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Maddy - NMSP Exam I - psych pharm > Pharm - Antidepressants > Flashcards

Pharm - Antidepressants Flashcards

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1
Q

describe the symptoms of withdrawal syndrome

A

FINISH

  • F: flu-like sx
  • I: insomnia
  • N: nausea
  • I: imbalance
  • S: sensory disturbances
  • H: hyperarousal
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2
Q

in addition to major depressive disorder, Buproprion can be used for _______

A

nicotine withdrawal

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3
Q

in addition to major depressive disorder, Imipramine can be used for _______

A

enuresis (repeated inability to control urination)

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4
Q

in addition to major depressive disorder, Duloxetine can be used for _______

A
  • diabetic peripheral neuropathy
  • fibromyalgia
  • chronic MSK pain
  • stress incontinence
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5
Q

list the SNRIs

A

(TDDVL)

  • TCAs
  • desvenlafaxine
  • duloxetine
  • venlafaxine
  • levomilnacipran
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6
Q

list the SSRIs

A

CFSEPVV

  • citalopram
  • fluoxetine
  • sertraline
  • escitalopram
  • paroxetine
  • vilazodone
  • vortioxetine
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7
Q

list the NDRIs

A

bupropion

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8
Q

list the SARAs

A

MNT

  • mirtazapine
  • nefazodone
  • trazodone
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9
Q

list the MAOIs

A

TIPS

  • tranylcypromine
  • isocarboxazid
  • phenelzine
  • selegiline
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10
Q

list the SNRI that also affects dopamine receptors

A

amoxapine

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11
Q

MOA SARAs

A

serotonin-adrenergic receptor antagonists

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12
Q

MOA vilazodone

A

serotonin-selective reuptake inhibitor

- ALSO partial agonist on 5-HT-1A

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13
Q

MOA vortioxetine

A

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
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14
Q

MOA bupropion

A

NDRI (noradrenergic-dopamine reuptake inhibitor)

ALSO:
- shown to increase NE/DA presynaptic release

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15
Q

why do SSRIs have less side effects and risks compared to TCAs

A

less impact on histamine, muscarinic, and adrenergic receptors

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16
Q

“normal” side effects of SSRIs

A
  • CNS: sedation, insomnia, agitation, nervousness
  • sexual dysfunction
  • weight gain
  • acute withdrawal reactions
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17
Q

rare, dose-dependent, toxic setting side effects of SSRIs

A
  • QT prolongation
  • hyponatremia
  • serotonin syndrome
  • suicidality
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18
Q

describe sx of serotonin syndrome

A
  • sweating
  • hyperreflexia
  • akathisia/myoclonus
  • shivering/tremors
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19
Q

compare the different SSRIs in terms of their likelihood of drug-drug interactions

A

most likely: fluoxetine

low/milk: citalopram, sertraline, vilazodone

least: vortioxetine and escitalopram

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20
Q

compare tertiary amine TCAs and secondary amine TCAs to the other SNRIs

A

tertiary: inhibits both NE and 5-HT equally
secondary: inhibits NE more than 5-HT

other SNRIs: inhibit 5-HT more than NE

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21
Q

what are the 3 key TCA system-based side effects

A

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

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22
Q

what are the 3 C’s of TCA toxic ingestion

A
  • coma
  • cardiotoxicity
  • convulsions
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23
Q

compare SNRIs’ side effects to SSRIs’

A

SNRIs have similar side effects with less risk for sexual dysfunction

24
Q

MOA trazodone and nefazodone

A

SARAs

  • selectively block POST-synaptic ALPHA 1 receptors on NE neurons
  • selectively block POST-synaptic 5-HT-2 receptors
25
Q

MOA mirtazapine

A

SARA

  • blocks PRE-synaptic ALPHA 2 receptors on NE and 5-HT neurons
  • blocks POST-synaptic 5-HT- 2/3 receptors
26
Q

side effects of SARAs

A
  • CNS: sedation
  • orthostatic hypotension
  • weight gain
27
Q

side effects NDRIs

A
  • agitation, insomnia
  • HTN, tachy, tremors
  • weight LOSS
  • seizures
28
Q

which MAOIs are non-selective and which are selective

A
  • selegiline is B-selective

- all others are non-selective (A/B)

29
Q

what is the anti-depressant form of selegiline

A

a patch

30
Q

side effects MAOIs

A
  • orthostatic hypotension
  • sexual dysfunction
  • weight gain
  • insomnia/agitation/nervousness
31
Q

drug interactions with MAOIs

A
  • anti-hypertensives, amphetamines, SSRIs/TCAs/SNRIs

there must be a 2 week wash-out period from an SSRI before starting an MAOI

32
Q

what is the major concern of using MAOIs

A

hypertensive crisis

33
Q

how do MAOIs cause hypertensive crisis

what MAOI should you use for the lowest risk

A

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

34
Q

signs/sx of hypertensive crisis

can be seen with MAOI use

A
  • severe HA
  • N/V
  • sweating/severe anxiety
  • nosebleeds
  • tachy
  • CP
  • vision changes
  • SOB
  • confusion
35
Q

MOA esketamine

A

NMDA-receptor antagonist

36
Q

indications for esketamine

A

treatment-resistant depression in conjunction with ongoing antidepressant therapy

37
Q

administration and observation for esketamine

A

administration: nasal
observation: for 2 hours post-dose

38
Q

MOA brexanolone

A

GABA-A receptor positive allosteric modulator

39
Q

indications for brexanolone

A

post-partum depression

40
Q

administration, observation, and efficacy of brexanolone

A

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

41
Q

list the 3 anti-seizure meds

A
  • carbamazepine
  • lamotrigine
  • divalproex/valproic acid
42
Q

lithium’s effect on doapmine neurotransmission

A

interferes with both stimulatory and inhibitory G proteins to keep them in inactive state

43
Q

lithium’s effect on NMDA receptor

A

downregulates the NMDA receptor

44
Q

effect of lithium on GABA neurotransmission

A

lithium promotes GABAergic neurotransmission

  • increases GABA in CSF
  • presynaptically facilitates GABA release
  • postsynaptically upregulates GABA-B receptors
45
Q

effect of lithium on phosphoinositide cycle

A

inhibits IPPase and IMPase

46
Q

effect of lithium on PKC, MARCKS, and GSK-3

A

inhibits them

47
Q

describe lithium’s effects on the kidney

A

lithium enters prinicpal cells of collecting duct –> accumulation of lithium in these cells –> resistance to ADH –> polyuria and polydipsia

48
Q

patient presenting with nephrogenic diabetes insipidus with a mood disorder was most likely prescribed:

A

lithium

49
Q

drug interactions with lithium

A
  • diuretics (thiazides)
  • ACEIs (lisinopril)
  • NSAIDs
50
Q

side effects of lithium

A
  • polyuria/polydipsia
  • tremors
  • mental confusion/dizziness/sedation
  • thyroid goiter
  • leukocytosis
  • seizures/serotonin syndrome
51
Q

indications for lithium

A
  • acute and maintenance tx of mania/bipolar I

- augmentation in unipolar depressive pts

52
Q

indications for valproic acid/divalproex

A

acute bipolar I

53
Q

indications for lamotrigine

A

maintenance of bipolar disorder I and II

54
Q

indications for carbamazepine

A

acute and maintenance tx of acute mania and mixed episodes (bipolar I)

55
Q

which mood stabilizer is a major CYP450 inducer

A

carbamazepine

Maddy - NMSP Exam I - psych pharm (23 decks)

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