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NMSP Exam 3 > Pharm: Antidepressants and Mood Stabilizers > Flashcards

Pharm: Antidepressants and Mood Stabilizers Flashcards

1
Q

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

A

Duloxetine

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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 histamin (H1) receptors?

A
  • Sedation/Fatigue
  • Dizziness/Seizures
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9
Q

Which 4 TCA’s are 3° amines?

A
  • Clomipramine
  • Amitriptyline
  • Doexpin
  • Imipramine
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10
Q

Which 3 TCA’s are 2° amines?

A
  • Amoxapine
  • Nortriptyline
  • Desipramine
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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

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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?

A

Fluoxetine

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16
Q

Which 2 drugs in the SSRI class are only mild inhibitors of CYP450s?

A

Citalopram and Sertraline

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17
Q

Which AE’s are most prominent with SSRI’s compard to other anti-depressants?

A

GI effects and Sexual effects

18
Q

What is the major AE of the SARA’s, Mirtazapine, Nefazodone, and Trazodone?

A

Sedation

19
Q

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

A

Selegiline

20
Q

Which atypical antidepressant has the least amount of AE’s associated with it?

A

Atomoxetine

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 some of the 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 I (with or w/o psychotic features)?

A

Divalproex

28
Q

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

A

Carbamazepine

29
Q

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

A

Lamotrigine

30
Q

What is the 2° amine (TCA), Amoxapine indicated for and what makes this drug stand out from others in the class?

A
  • Sx’s of depression in pt’s with neurotic or reactive depressive disorders
  • Depression accompanied by anxiety and agitation
  • Amoxapine has a more rapid onset than other TCA’s!
31
Q

All antidepressants can cause Withdrawal Syndrome, thus necessitating downward titration. What are the s/s of Withdrawal Syndrome?

A

“FINISH”

F-flu like sx

I-Insomnia

N-Nausea

I-Imbalance

S-Sensory disturbances

H-Hyperarousal

32
Q

What two SSRIs have multiple targets?

A

Vilazodone- ptAgonist at 5HT

Vortioxetine- partial and full agonist at 5HT

33
Q

With SSRIs, what is a concern when stopping the medication?

A

Acute Withdrawal Reaction

34
Q

Describe Serotonin Syndrome

A

Sweating

Hyperreflexia

Akathisia/Myoclonus

Shivering/Tremors

35
Q

What is considered a black box warning for SSRIs?

A

Suicidality

(become undepressed enough to carry out plan, and still depressed enough to feel suicidal)

36
Q

What is a common side effect of NDRIs (Bupropion)

A

Seizures

37
Q

What is necessary with MAOIs due to interactions between it and 5HT/NE affecting drugs?

A

A 2 week wash out period (or 5wks for Fluoxetine)

38
Q

What is a major concern for pt’s on MAOIs?

A

Hypertensive crisis

39
Q

As a monovalent ion, Lithium is handled how by the kidney?

A

Similar to Na/K

Competes with Na for reabsorption

40
Q

Lithium can cause polyuria and polydipsia, leading to a clinical picture that is similar to what?

A

Diabetes Insipidus

NMSP Exam 3 (21 decks)

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