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1. Psych Exam 1 > Pharm: Antidepressants and Mood Stabilizers > Flashcards

Pharm: Antidepressants and Mood Stabilizers Flashcards

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1
Q

Which anti-depressant is used off-label for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain, and stress incontinence?

Enuresis?

A

Duloxetine

Enuresis = imipramine

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2
Q

List the 8 SSRIs

A
  • Citalopram + Escitalopram
  • Fluoxetine + Paroxetine + Vortioxetine
  • Sertraline
  • Vilazodone
  • Fluvoxamine
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3
Q

List the 5 SNRI’s used as anti-depressants

A
  • All TCA’s
  • Desvenlafaxine + Venlafaxine
  • Duloxetine
  • Levomilnacipran
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4
Q

TCA-based SNRI’s have impact on what 3 key non-efficacy related receptors?

A
  • Histamine (H1)
  • Muscarinic (cholinergic)
  • α1-adrenergic
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5
Q

Amitriptyline should not be combined with what other drug class; why?

A

MAO inhibitors –> hypertensive crises, severe convulsions, and death

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6
Q

What are the 3 C’s of toxic ingestion with TCA’s?

A
  • Coma
  • Cardiotoxicity (Conduction abnormalities)
  • Convulsions
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7
Q

What are the AE’s associated with TCA’s antagonizing α1-adrenergic receptors?

A

CV –> Tachycardia + Orthostatic hypotension + Dysrhythmias

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8
Q

What are the AE’s associated with TCA’s antagonizing H1 receptors?

What about anticholinergic receptors?

A

Histamine:

  • Sedation/Fatigue
  • Dizziness/Seizures

Muscarinic:

  • Dry mouth
  • Urine retention
  • Blurred vision
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9
Q

Which 4 TCA’s are 3° amines?

What is their MOA?

A
  • Clomipramine
  • Amitriptyline
  • Doexpin
  • Imipramine

MOA = inh both NE/5-HT equally

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10
Q

Which 3 TCA’s are 2° amines?

What is their MOA?

A
  • Amoxapine
  • Nortriptyline
  • Desipramine

MOA = inhibit NE more than 5-HT

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11
Q

What is a black box warning associated with the TCA, Amoxapine?

A

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

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12
Q

Which class of anti-depressants is associated with little to no GI-related AE’s?

A

TCA’s

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13
Q

What is important to consider when discontinuing the SSRI, Escitalopram?

A

Should be tapered down

All SSRI will cause acute withdrawal sx

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14
Q

Which drug class may interact with antidepressants and migraine medicines to cause serotonin syndrome?

A

Opioids

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15
Q

Which drug in the SSRI class is the broadest and strongest inhibitor of CYP450?

Which is the least?

A

Fluoxetine = strong

Vortioxetine & escitalopram = least

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16
Q

Which 3 drugs in the SSRI class are only mild inhibitors of CYP450s?

A

Citalopram, Sertraline, Vilazodone

17
Q

Which 4 rare SEs of SSRI’s are of concern?

A

1. Serotonin syndrome = sweat, hyperreflexia, akathisia, shiver, tremor

2. Suicidality = higher risk w kids and YA

  1. QT prolonged
  2. Hyponatremia from SIADH
18
Q

What are the major AE of the SARA’s?

Mirtazapine, Trazodone, Nefazodone?

A

Sedation = Trazodone and Mirtazapine

Weight gain = Mirtazapine

19
Q

Which MAO inhibitor has the least amount of AE’s associated with it?

What is the major concern w MAOIs?

A

Selegiline

Hypertensive crisis w ingestino of tyramines = major concern

20
Q

Misc antidepressants MOA

  1. Esketamine
  2. Brexanolone
A
  1. Esketamine = NMDA rec antagonist. Nasal admin
  2. Brexanolone = GABAa rec modulator
21
Q

Which 3 antidepressant drugs are not associated with sexual dysfunction?

A
  • Buproprion
  • Nefazodone
  • Selegiline
22
Q

If a patient does not respond to a given antidepressat after an 8 week trial on an adequate dose, what should be done?

A

Switch to another antidepressant with a different MOA (incl. ‘antipsychotics)

23
Q

When is it okay to use a monotherapy of antidepressants?

A

ONLY for unipolar depression

24
Q

What are 5 AE’s associated with Lithium?

A
  • Polyuria (polydipsia): nephrogenic DI
  • Tremor
  • Mental confusion/dizziness/sedation: take at bedtime
  • Thyroid goiter (hypothyroidism)
  • Leukocytosis
  • Seizures and serotonin syndrome
25
Q

Which drug interactions must you be aware of when treating with Lithium?

A
  • Diuretics, via preferential Na+ loss and Li+ reabsorption
  • ACEIs: especially lisinopril (renally excreted)
  • NSAIDs
26
Q

What are 2 main indications for use of Lithium and what is an off-label use?

A
  • 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
27
Q

Which anti-seizure mood stabilizer is used for acute bipolar 1 (with or w/o psychotic features)?

A

Divalproex/Valproic Acid

28
Q

Which anti-seizure mood stabilizer is used for acute and maintenance tx of acute mania and mixed episodes (bipolar 1)?

A

Carbamazepine

29
Q

Which anti-seizure mood stabilizer is used for maintenance of bipolar disorder (I and II)?

A

Lamotrigine

30
Q

What mood stabilizer is a major CYP450 inducer?

A

Carbamazepine

31
Q

Recovery versus Remission?

Relapse versus Reccurence?

A

Remission = no sx

Recovery = remission for 2-6mo

Relapse = return of sx after remission BEFORE recovery

Recurrence = return of sx after recovery

32
Q

What med is an SNRI and DA agonist?

A

Amoxapine

33
Q

What SSRI is used only for OCD?

A

Fluvoxamine

34
Q

MOA of Vilazodone?

MOA of Vortioxetine?

A

Both are SSRI’s via SERT

Vilazodone = partial agonist of 5-HT1A

Vortioxetine = partial agonist of 5-HT1B and full agonist of 5-HT1A. Full antagonist of 5-HT3

35
Q

NMS versus Serotonin syndrome

A

NMS = DA agents like antipsychotics. Hyporeflexia!

SS = Serotonergic agents like SSRI/SNRI/TCA/MOA. Hyperreflexia

36
Q

What med is an NDRI?

This med also inc the pre-syn release of NE and DA. How does it do this?

What is the SE of this med?

A

Buproprion

MOA = acts on VMAT2 to inc pre-syn release of NE and DA

SE = seizures

37
Q

Before starting an MAOI for resistant depression, what should we do first?

A

Allow for a 2 week wash out period of other drugs (TCA, SSRI, SNRI)

To avoid SS and hypertensive crisis

1. Psych Exam 1 (22 decks)

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