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NMSP Exam 1 > [PHARM] Antidepressants [Segars] > Flashcards

[PHARM] Antidepressants [Segars] Flashcards

1
Q

ALL antidepressants either are known to be or can be associated with a _____________________

A

ALL antidepressants either are known to be or can be associated with a WITHDRAWAL SYNDROME

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2
Q

What are the symptoms of withdrawal syndrome?

A

“F-I-N-I-S-H”

F= Flu-like symptoms

I= Insomnia

N= Nausea

I= Imbalance

S= Sensory disturbances

H= Hyperarousal

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3
Q

Special indications for ‘Antidepressant’ meds:

Drug for nicotine withdrawal

A

Nicotine withdrawl = Bupropion

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4
Q

Special indications for ‘Antidepressant’ meds:

Drug for enuresis

A

Enuresis (involuntary urination) = Imipramine

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5
Q

Special indications for ‘Antidepressant’ meds:

Drug for Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain

A

Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain = Duloxetine

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6
Q

Special indications for ‘Antidepressant’ meds:

Drug for Stress Incontinence

A

Stress incontinence = Duloxetine

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7
Q

What does SSRI stand for?

A

Selective Serotonin Reuptake Inhibitor

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8
Q

What are the (7) SSRIs?

A

Fluoxetine

Paroxetine

Sertraline

Citalopram

Escitalopram

Vilazodone

Vortioxetine

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9
Q

What should you remember about the SSRIs that start with a “V”?

What are they?

A

Make a “V” with your fingers, makes a number two. Remember that these drugs have TWO mechanisms of action. In addition to the standard SSRI MOA, they have another!

Vilazodone (also partial agonist on 5-HT1A)

Vortioxetine (also partial agonist on 5-HT1B and full agonist on 5-HT1A and full antagonist on 5-HT1D,3,7)

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10
Q

Where do SSRI’s act?

A

SSRI’s act on the SERT transporter on the presynaptic neuron

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11
Q

Why are SSRI’s the first line class of drugs used?

A

As a class, fewer side effects and risks than other classes (eg TCAs)

Much less impact on histamine, muscarinic and adrenergic receptors

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12
Q

What are the common side effects associated with SSRIs?

A
  • CNS (sedation or insomnia)
  • Sexual dysfunction
  • Weight gain
  • ACUTE WITHDRAWAL REACTIONS
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13
Q

What are some of the rare side effects of SSRIs?

A

Serotonin syndrome (sweating, hyperreflexia, shivering, tremors)

Suicidality

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14
Q

Which SSRI has the MOST drug-drug interactions?

A

Fluoxetine

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15
Q

Which two SSRI’s have the LEAST number of drug-drug interactions?

A

Vortioxetine

Escitalopram

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16
Q

What does SNRI stand for?

A

Serotonin and Norepinephrine reuptake inhibitor

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17
Q

Where do SNRI’s act?

A
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18
Q

What are the 3 non-efficacy related receptors that are affected with TCA’s?

A
  1. Histamine (H1)
  2. Muscarinic (cholinergic)
  3. Alpha1 (adrenergic)
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19
Q

What are the 3 key TCA system based side effects?

A
  1. Cardiovascular (alpha) : Tachycardia, orthostatic hypotension, dysrhythmias
  2. Anticholinergic (muscarinic) : Dry mouth, urinary retention, blurred vision
  3. CNS (histamine) : Sedation/fatigue, dizziness/seizures
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20
Q

What are the “3 C’s” associated with TCA overdose?

A

Coma

Cardiotoxicity

Convulsions

21
Q

What does SARA stand for?

A

Seratonin Adrenergic Receptor Antagonists

22
Q

What are the (3) SARA drugs?

A

Mirtazapine

Nefazodone

Trazodone

23
Q

Where do SARAs act?

A
24
Q

What are the side effects of SARAs?

A

CNS (sedation)

Orthostatic hypotension

Weight gain

25
Q

What does NDRI stand for?

A

Norepinephrine and Dopamine Reuptake inhibitor

26
Q

What is the (1) NDRI?

A

Bupropion

27
Q

What is the major side effect of NDRIs?

A

Seizures

28
Q

What does MAOI stand for?

A

Monoamine oxidase inhibitors

29
Q

What are the (4) MAOIs?

A

Isocarboxazid

Phenelzine

Selegiline

Tranylcypromine

30
Q

Where do MAOIs act?

A
31
Q

What is the one selective MAOI?

A

Selegiline

(Starts with an S for selective)

32
Q

What are the side effects of MAOIs?

A

Orthostatic hypotension

Sexual dysfunction

Weight gain

Insomnia/agitation/nervousness

33
Q

Why do most physicians choose not to use MAOIs?

A

There is a 2 week wash out period, where you need to remove the previous anti-depressant in order to add MAOIs

34
Q

What is the MAJOR concern when using MAOIs?

A

Hypertensive crisis

(has to do with over ingestion of tyramine in diet)

35
Q

What are the symptoms/signs of a hypertensive crisis?

A

Severe headache

N/V

Sweating/severe anxiety

Nosebleeds

Tachycardia

Chest pain

Changes in vision

Shortness of breath

Confusion

36
Q

What are the two miscellaneous agents?

A

Esketamine

Brexanolone

37
Q

What is the MOA of esketamine?

A

NMDA receptor antagonist

38
Q

What is esketamine indicated for?

A

Treatment-resistant depression in conjunction with ongoing anti-depressant therapy

39
Q

What is the MOA of brexanolone?

A

GABA(a) receptor positive allosteric modulator

40
Q

What is the indication for brexanolone?

A

Post-partum depression

41
Q

What are the two categories of mood stabilizer drugs?

A

Anti-seizure agents

Miscellaneous

42
Q

What are the (3) anti-seizure agents used to treat mood disorders?

A

Carbamazepine

Lamotrigine

Divalproex/Valproic acid

43
Q

What is the (1) miscellaneous mood stabilizer drug?

A

Lithium

44
Q

What are the top 3 actions of lithium?

A

Brain structure

Neurotransmitter modulation

Intracellular changes

45
Q

How does lithium change the brain structures?

A

Has neuroprotective/neuroproliferative effects

46
Q

How does lithium affect neurotransmitter modulation?

A

Lithium inhibits dopamine neurotransmission

47
Q

MOA of lithium?

A

A monovalent ion

48
Q

Common system affected by lithium?

A

RENAL

49
Q

What is the major CYP40 inducer?

A

Carbamazepine

NMSP Exam 1 (22 decks)

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