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?
Citalopram and Sertraline
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
Which 3 antidepressant drugs are not associated with sexual dysfunction?
- Buproprion
- Nefazodone
- Selegiline
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)
When is it okay to use a monotherapy of antidepressants?
ONLY for unipolar depression
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 acute and maintenanc tx of acute mania and mixed episodes (bipolar I)?
Carbamazepine
Which anti-seizure mood stabilizer is used for maintenance of bipolar disorder (I and II)?
Lamotrigine
What is the 2° amine (TCA), Amoxapine indicated for and what makes this drug stand out from others in the class?
- 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!
All antidepressants can cause Withdrawal Syndrome, thus necessitating downward titration. What are the s/s of Withdrawal Syndrome?
“FINISH”
F-flu like sx
I-Insomnia
N-Nausea
I-Imbalance
S-Sensory disturbances
H-Hyperarousal
What two SSRIs have multiple targets?
Vilazodone- ptAgonist at 5HT
Vortioxetine- partial and full agonist at 5HT
With SSRIs, what is a concern when stopping the medication?
Acute Withdrawal Reaction
Describe Serotonin Syndrome
Sweating
Hyperreflexia
Akathisia/Myoclonus
Shivering/Tremors
What is considered a black box warning for SSRIs?
Suicidality
(become undepressed enough to carry out plan, and still depressed enough to feel suicidal)
What is a common side effect of NDRIs (Bupropion)
Seizures
What is necessary with MAOIs due to interactions between it and 5HT/NE affecting drugs?
A 2 week wash out period (or 5wks for Fluoxetine)
What is a major concern for pt’s on MAOIs?
Hypertensive crisis
As a monovalent ion, Lithium is handled how by the kidney?
Similar to Na/K
Competes with Na for reabsorption
Lithium can cause polyuria and polydipsia, leading to a clinical picture that is similar to what?
Diabetes Insipidus
