Pharm - Antidepressants Flashcards
describe the symptoms of withdrawal syndrome
FINISH
- F: flu-like sx
- I: insomnia
- N: nausea
- I: imbalance
- S: sensory disturbances
- H: hyperarousal
in addition to major depressive disorder, Buproprion can be used for _______
nicotine withdrawal
in addition to major depressive disorder, Imipramine can be used for _______
enuresis (repeated inability to control urination)
in addition to major depressive disorder, Duloxetine can be used for _______
- diabetic peripheral neuropathy
- fibromyalgia
- chronic MSK pain
- stress incontinence
list the SNRIs
(TDDVL)
- TCAs
- desvenlafaxine
- duloxetine
- venlafaxine
- levomilnacipran
list the SSRIs
CFSEPVV
- citalopram
- fluoxetine
- sertraline
- escitalopram
- paroxetine
- vilazodone
- vortioxetine
list the NDRIs
bupropion
list the SARAs
MNT
- mirtazapine
- nefazodone
- trazodone
list the MAOIs
TIPS
- tranylcypromine
- isocarboxazid
- phenelzine
- selegiline
list the SNRI that also affects dopamine receptors
amoxapine
MOA SARAs
serotonin-adrenergic receptor antagonists
MOA vilazodone
serotonin-selective reuptake inhibitor
- ALSO partial agonist on 5-HT-1A
MOA vortioxetine
serotonin-selective reuptake inhibitor
ALSO:
- partial agonist on 5-HT-1B
- full agonist on 5-HT-1A
- full antagonist on 5-HT-1D,3,7
MOA bupropion
NDRI (noradrenergic-dopamine reuptake inhibitor)
ALSO:
- shown to increase NE/DA presynaptic release
why do SSRIs have less side effects and risks compared to TCAs
less impact on histamine, muscarinic, and adrenergic receptors
“normal” side effects of SSRIs
- CNS: sedation, insomnia, agitation, nervousness
- sexual dysfunction
- weight gain
- acute withdrawal reactions
rare, dose-dependent, toxic setting side effects of SSRIs
- QT prolongation
- hyponatremia
- serotonin syndrome
- suicidality
describe sx of serotonin syndrome
- sweating
- hyperreflexia
- akathisia/myoclonus
- shivering/tremors
compare the different SSRIs in terms of their likelihood of drug-drug interactions
most likely: fluoxetine
low/milk: citalopram, sertraline, vilazodone
least: vortioxetine and escitalopram
compare tertiary amine TCAs and secondary amine TCAs to the other SNRIs
tertiary: inhibits both NE and 5-HT equally
secondary: inhibits NE more than 5-HT
other SNRIs: inhibit 5-HT more than NE
what are the 3 key TCA system-based side effects
1) cardiovascular (from alpha receptor antagonism)
- tachy, orthostatic hypotension, dysrhythmias
2) anticholinergic
- dry mouth, urinary retention, constipation, blurred vision
3) CNS (from histamine receptor antagonism)
- sedation, fatigue, dizziness, seizures
what are the 3 C’s of TCA toxic ingestion
- coma
- cardiotoxicity
- convulsions
compare SNRIs’ side effects to SSRIs’
SNRIs have similar side effects with less risk for sexual dysfunction
MOA trazodone and nefazodone
SARAs
- selectively block POST-synaptic ALPHA 1 receptors on NE neurons
- selectively block POST-synaptic 5-HT-2 receptors
MOA mirtazapine
SARA
- blocks PRE-synaptic ALPHA 2 receptors on NE and 5-HT neurons
- blocks POST-synaptic 5-HT- 2/3 receptors
side effects of SARAs
- CNS: sedation
- orthostatic hypotension
- weight gain
side effects NDRIs
- agitation, insomnia
- HTN, tachy, tremors
- weight LOSS
- seizures
which MAOIs are non-selective and which are selective
- selegiline is B-selective
- all others are non-selective (A/B)
what is the anti-depressant form of selegiline
a patch
side effects MAOIs
- orthostatic hypotension
- sexual dysfunction
- weight gain
- insomnia/agitation/nervousness
drug interactions with MAOIs
- anti-hypertensives, amphetamines, SSRIs/TCAs/SNRIs
there must be a 2 week wash-out period from an SSRI before starting an MAOI
what is the major concern of using MAOIs
hypertensive crisis
how do MAOIs cause hypertensive crisis
what MAOI should you use for the lowest risk
non-selective MAOIs inhibit MAO-A necessary in GI for tyramine metabolism
–> increased tyramine –> significant catecholamine release –> hypertensive crisis
lowest risk: low-dose selegiline patch
signs/sx of hypertensive crisis
can be seen with MAOI use
- severe HA
- N/V
- sweating/severe anxiety
- nosebleeds
- tachy
- CP
- vision changes
- SOB
- confusion
MOA esketamine
NMDA-receptor antagonist
indications for esketamine
treatment-resistant depression in conjunction with ongoing antidepressant therapy
administration and observation for esketamine
administration: nasal
observation: for 2 hours post-dose
MOA brexanolone
GABA-A receptor positive allosteric modulator
indications for brexanolone
post-partum depression
administration, observation, and efficacy of brexanolone
administration: 60 hour IV administration
observation: every 2 hours for somnolence and LOC
efficacy: superior efficacy to placebo at 60 hours (1 dose) and lasts up to 30 days
list the 3 anti-seizure meds
- carbamazepine
- lamotrigine
- divalproex/valproic acid
lithium’s effect on doapmine neurotransmission
interferes with both stimulatory and inhibitory G proteins to keep them in inactive state
lithium’s effect on NMDA receptor
downregulates the NMDA receptor
effect of lithium on GABA neurotransmission
lithium promotes GABAergic neurotransmission
- increases GABA in CSF
- presynaptically facilitates GABA release
- postsynaptically upregulates GABA-B receptors
effect of lithium on phosphoinositide cycle
inhibits IPPase and IMPase
effect of lithium on PKC, MARCKS, and GSK-3
inhibits them
describe lithium’s effects on the kidney
lithium enters prinicpal cells of collecting duct –> accumulation of lithium in these cells –> resistance to ADH –> polyuria and polydipsia
patient presenting with nephrogenic diabetes insipidus with a mood disorder was most likely prescribed:
lithium
drug interactions with lithium
- diuretics (thiazides)
- ACEIs (lisinopril)
- NSAIDs
side effects of lithium
- polyuria/polydipsia
- tremors
- mental confusion/dizziness/sedation
- thyroid goiter
- leukocytosis
- seizures/serotonin syndrome
indications for lithium
- acute and maintenance tx of mania/bipolar I
- augmentation in unipolar depressive pts
indications for valproic acid/divalproex
acute bipolar I
indications for lamotrigine
maintenance of bipolar disorder I and II
indications for carbamazepine
acute and maintenance tx of acute mania and mixed episodes (bipolar I)
which mood stabilizer is a major CYP450 inducer
carbamazepine
