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2-pharm Exam > SSRI's/Tricyclic's > Flashcards

SSRI's/Tricyclic's Flashcards

1
Q

what is the most broad class of antidepressants used as first line for panic disorder and obsessive compulsive syndrome

A

SSRI’s

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2
Q

SSRI’s are also effective for what two additional issues

A

social phobia and post traumatic stress disorder

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3
Q

what pathways do newer SSRI acton in the brain

A

serotonin and norepinephrine

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4
Q

why is it possible to switch a person from one SSRI to a different SSRI if they dont do well on the first one

A

SSRI hav different side effect profiles- making it good to swap to a different SSRI if one doesn’t work. must try several different ones before moving on to a different one

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5
Q

what receptors are involved in the etiology of anxiety

A

serotonin

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6
Q

what is necessary for the effective treatment of obsessive compulsive disorder

A

potent inhibition of serotonin reuptake.

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7
Q

when comparing tricyclic antidepressants to SSRI- what is the most important advantage of SSRI compared to tricyclic

A

relative safety when taken in overdose.

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8
Q

name the one SSRI that is dangerous if taken in overdose

A

venlafaxine- proconvulsant and cardiac side effects

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9
Q

name the 4 comparisons of SSRI to tricyclic antidepressants

A

lack anticholinergic properties
do not cause postural hypotension
no delayed conduction of cardiac impulses
do not appear to have a major side effect on the seizure threshold

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10
Q

what is the prominent cause of SSRI noncompliance

A

sexual dysfunction

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11
Q

what are the 5 common side effects of SSRI

A 
insomnia
agitation
headache
nausea 
diarrhea
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12
Q

Abrupt d/c with short acting half times (paroxetine, venlafaxine) may be associated with

A 
Dizziness
Paresthesias
Myalgias
Irritability
Visual disturbances
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13
Q

SSRI with short elimination half times how do we discontinue them

A

taper them

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14
Q

what is the black box warning for SSRI

A

suicidal tendencies in children and adolescents

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15
Q

for management of anesthesia with SSRI-what do these patients have increased risk of? How do we manage that

A

bleeding as SSRI have an anti platelet activity

may consider holding anti platelet medication in the perioperaive setting if their

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16
Q

what is the washout time for SSRI and reinitiating may require how many weeks for reestablishment

A

washout 2-3 weeks

reinitiating 2-4 weeks

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17
Q

if we discontinue SSRI what are we risking? who should discontinue them

A

major depressive episode- have the ordering provider discontinue them

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18
Q

how does trazodone work

A

inhibits serotonin reuptake and may act as a serotonin agonist via active metabolite

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19
Q

what is trazodone used best as

A

treatment of insomnia

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20
Q

venlafaxine MOA

A

inhibits the reuptake of norepinephrine and serotonin and may potentiate the action of dopamine in the CNS

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21
Q

what is venlafaxine effect on BP

A

increase in diastolic blood pressure

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22
Q

T?F venlafaxine can be beneficial for neuropathic pain

A

true

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23
Q

bupropion MOA

A

inhibit dopamine and Norepinephrine uptake

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24
Q

bupropion uses

A

major depression

smoking cessation

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25
bupropion is associated with what incidence greater than other antidepressants
greater incidence of seizures
26
is bupropion associated with sexual dysfunction
no
27
sertraline causes more ___compared to fluoxetine
nausea, diarrhea
28
when is fluoxetine administered
once daily in the am. every other day due to prolonged elimination half time.
29
how many weeks does fluoxetine need for washout prior to maoi medication
5 weeks
30
what is the first most inhibitor of p-450 and the second most inhibitor of p-450
fluoxetine is the most potent inhibitor followed by a less potent inhibitor sertraline
31
MAOI plus fluoxetine result in what development
serotonin syndrome
32
fluoxetine and lithium or carbamazepine may also develop
serotonin syndrome
33
what drug was most commonly used prior to SSRI
tricyclic antidepressants
34
what are the three side effect profiles seen with tricyclic
anticholinergic properties antiadrenergic properties antihistamine properties
35
what is the therapeutic index of tricyclic and what level do you see toxicity
100-300 greater than 500
36
it is preferable to taper tricyclic and tetracyclic antidepressants during a 4 week period to avoid
chills coryza muscles aches
37
in low doses what can amitriptyline and imipramine be used to treat
chronic neuropathic pain and other chronic pain syndromes-fibromyalgia
38
tricyclic antidepressants produce anti-inflammatory effects similar to what drug
local anesthetics
39
why is efficacy limited for tricyclic treatment of chronic pain syndromes
narrow therapeutic index range + intolerability of side effects
40
prototype of tricyclic antidepressants
Imipramine
41
what two things does the structure of tricyclic antidepressants resemble
local anesthetics and phenothiazine
42
which tricyclic enhances central norepinephrine and serotonin activity in the CNS
mirtazapine
43
the clinical profile of maprotiline resembles
imipramine
44
maprotiline and mirtazaine should not be given with
MAOI
45
secondary amines are primarily what type of reuptake inhibitors
NE
46
teriteray amines are primary what type of uptake inhibitors
NE and serotonin
47
tricyclic antidepressants work how soon
2-3 weeks
48
chronic administration of tricyclic antidepressants decrease sensitivity to which receptors
postsynaptic B1 Serotonin2 presynaptic a2
49
chronic administration of tricyclic antidepressants INCREASES sensitivity to which receptors
alpha 1
50
metabolism of imipramine
metabolized to its active compound desipramine. Both are inactivated by oxidation of hydroxyl metabolites and by conjugation with glucuronic acid.
51
Nortriptyline metabolism
Nortriptyline is the active demethylated metabolite of imipramine and amitriptyline and can accumulate to levels that exceed the precursors
52
Doxepin metabolism
appears to be converted to active metabolite nordoxepin by demethylation
53
which tricyclic has the highest incidence of anticholinergic effects (dry mouth, blurred vision, tachycardia, urinary retention, slowed gastric emptying, ileus)
amitriptyline
54
which tricyclic has the fewest effects with anticholinergic effects
desipramine
55
at which tricyclic doses do you see anticholinergic effects
high doses
56
which population has the highest incidence of anticholinergic effect even at therapeutic doses
elderly
57
what two reasons do the elderly have the highest incidence of anticholinergic effects even at therapeutic doses
1. greater sensitivity to anticholinergic effects compared to young people 2. reflects polypharmacy (OTC for diarrhea or insomnia)
58
what is the most common cardiovascular side effect of tricyclic antidepressants
orthostatic hypotension | modest increases in heart rate
59
what population does tricyclic orthostatic hypotension affect the most
elderly patients - increased risk of fractures when they fall.
60
what is the risk of hypotension during general anesthesia in patients taking tricyclic
low risk- but has been reported
61
in the absence of severe preexisting cardiac dysfunction, what properties exist for tricyclic antidepressants
cardiac antidysrhythmic properties
62
what EKG changes does tricyclic antidepressants possess. | Are these EKG changes worrisome
prolong PR interval widening QRS Flattening or inversion of the T wave benign changes- disappear with continued therapy
63
what medication is used when someone on tricyclics has dangerously slow atrioventricular or intraventricular conduction of cardiac impulses
Atropine!!
64
the Direct cardiac depressant effect of tricyclics reflect which drug actions on the heart
quinidine- due to the slowing of sodium ion flux into cells resulting in altered depolarization and conduction of cardiac impulses
65
what CNS effect seen with tricyclic may be desirable for management of depressed patients with insomnia
sedation
66
what two tricyclic produce the greater degree of sedation
amitriptyline and doxepin
67
what is the concern with maprotiline and clomipramine administration
lower the seizure threshold =is it safe to administer these drugs to patients with seizure disorders
68
what population is most sensitive to seizure inducing effects of tricyclic antidepressants
children
69
which anesthetic gas are we concerned about CNS stimulating effects when combined with tricyclic
enflurane
70
weakness and fatigue are seen in patients treated with tricyclic's similar to what medication
phenothiazines- like who cares?!?
71
do extrapyramidal reactions occur with tricyclic
no
72
what percent of patients -especially the elderly -develop a fine tremor
10%
73
tricyclic overdose can be fatal due to what three occurances
cardiac toxicity tendency to cause seizures CNS depressants
74
combination of tricyclic and MAOI result in CNS toxicity resulting in what three things
hyperthermia seizures coma
75
tricyclic binding to plasma albumin can be decreased by competition from:
Phenytoin Asa Scopolamine
76
what type of acting sympathomimetic may produce exaggerated pressor response due to increased amount of norepinephrine available to stimulate postsynaptic adrenergic receptors
Indirect acting and direct acting
77
for patients taking chronic tricyclic (>6weeks) administration of either direct or indirectly sympathomimetic - how much do we change the dose
one-third the usual dose
78
in patients - a potent direct-acting sympathomimetic should be administered such as
NE
79
is the dose of exogenous EPI increased or decreased during anesthesia needed to produce cardiac dysrhythmias
decreased!
80
in theory - what medication would be best to give to a patient on tricyclics to avoid anticholinergic
glycopyrrolate
81
are tricyclics synergistic with opioids
yes
82
what tolerances develop with tricyclic
tolerance to anticholinergic effects tolerance does not develop to antidepressant effects.
83
overdose of tricyclic antidepressants is considered
life threatening | can quickly become unresponsive
84
what are the most frequent terminal events.
Intractable myocardial depression or ventricular cardiac dysrhythmias are the most frequent terminal events.
85
physostigmine dose for anticholinergic effects
0.5-2mg IV
86
what is seen on the EKG- with tricyclic antidepressants
prolonged QRS
87
comatose phase last in tricyclic antidepressants
24-72
88
during overdose what do you give for seizures
benzo
89
what is the quickest thing we can give to help alkalization of the plasma (PH>7.45)
hyperventilation.
90
whats the second thing you can do to alkalization with tricyclic overdose
sodium bicarb
91
what two drugs help suppress cardiac ventricular dysrhythmias
phenytoin | lidocaine
92
does HD or diuresis work to remove overdose of tricyclic antidepressants
no
93
gastric lavage / activated charcoal may be helpful but what must you do
have a cuffed tube to avoid aspiration

2-pharm Exam (10 decks)

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