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Mod4 Psychiatry > Psychopharmacology: Anti-depressants > Flashcards

Psychopharmacology: Anti-depressants Flashcards

1
Q

Anti-histamine

A

Weight gain; sedation

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2
Q

Anti-adrenergic

A

Orthostasis; arrythmias

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3
Q

Anti-cholingeric

A

Blurry vision, cognitive changes; urinary retention; constipation; xerostomia

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4
Q

Tx of Serotonin Syndrome

A

Stop drugs

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5
Q

Hypertensive crisis cause

A

Eating tyramine while on a MAOI

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6
Q

Extra-pyramidal side effects (nigrostriatal)

A

Acute dystonia; akithisia; parkinsonianism; tardive dyskinesia

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7
Q

Can EPS be life-threatening? How?

A

Yes. One example is acute dystonia of the diaphragm, which can cause asphyxiation.

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8
Q

What is one atypical antipsychotic that displays hyperprolactinemia

A

Risperidone

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9
Q

What is tardive dyskinesia, and how long after starting neuroleptics does it happen?

A

Choreoathetoid muscle movements (esp of mouth and tongue); occurs after years of antipscyhotic use

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10
Q

Neuroleptic malignant syndrome

A

Fever, tachycardia, HTN, tremor, elevated CPK (muscle breakdown); lead pipe rigidity

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11
Q

How long after starting antipscyhotics does NMS happen

A

Either short or long time (increased risk with typicals)

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12
Q

Is NMS benign?

A

Obviously not (malignant in name). 20% mortality rate.

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13
Q

Inducers of P450

A

Smoking, carbamazepine, barbiturates, St. John’s Wort

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14
Q

Inhibitors of P450

A

Fluvoxamine; Fluoxetine; Paroxetine; Duloxetine; Sertraline

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15
Q

2 NTs involved in Anxiety

A

5-HT, NE

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16
Q

3 NTs involved in mood

A

NE, 5-HT, DA

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17
Q

NT involved in obsessions and compulsion

A

5-HT

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18
Q

NT involved in alertness

A

NE

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19
Q

NT involved in attention, pleasure reward, and motivation

A

DA

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20
Q

TCAs that preferentially increase serotonin

A

Clomipramine; Imipramine

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21
Q

What is the problem with TCAs in overdoses, and why is this problematic in depression?

A

Cause cardiac toxicity easily in overdoses. Problematic in depression because dont want to give potentially suicidal people easy means to overdose

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22
Q

Why do patients not subjectively like TCAs?

A

Their anti-HAM properties

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23
Q

What specific arrythmia is caused by an overdose of TCAs?

A

Torsade de Pointes

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24
Q

In the real world, when do TCA overdoses tend to happen (i.e. when taking what other substance/drug?)

A

Alcohol (liver occupancy)

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25
Q

What is a side effect of SSRIs associated with 5-HT2a

A

Sexual dysfunction

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26
Q

What is a side effect of SSRIs associated with 5-HT3

A

GI upset

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27
Q

Which SSRI has the widest dosing window?

A

Sertraline (Zoloft)

28
Q

Which SSRI has the highest hepatic burden?

A

Fluvoxamine (Luvox)

29
Q

Which SSRI is used for OCD?

A

Fluovoxamine (Luvox)

30
Q

Which SSRI is most often discontinued?

A

Paroxetine (Paxil)

31
Q

What strange receptor does Vortioxetine have affinity for that might make it good for cognition

32
Q

Does sexual dysfunction to one SSRI predict sexual dysfunction to another?

A

Strangely, no

33
Q

Is GI upset with SSRIs transient or chronic?

34
Q

Name 3 NE preferential TCAs

A

Desipramine, Nortriptyline, Amoxapine

35
Q

Name 2 Norepinephrine Reuptake Inhibitors

A

Reboxetine; Atomoxetine

36
Q

What off-label uses do Reboxetine and Atomoxetine potentially have?

A

Anxiety, ADD

37
Q

What are a couple common side effects that result from NRIs (this NE effect in body)

A

Tremor, tachycardia

38
Q

Psychosis is a result of what disturbance to dopamine?

39
Q

Attention deficit disorder and hyperactivity are a result of what disturbance to dopamine

A

Too little

40
Q

What anti-depressant is a DA and NE agonist?

A

Buproprion (Wellbutrin)

41
Q

What is a good and bad property of Wellbutrin as compared to other anti-depressants

A

Good - no sexual side effects. Bad - lowers seizure threshold.

42
Q

In what type of patient should you not reach for Buproprion

A

Pts with eating disorders (electrolyte imbalance can predispose to seizures, as can Buproprion)

43
Q

Which drugs are 5-HT and NE agonists?

A

Certain TCAs, venlafaxine, duloxetine, mirtazapine, nefazodone

44
Q

What is unique about the mechanism of mirtazapine (Remeron)?

A

It is the only anti-depressant that enhances monoamine production. It is also a wafer (who gives a shit?)

45
Q

Name 3 TCAs that preferentially agonize 5-HT and NE

A

Amitryptyline, Protritpyline, Trimipramine

46
Q

Venlafaxine’s complicated relationship with monoamines

A

Pro-5-HT at low doses; pro-NE at medium doses; pro-DA at high doses

47
Q

If you are getting serotonin side effects on venlafaxine, what do you do to the doese?

A

Increase (get it in NE range)

48
Q

What should you beware of when using venlafaxine

A

Idiopathic HTN

49
Q

Duloxetine use?

A

Neuropathic pain

50
Q

Let’s talk about mirtazapine. What receptor does it block?

A

Alpha-2 receptor on presynaptic bouton (blocks negative feedback for 5-HT and NE).

51
Q

What side effect does mirtazapine lack, like buproprion?

A

Sexual side effects

52
Q

What side effects does mirtazapine have that make it particularly well-suited to some elderly depressed patients?

A

Pro-sleep and pro-appetite

53
Q

Does mirtazapine (Remeron) give sedation at lower or higher doses?

A

Lower. More antidepressant at higher doses

54
Q

Nefazadone toxicity

A

LIver - fulminant hepatic failure (black box)

55
Q

What is a descendant of nefazadone that is often used for sleep and not really as an anti-depressant

56
Q

Name 5 MAOIs

A

Tranylcypromine, Phenelzine, Isocarboxacid, Selegiline (Selective), Moclobemide (Reversible)

57
Q

MAOIs can induce a what, when used with tyramine

A

Hypertensive crisis - incredibly high blood pressure

58
Q

What are some drugs to turn to if you’re worried about interactions?

A

Citalopram (Celexa), Escitalopram (Lexapro), Mirtazapine (Remeron), Sertraline (Zoloft), Venlafaxine (Effexor) - these all have the least P450 binding

59
Q

What is good about venlafaxine that make it OK to use with drugs like warfarin and theophylline?

A

It has the least protein (albumin) binding of any anti-depressant

60
Q

How should you select an antidepressant with regards to PMH/FH/SH

A

Choose based on personal/familial response OR response of an acquantaince (strange pseudo-Freudian placebo-ish effects going on here; very Oedipal)

61
Q

If you’re on a drug that increases NE like a MAOI, what should you already be prescribed in the event of a HTNsive crisis?

A

A Ca2+ channel blocker (Amlodipine [Lotrel])

62
Q

Mirtazapine (Remeron) actively loses its pro-sleep properties as you increase the dose. Why?

A

At low doses, it’s predominantly anti-histamine (pro-sedating) with few pro-NE effects. At higher doses, NE effects become greater (promoting alertness/wakefulness)

63
Q

What is one side effect from trazadone that’s particularly “hard” to deal with?

A

Priapism. Sometimes need to shoot dick with an Epi pen (Spare me the Trazadone, in that case)

64
Q

How does trazadone work?

A

It antagonizes 5-HT2a-c. 5-HT2a-c usually inhibits 1A, so Trazadone inhibiting 2a-c relivees block on 1A and allows it to flourish`

65
Q

What’s the only official indication for buspirone?

A

GAD, as an adjunct

Mod4 Psychiatry (4 decks)

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