TCAs, NDRI, SARI, and mirtazapine Flashcards
1
Q
what are the three most commonly used TCAs
A
amitriptyline
doxepine
nortriptyline
2
Q
brand name of amitriptyline
A
elavil
3
Q
brand name of doxepine
A
sinequan
4
Q
brand name of nortriptyline
A
pamelor
5
Q
dosage range for amitriptyline
A
25-100mg qd
6
Q
FDA approved uses for amitriptyline
A
depression
7
Q
off label uses for amitriptyline
A
neuropathic pain
fibromyalgia
migraine
back/neck pain
anxiety
insomnia
tx resistant depression
8
Q
max dose of amitriptyline for elderly
A
100mg
9
Q
labs to monitor for amitripyline
A
baseline ECG, CBC, LFT, fasting glucose
10
Q
pregnancy risk of amitriptyline
A
risk v. benefit
11
Q
which TCAs have to be tapered to dc
A
all of them slowly
12
Q
contraindications for TCAs
A
recent MI
other meds that prolong QT interval, arrythmias
HF
13
Q
interaction between amitriptyline and CBD
A
CBD increases concentration of amitriptyline
14
Q
what medical history would make you be cautious with TCAs
A
hx of seizures
urinary retention
hypokalemia
renal/hepatic impairment
15
Q
dosage range for doxepine to treat insomnia
A
3-6mg QHS
16
Q
dosage range for doxepine to treat depression
A
25-150mg QHS
17
Q
FDA approved uses for doxepine
A
psychoneurotic depression/anxiety
depression/anxiety associated with alcoholism
psychotic disorders w/ anxiety
insomnia
18
Q
geriatric considerations for doxepin
A
baseline ECG
more sensitive to anticholinergic side effects
19
Q
labs to monitor with doxepine
A
ECG (if CV dx)
CBC
LFT
fasting glucose
20
Q
pregnancy risk with doxepine
A
risk v. benefit
Not in lactation
21
Q
what additional medical contraindication for doxepin
A
angle-closure glaucoma
22
Q
dosage for nortriptyline
A
100mg qd
23
Q
uses for nortriptyline
A
MDD
smoking
24
Q
what is the only NDRI
A
bupropion
25
brand name for bupropion
wellbutrin
26
dosage range for bupropion XL
150-450mg qd
27
dosage range for bupropion IR
100-450mg BID
28
FDA approved uses for bupropion
MDD
seasonal afffective disorder
nicotine addiction
29
off label uses for bupropion
bipolar depression
ADHD
sexual dysfunction
30
geriatric considerations for bupropion
lower doses
31
pregnancy risk for bupropion
risk v. benefit
32
what dosage of bupropion increases seizure risk
>450mg
33
contrindications for bupropion
hx of seizures
anorexia/bulimia
recent head injury
nervous system tumor
34
what is something important to remember about bupropion
can be abused by crushing/snorting or injecting
35
bupropion dose with renal/hepatic impairment
75mg
36
dose of bupropion with severe cirrhosis
150mg every other day
37
interaction of bupropion with narcotic pain relievers
bupropion decreases their effectiveness
38
is bupropion associated with discontinuation syndrome
no
39
therapeutic indications for bupropion
MDD
smoking cessation
bipolar disorders
ADHD
cocaine detox
hypoactive sexual desire disorder
40
does bupropion precipitate mania
less likely to than TCAs or other antidepressants
41
why is bupropion contraindicated w/ substance abuse
potential euphoric effects
42
what type of patients should not be prescribed bupropion
those with severe anxiety or panic disorder
43
bupropion in pregnancy
safe
44
bupropion/fluoxetine combo
can cause panic, delirium, and seizures
45
bupropion/lithium combo
may cause CNS toxicity (including seizures)
46
bupropion administration with dopaminergic drugs (antiparkinson drugs)
increased risk of psychotic sx
47
lab interference with bupropion
false positive for amphetamines
48
bupropion and metoprolol
sinus bradycardia
49
max amount for single dose of IR bupropion
150mg
50
dose increases of IR bupropion should never exceed what
100mg in 3 days d/t increased risk of seizures
51
max single dose for SR bupropion
300mg
52
max single dose of ER bupropion
450mg
53
bupropion dosage for smoking cessation
150mg BID
54
how long does bupropion therapy continue for smoking cessation
usually 7-12 weeks
55
mechanism of action for mirtazapine
increases firing of norepinephrine and serotonin neurons d/t antagonism of a2-adrenergic receptors
56
half-life of mirtazapine
30 hours
57
major side effects of mirtazapine
sedation
appetite stimulation
somnolence
58
what is mirtazapine often combined with
SSRIs or venlafaxine
59
mirtazapine in pregnancy
not studied (avoid)
cannot take while breast feeding
60
initial dose of mirtazapine
15mg
61
therapeutic indications for nefazodone
MDD
panic disorder
GAD
PMDD
chronic pain
increased REM sleep
PTSD
chronic fatigue syndrome
62
nefazodone's relationship to trazodone
nefazodone is an analogue of trazodone
63
which antidepressant can cause tracers
nefazodone
64
why must you monitor hepatic enzymes with nefazodone
can cause severe elevation in hepatic enzymes leading to failure
65
metabolism of which medications are slowed by nefazodone
digoxin
haldol
66
which benzodiazepines have significant interactions with nefazodone
triazolam
alprazolam
67
half-life of trazodone
5-9 hours
68
excretion of trazodone
75% of metabolites excreted in urine
69
therapeutic indications for trazodone
depression
insomnia
erectile disorder
70
trazodone dose for depression
250-600mg
71
trazodone dose for insomnia
25-100mg
72
trazodone dose for ED
150-200mg
73
trazodone comes with an increased risk of what
priapism
74
low doses of trazodone useful in treating agitation in what 2 subsets of patients
children w/ developmental disabilities
elderly patients w/ dementia
75
most common side effects of trazodone
-sedation
orthostatic hypotension
dizziness
HA
nausea
76
trazodone and food
slows absorption and decreases peak plasma concentrations
77
trazodone in pregnancy
contraindicated
78
can trazodone be used to tx MAOI-induced insomnia
yes, without HTN crisis
79
usual starting dose of trazodone for insomnia
50mg
80
which TCA is the least anticholinergic
desipramine
81
which TCAs have longer half-lives allowing for daily dosing
nortriptyline
protriptyline
maprotiline
82
main mechanism of action for TCAs
blocks transporters for norepinephrine and serotonin
-receptor affinity varies by agent
83
most serotonin-selective TCA
clomipramine
84
most norepinephrine-selective TCA
desipramine
85
TCA with the most antihistaminic activity
doxepin
86
advantages of TCAs over SSRIs
less sexual side effects, significant long-term weight gain, and sleep disturbances
87
Therapeutic Indications for TCAs
MDD
panic disorder w/ agorophobia
GAD
OCD
pain
88
what is clomipramine approved for in US
only OCD
89
which is the most studied TCA for panic disorder
imipramine
small starting dose w/ slow titration
90
which TCA is approved for GAD
doxepin
91
what types of pain are TCAs used for
neuropathic pain
migraine prophylaxis
92
most frequently used TCA for pain
amitriptyline
93
are amitriptyline doses for pain higher or lower than for MDD
lower
94
which TCA is used for childhood enuresis
imipramine
95
which TCA is used for premature ejaculation
clomipramine
96
psychiatric adverse effects of TCAs
induction of mania/hypomania
exacerbation of psychotic disorders
97
most common reasons for TCA discontinuation
tachycardia
orthostatic hypotension
98
treatment for orthostatic hypotension d/t TCA
caffeine avoidance
2L fluid/day
increase dietary salt intake
99
most sedating TCAs
amitriptyline
trimipramine
doxepin
100
least sedating TCAs
desipramine
protriptyline
101
other adverse effects of TCAs
weight gain
gynecomastia
amenorrhea
SIADH
102
TCAs and pregnancy
neonatal withdrawal may occur
excreted in breast milk
103
TCAs and ECT
increased risk of cardiac effects if administered during ECT treatment
104
TCAs and antihypertensives
TCA bloks therapeutic effect of antihypertensives
105
TCAs and oral birth control
may decrease TCA plasma concentrations
106
routine lab monitoring for TCAs
CBC w/ diff
electrolytes
serum LFTs
107
when to obtain ECG for TCA use
women 40+
men 30+
108
starting dose for all TCAs
25mg
EXCEPT protriptyline
109
starting dose of protriptyline
15mg
110
discontinuation taper for TCAS
decrease to 3/4 max dose x2 months
then taper by 25mg q4-7 days
111
treatment of cholinergic rebound during dc of TCAs
add back small amount and then taper slower
112
TCA OD
severe and often fatal
113
TCA prescriptions in suicidal patients
scripts are nonrefillable and not for more than 1 week at a time
114
medication class of nefazodone and trazodone
Serotonin antagonist/reuptake inhibitor
SARI
115
name the 10 tricyclics
amitriptyline
nortriptyline
protriptyline
doxepin
amoxepine
desipramine
imipramine
trimipramine
chlomipramine
maprotiline
116
brand name for imipramine
tofranil
117
brand name for protriptyline
vivactil
118
brand name for clomipramine
anafril
119
most commonly used TCA for panic disorder with agoraphobia
imipramine
120
TCA used for OCD
clomipramine
121
main drug classes that interact with TCAs
MAOIs
antihypertensives
antiarrythmics
DRAs
CNS depressants
sympathomimetics
oral contraceptives
122
interaction between TCAs and antihypertensives
TCAs block action of antihypertensives
123
interaction between TCAs and antiarrhythmics
additive effects to quinidine
124
TCA and DRA interaction
increases plasma concentration of both drugs
125
TCA and CNS depressant interactions
additive effects
126
TCA and sympathomimetic interaction
serious cardio effects
127
TCA and birth control interaction
birth control can decrease TCAs
128
what CYP enzyme is inhibited by bupropion
2D6
129
Trazadone with antihypertensives
may cause hypotension
130
which TCA is least likely to cause orthostatic hypotension
nortriptyline
131
what are some typical psych meds that interact w/ TCAs d/t competition for enzyme 2D6
fluoxetine
sertraline
paroxetine
carbamazepine
132
which TCAs have the least anticholinergic activity
amoxapine
nortriptyline
desipramine
maprotiline
133
most studied TCA for panic disorder with agorophobia
imipramine
134
which TCA is approved for GAD
doxepin
135
which TCA is approved for OCD
clomipramine
136
which TCA is used for childhood enuresis
imipramine
137
what is the most common reasons for TCA discontinuation
tachycardia and orthostatic hypotension
138
most sedating TCAs
amitriptyline
trimipramine
doxepin
139
moderately sedating TCAs
imipramine
amoxapine
nortriptyline
maprotiline
140
least sedating TCAs
desipramine
protriptyline
141
which TCAs lower the seizure threshold the most
clomipramine and amoxapine
