Pharm: Antidepressants and Mood Stabilizers Flashcards
Which anti-depressant is used off-label for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain, and stress incontinence?
Duloxetine
List the 8 SSRIs
- Citalopram + Escitalopram
- Fluoxetine + Paroxetine + Vortioxetine
- Sertraline
- Vilazodone
- Fluvoxamine
List the 5 SNRI’s used as anti-depressants
- All TCA’s
- Desvenlafaxine + Venlafaxine
- Duloxetine
- Levomilnacipran
TCA-based SNRI’s have impact on what 3 key non-efficacy related receptors?
- Histamine (H1)
- Muscarinic (cholinergic)
- α1-adrenergic
Amitriptyline should not be combined with what other drug class; why?
MAO inhibitors –> hypertensive crises, severe convulsions, and death
What are the 3 C’s of toxic ingestion with TCA’s?
- Coma
- Cardiotoxicity (Conduction abnormalities)
- Convulsions
What are the AE’s associated with TCA’s antagonizing α1-adrenergic receptors?
CV –> Tachycardia + Orthostatic hypotension + Dysrhythmias
What are the AE’s associated with TCA’s antagonizing histamin (H1) receptors?
- Sedation/Fatigue
- Dizziness/Seizures
Which 4 TCA’s are 3° amines?
- Clomipramine
- Amitriptyline
- Doexpin
- Imipramine
Which 3 TCA’s are 2° amines?
- Amoxapine
- Nortriptyline
- Desipramine
What is a black box warning associated with the TCA, Amoxapine?
Both adults and ped’s pt’s may experience worsening of their depression and/or emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior
Which class of anti-depressants is associated with little to no GI-related AE’s?
TCA’s
What is important to consider when discontinuing the SSRI, Escitalopram?
Should be tapered down
Which drug class may interact with antidepressants and migraine medicines to cause serotonin syndrome?
Opioids
Which drug in the SSRI class is the broadest and strongest inhibitor of CYP450?
Fluoxetine
Which 2 drugs in the SSRI class are only mild inhibitors of CYP450s?
Vortioxetine and Escitalopram
Which AE’s are most prominent with SSRI’s compard to other anti-depressants?
GI effects and Sexual effects
What is the major AE of the SARA’s, Mirtazapine, Nefazodone, and Trazodone?
Sedation
Which MAO inhibitor has the least amount of AE’s associated with it?
Selegiline
Which atypical antidepressant has the least amount of AE’s associated with it?
Atomoxetine
If a patient does not respond to a given antidepressat after an 8 week trial on an adequate dose, what should be done?
Switch to another antidepressant with a different MOA (incl. ‘antipsychotics)
What are some of the AE’s associated with Lithium?
- Polyuria (polydipsia): nephrogenic DI
- Tremor
- Mental confusion/dizziness/sedation: take at bedtime
- Thyroid goiter (hypothyroidism)
- Leukocytosis
- Seizures and serotonin syndrome
Which drug interactions must you be aware of when treating with Lithium?
- Diuretics, via preferential Na+ loss and Li+ reabsorption
- ACEIs: especially lisinopril (renally excreted)
- NSAIDs
What are 2 main indications for use of Lithium and what is an off-label use?
- For acute and maintenance tx of mania/bipolar I disorder
- For augmentation in unipolar depressive pt’s with inadequate response to antidepressant therapy
- Off label: reduced risk of suicide and all-cause mortality in pt’s with mood disorders
Which anti-seizure mood stabilizer is used for acute bipolar I (with or w/o psychotic features)?
Divalproex
Which anti-seizure mood stabilizer is used for maintenance of bipolar disorder (I and II)?
Lamotrigine
