serotonin syndrome?

A
  1. Linezolid (antibiotic against resistant gram-positives)2. Tramadol (opioid painkiller)3. Miperidime (Demerol, opioid painkiller)4. Dextromethorphan (cough suppressant opioid)
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20
Q

What TCA has the fewest anti-cholinergic side effects?

A

Desipramine (Norpramin)(also least sedating)

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21
Q

What else can SNRIs potentially help with?

A

Chronic pain

22
Q

What SSRI has a very low incidence of common SSRI-related side effects?

A

Citalopram (Celexa)(Except can prolong QTc)

23
Q

What SSRI is worst for sexual dysfunction?

A

Fluoxetine (Prozac)

24
Q

In what types of patients is mirtazapine especially useful in?

A

Patients with poor appetite (stimulates appetite) and, at low doses, difficulty sleeping (sedating at low doses)

25
Q

What are dangerous side-effects of TCAs?

A
  1. Cardiac conduction disruption, leads widened QRS, long QT, and arrhythmia)2. Lethal in overdose
26
Q

What are 4 common MAOIs?

A

Phenelzine (Nardil)Tranylcypromine (Parnate)Isocarboxazid (Marplan)Selegiline (MAO-B selective)

27
Q

How is hypertensive crisis with MAOI tyramine interaction treated?

A

Phentolamine (alpha blockade)Do NOT give beta blockers (without giving alpha blockers first), as this would lead to vasoconstriction due to unopposed alpha blockage.

28
Q

What SSRI(s) have few drug-drug interactions?

A

Sertraline (Zoloft)Citalopram (Celexa) and Escitalopram (Lexapro)(Newer drugs)

29
Q

Compare and contrast Fluoxetine and Paxil in terms of:1. Activation/sedation2. Effect on anxiety3. Half-life

A

Fluoxetine: Activating, can worsen anxiety, long half-life (no need to taper doses before stopping)Paroxetine: Sedating, can be used in anxiety disorders, short half-life (discontinuation syndrome)

30
Q

What is the mechanism of action of buproprion?

A

NDRI: NE/DA reuptake inhibitor

31
Q

What are the advantages of buproprion?

A
  1. Rarely has sexual side effects2. Can help stop smoking.3. Relatively activating (but can worsen anxiety)
32
Q

What monoamines are broken down by MAO-A? MAO-B?

A

MAO-A: Serotonin, melatonin, Epi, NE, DA.MAO-B: DA, phenylethylamine, trace amines(Note that DA is broken down by both)

33
Q

What is the on-target pharmacologic actions of tricyclic antidepressants?Off-target?

A

On target: Inhibits NE and 5-HT reuptakeOff-ticked: Histamine, Muscarinic, Alpha-adrenergic blockade

34
Q

What are symptoms of serotonin syndrome?

A

Flushing, diaphoresis, myoclonic jerks

35
Q

What SSRI tends to cause more GI upset when starting?

A

Sertraline (Zoloft)

36
Q

What SSRI(s) has a short-life and therefore significant discontinuation syndrome with missed doses?

A

Paroxetine (Paxil)Sertraline (Zoloft)Fluvocamine (Luvox) - so short it requires BID dosing.

37
Q

What is the “dirtiest” SSRI with the most side effects in general?

A

Fluoxetine (Prozac)Sexual dysfunction is particularly bad

38
Q

What MAOI has amphetamine-like properties?

A

Tranylcypromine (Parnate)

39
Q

What TCA is least likely to cause orthostatic hypotension?

A

Nortriptyline (Pamelor)

40
Q

What SSRI(s) can worsen anxiety?

A

Fluoxetine (Prozac)(Relativley activating)

41
Q

What SSRI is considered relatively activating?

A

Fluoxetine (Prozac)(Can worsen anxiety)

42
Q

What are the dangerous side effects of MAOIs?

A

Serotonin syndromeHypertensive crisis (tyramine interaction)

43
Q

What are common side-effects of TCAs?

A

Anti-HAM:a. H1 block: sedation, weight gainb. Alpha-1 adrenergic block: orthostatic hypotensionc. Antimuscarinic block: Memory impairment, confusion, cardiac (e.g. tachycardia), blurred vision, dry mouth, constipation.

44
Q

What are three TCAs?

A

Nortyrptyline (Pamelor)Desipramine (Norpramin)Clomipramine (Anafranil)Others: Imipramine, Amitryptyline, Doxepin

45
Q

What SSRI is considered relatively sedating?

A

Paroxetine (Paxil)

46
Q

In what patients is the SNRI contraindicated in?

A

Poorly controlled hypertension

47
Q

What SSRI is actually not approved for depression?What is is approved for?

A

Fluvoxamine (Luvox)Approved for OCD and social anxiety disorder.

48
Q

What are the disadvantages of buproprion?

A
  1. Can worsen anxiety (relatively activating)2. Lowers seizure threshold, CI in epilepsy3. CI in eating disorder patients
49
Q

Other than depression, what can TCAs be used to treat?

A

Chronic pain, headache.(Clomipramine (Anafranil) can be used for OCD as well)

50
Q

What are common side effects of SSRIs?

A

Sexual dysfunction, GI upset, headache.

51
Q

What TCA is least sedating?

A

Desipramine (Norpramin)(also fewest anticholinergic side effects)

Psychiatry (9 decks)

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