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Year 2 Psych exam I > Pharm, antidepressants, Linger > Flashcards

Pharm, antidepressants, Linger Flashcards

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1
Q

What are the sSRIs

A 
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
setraline
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2
Q

what are the Selective serotonin NE reuptake inhibitors

A

duloxetine

venlafaxine

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3
Q

what tricyclic antideppressants are used in depression

A

amitriptyline
desipramine
imipramine
nortriptyline

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4
Q

what is the 5-HT2 antagonist used in depression

A

tazodone

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5
Q

what are the tetracyclic and unicyclic agents

A

buproprion

mirtazapine

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6
Q

what MAOI is used in depression

A

selegiline

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7
Q

forms MAOI selegiline is available in

A

transdermal patch
sublingual
bypass gut and liver for increased bioavialability

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8
Q

MOA SSRI

A

allosterically inhibit serotonin transporter to increase [ ] in cleft
80% SET blocked at therapeutic dose

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9
Q

what is MOA proposed for chronic use SSRI

A

down regulation post synaptic %-HT2a R density

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10
Q

SNRIs and tricyclic antidepressant MOA

A

inhibit SERT and NET increasing NT [ ]

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11
Q

affinity of tricyclic antidepressants for R

A

muscarinic too, Histamine and alpha adrenergic

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12
Q

5-HT2 antagonist MOA

A

trazodone and nefazodone

antagonize postsynaptic R to enhance tone

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13
Q

MOA Bupropion

A

selective inhibitor of dopamine transporter stimulates release NE and DA
no direct effect on serotonin reuptake or R

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14
Q

MAOI MOA

A

cause accumulation NE 5-HT and DA in vesiicles at nerve endings

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15
Q

MOA selefiline

A

selective irreversible MAO-B inhibitor at low doses

nonselective MAOA/B inhibitor at high dosese (depression)

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16
Q

MOA phenelzine and tranylcypromine

A

nonselective irreversible MAOIs

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17
Q

which tricyclic antidepressants stimulate muscarinic R the most

A

amitriptyline

protriptyline

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18
Q

which antidepressants work on SERT the most

A 
citalopram
clomipramine
fluoxetine
flucoxamine
parozetine
sertraline
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19
Q

which antidepressants have highest affinity for NET

A

despramine

protriptyline

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20
Q

70-80% depressino patients achieve remission via what

A

switching to another agent or augmentation by addition of another drug

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21
Q

When adequate response for depression achieved, what is therapy recommendation

A

minimum 6-12 mo to reduce risk of relapse

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22
Q

patients considered for long term maintenance when

A

> 2 MDD episodes in previous 5 years or >3 in lifetime

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23
Q

second most common use antidepressants

A

anxiety disorders

PTSD, OCD, social anxiety, generalized anxiety and panic disorder

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24
Q

OCD is known to respond to what agents

A

serotonergic agents like fluoxetine and fluvoxamine, paroxetine and clompramine

25
Q

what antidepressants are used in pain disorders

A

TCA and SSRI

26
Q

What antidepressants are used for premenstrual dysphoric disorder

A

SSRIs
fluoxetine
setraline

27
Q

Tx schedule for premenstrual dysphoric disorder

A

2 weeks during luteal phase

28
Q

which antidepressants are used in eatind disorders

A

fluoxetine and others

bulimia not anorexia

29
Q

what antidepressants are used for insomina

A

amitriptyline and trazodone

30
Q

Which TCA is used for pruritis

A

doxepin because works on histamine R

31
Q

first line for Tx MDD and anxiety

A

SSRIs because fewer antimuscarinic effects and less cardiotoxic in overdose

32
Q

What is a drug for depression in patients who cannot tolerate sexual dysfunction, weight gain and sedation

A

bupropion

33
Q

2nd 3rd line agents for MDD

A

TCAs and MAOIs because potentially lethal in overdose
need titration to achieve therapeutic dose
serious effects and interactions

34
Q

Adverse effects of all antidepressants

A

increased suicidality in patients under age 25

35
Q

side effects SSRIs

A

mild sedation and antimuscarinic effects
GI: nuasea, vomiting, upset stomach, constipation
diminished sexual function libido delayed orgasm, diminished arousal
HA, insomnia, hypersomnia and weight gain

36
Q

What is discontinuation syndrome

A

dizziness and paresthesia after sudden discontinuation

seen with SSRI and SNRI and TCA

37
Q

Serotonin syndrome

A

overdose SSRI or concurrent MAOI use

38
Q

CI to SSRI

A

patients displaying active manic Sx

paroxetine CI in pregnant patients

39
Q

Adverse effects to SNRIs

A

serotonergic effects and! noradrenergic like insomnia, anxiety and agitation
inc BP and HR
venlafaxine inc bleeding risk and related with cardiac toxicity in overdose

40
Q

adverse effects TCA

A 
anticholinergic: dry mouth, constipation urinary retention, blurred vision and confusion
orthostatic hypotension
weight gain and sedation
cardiotoxicity arrhythmias and heart block
hepatic dysfunction
hyponatremima
hematologic abnormalities
sexual side effects like sSRI
41
Q

which TCA exhibit marked antimuscarinic and cardiac side effects

A

imipramine and amitriptyline

42
Q

CI to TCA

A

arrhythmias, recent MI, liver disease, glaucoma, mania

43
Q

adverse effects 5-HT2 antagonist

A

sedation and GI disturbances

orthostatic hypotension

44
Q

black box warning nefazodone

A

hepatotoxicity and potentially lethal hepatic failure

45
Q

adverse effects bupropion

A

agitation and insomnia and anorexia

46
Q

which antidepressants do not have significant sexual side effects

A

5-HT2 antagonists

bupropion and mirtazapine

47
Q

adverse effects MAOIs

A

orthostatic hypotension and weight gain

highest rate sexual side effects!!!!!!!!

48
Q

discontinuation syndrome in MAOI

A

delirium like presentation with psychosis, excitement and confusion

49
Q

amitriptyline overdose

A

arrhythmia, altered mental status and seizures

50
Q

amitriptyline overdose

A

arrhythmia, altered mental status and seizures

gastric decontamination is helpful up to 8 hr post ingestion

51
Q

MAOI overdose

A 
autonomic instability
hyperadrenergic Sx
psychotic Sx
confusion
delirium, fever and seizures
52
Q

pharmokinetics of antidepressants

A

inhibitors of CYP450 or substrates

53
Q

St Johns wort PK

A

herbal med that induces CYP450

used to Tx depression

54
Q

Sx serotonin syndrome

A

cognitive: delirium, agitation coma
ANS: HTN, tachy, hyperthermia, diaphoreses
somatic: myoclonus, hyperreflexia, tremor

55
Q

switching between SSRI and MAOI

A

current therapy needs to be discontinued for at least 2 weeks
6 weeks for fluoxetine because longer half life

56
Q

Tx serotonin syndrome

A

withdraw offending drug, sedation with benzo, paralysis, intubation, ventilation
consider 5-HT2 block with cyproheptadine or clorpromazine

57
Q

Foods with significant amounts tyramine

A

pickled, aged, smoked, marinated, meats (spoiled), chocolate, alcoholic beverages, fermented foods like cheese

58
Q

CI with tyramine food

A

MAOI because normally metabolized by MAO so with large amounts leads to HTN crisis
NE release from peripheral nerves and inc HR and BP (potentially fatal!*)

Year 2 Psych exam I (15 decks)

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