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Psychiatry pro +1700 > Somatic Therapies > Flashcards

Somatic Therapies Flashcards

1
Q

Why do antidepressants take a long time to work?

A

Need to increase receptors, and gene transcription

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2
Q

What is the MOA of imipramine? Use?

A

TCA

Enuresis

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3
Q

What is the MOA of bupropion?

A

NE and dopamine reuptake inhibitor

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4
Q

What is the MOA of venlafaxine?

A

SNRI

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5
Q

What is the MOA of desvenlafaxine?

A

SNRI

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6
Q

What is the MOA of duloxetine?

A

SNRI

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7
Q

What is the MOA of levomilnacipran?

A

SNRI

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8
Q

What are the two TCAs that are used to treat pain?

A

Amitriptyline

Nortriptyline

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9
Q

What is the only SSRI that is not approved for use in MDD? What is it used for?

A
  • Fluvoxamine

- OCD

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10
Q

Which SSRI is used for bulimia?

A

Fluoxetine

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11
Q

Which SSRIs are used to treat GAD?

A

Escitalopram

Paroxetine

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12
Q

True or false: structurally, the SSRIs are structurally similar

A

False

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13
Q

What is the major side effect of bupropion?

A

Lowers seizure threshold

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14
Q

SSRIs are metabolized through what organ?

A

Liver

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15
Q

Which of the SSRIs have long lasting, active metabolites? (2)

A
  • Fluoxetine

- Sertraline

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16
Q

What are the side effects of SSRIs?

A
  • Weight gain or loss
  • Vivid dreams
  • mild GI symptoms
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17
Q

What is the treatment for serotonin syndrome?

A

Cyproheptadine

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18
Q

What is the effect of SSRIs and the p450 system?

A

Metabolized by it–cause drug interactions

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19
Q

What is the age range that SSRIs can cause increased suicidality?

A

up to 24

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20
Q

True or false: there is no evidence that there is an increased in actual suicide with antidepressants, just thoughts

A

True

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21
Q

What are the s/sx of serotonin syndrome?

A
  • Diaphoresis
  • Mental confusion
  • Flushing
  • Hyperthermia
  • Hypertonicity
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22
Q

True or false: SNRIs inhibit both NE and 5HT in equal amounts

A

True

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23
Q

What is the SNRI that has been approved for MDD, GAD, panic DO, SAD, pain syndrome?

A

Venlafaxine

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24
Q

What is the effect of venlafaxine at higher and lower doses?

A

Lower = 5HT reuptake inhibition

Higher = NE and dopamine

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25
What is the effect of venlafaxine an p450 enzymes?
Does not use the p450 system
26
What is the major downside of venlafaxine withdrawal?
fast onset
27
What is the MOA of levomilnacipran?
SNRI
28
What is the role of bupropion in the treatment for anxiety disorders?
Not effective
29
Why is it that bupropion may test positive for amphetamine use?
Similar structure
30
What is the effect of bupropion on sexual function?
No effect
31
What is the factor that determines the risk of bupropion on seizure threshold?
Plasma levels--even transiently
32
What is the MOA of vilazodone?
SSRI and 5HT1A partial agonist, to enhance serotonergic activity
33
What is the MOA of vortioxetine?
Lots of 5HT modulation and reuptake inhibition
34
What is the MOA of trazodone? Use?
Weak inhibitor of serotonin, but also blocks 5HT2 receptors Sleep agent
35
What is the risk for addiction of trazodone?
Low to none
36
What is the MOA and use of nefazodone? Major side effect
- Weak inhibition of neuronal 5HT - MDD - Hepatotoxic
37
What is the MOA of mirtazapine? Use?
Potent antagonist at post synaptic 5HT2 and 5HT3 receptors used as a sleep aid
38
What are the side effects of mirtazapine?
-Sedation Weight gain -minimal p450 interaction
39
Which of the TCAs can treat OCD?
Clomipramine
40
What is the major side effect of clozapine?
Agranulocytosis
41
What is the general MOA of TCAs?
Blocks reuptake of NE, and 5HT
42
What are the adverse effects of TCAs?
- Anticholinergic - Antihistamine - Anti-alpha adrenergic
43
What organ metabolizes TCAs?
LIver
44
What is the interaction between p450 enzymes and TCAs?
TCAs metabolized by them, so anything that inhibits them will increase blood TCA levels
45
What is the use of obtaining blood levels of TCAs? (2)
- Ensure no cardiac issues | - treatment adherence
46
What are the major side effects of TCA?
- anticholinergic effects | - sedation and weight gain (antihistamine effect)
47
What are the alpha adrenergic effects of TCAs?
- Orthostatic hypotension | - reflex tachycardia
48
Are TCAs safe in prego?
No
49
What are the cardiovascular effects of TCAs?
- QT prolongation | - Arrhythmias
50
What is the dose range for amitriptyline for pain control, as compared to antidepressant effects?
Much smaller for pain control
51
What is the general MOA of MAOIs?
blocks enzyme that degrades neurotransmitters. Increased 5HT, NE, dopamine
52
Draw out the dopamine pathway
Draw
53
True or false: MAOIs do not have active metabolites
True
54
What are the three major MAOIs?
- Tranylcypromine - Phenelzine - Selegiline
55
What are the side effects of MAOIs?
- Sedation - Orthostatic hypotension - anticholinergic
56
What are the high tyramine foods? (6)
- Chicken liver - Beer - Wine - Soft cheeses - fava beans - chocolate
57
What is the major issue with MAOIs and tyramine?
Hypertensive crises and strokes
58
What is the major use of selegiline?
MAO-A inhibitor for PD
59
What is the major benefit of transdermal selegiline?
No tyramine dietary restrictions
60
What is the usual timeframe in which antidepressants work?
within 6 weeks
61
True or false: bipolar depression does not respond well to antidepressants
True
62
What endocrine lab must be monitored with Li?
Hypothyroidism
63
True or false: In general, the less severe the depression, the less response to antidepressants
True
64
True or false: secondary MDD respond better than primary with antidepressants
False--worse
65
What is the difference between remission and response?
``` Response = 50% better Remission = 100% better ```
66
What is the only SSRI that is not given daily?
fluvoxamine
67
At what point should you switch drugs if not working?
2-3 months
68
What is the only SSRI that does not need to taper off of?
Fluoxetine
69
Who needs to start at lower doses of SSRIs?
Old or hepatically disabled
70
For unresponsiveness with SSRIs, what should always be done?
Reassess for other diseases
71
What are the pharmacological augmentation strategies?
Add second antidepressant with a different MOA: - stimulant - buspirone
72
What are the non-pharmacological augmentation strategies?
- Sleep promoters - Lifestyle changes - Psychotherapy
73
What is the MOA of buspirone? Use?
- serotonin 5-HT1A receptor partial agonist | - Non-sedating anxiolytic
74
What is the treatment duration for antidepressants?
stable for 6 months or 12 month for a complicated case
75
What happens to treatment time with increasing age?
Shorter treatment time needed
76
What are the major fetal effects on SSRIs?
- Paroxetine | - persistent pHTN
77
What is the focus of SSRIs in pregnancy?
Maintaining health of the mother
78
Where are MAO-A enzymes found? MAO-B?
A = brain, liver, gut | B - Brain, liver, platelets

Psychiatry pro +1700 (28 decks)

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