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Meds > TCAs, NDRI, SARI, and mirtazapine > Flashcards

TCAs, NDRI, SARI, and mirtazapine Flashcards

1
Q

what are the three most commonly used TCAs

A

amitriptyline
doxepine
nortriptyline

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2
Q

brand name of amitriptyline

A

elavil

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3
Q

brand name of doxepine

A

sinequan

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4
Q

brand name of nortriptyline

A

pamelor

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5
Q

dosage range for amitriptyline

A

25-100mg qd

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6
Q

FDA approved uses for amitriptyline

A

depression

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7
Q

off label uses for amitriptyline

A

neuropathic pain
fibromyalgia
migraine
back/neck pain
anxiety
insomnia
tx resistant depression

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8
Q

max dose of amitriptyline for elderly

A

100mg

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9
Q

labs to monitor for amitripyline

A

baseline ECG, CBC, LFT, fasting glucose

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10
Q

pregnancy risk of amitriptyline

A

risk v. benefit

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11
Q

which TCAs have to be tapered to dc

A

all of them slowly

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12
Q

contraindications for TCAs

A

recent MI
other meds that prolong QT interval, arrythmias
HF

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13
Q

interaction between amitriptyline and CBD

A

CBD increases concentration of amitriptyline

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14
Q

what medical history would make you be cautious with TCAs

A

hx of seizures
urinary retention
hypokalemia
renal/hepatic impairment

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15
Q

dosage range for doxepine to treat insomnia

A

3-6mg QHS

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16
Q

dosage range for doxepine to treat depression

A

25-150mg QHS

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17
Q

FDA approved uses for doxepine

A

psychoneurotic depression/anxiety
depression/anxiety associated with alcoholism
psychotic disorders w/ anxiety
insomnia

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18
Q

geriatric considerations for doxepin

A

baseline ECG
more sensitive to anticholinergic side effects

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19
Q

labs to monitor with doxepine

A

ECG (if CV dx)
CBC
LFT
fasting glucose

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20
Q

pregnancy risk with doxepine

A

risk v. benefit
Not in lactation

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21
Q

what additional medical contraindication for doxepin

A

angle-closure glaucoma

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22
Q

dosage for nortriptyline

A

100mg qd

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23
Q

uses for nortriptyline

A

MDD
smoking

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24
Q

what is the only NDRI

A

bupropion

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25
Q

brand name for bupropion

A

wellbutrin

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26
Q

dosage range for bupropion XL

A

150-450mg qd

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27
Q

dosage range for bupropion IR

A

100-450mg BID

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28
Q

FDA approved uses for bupropion

A

MDD
seasonal afffective disorder
nicotine addiction

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29
Q

off label uses for bupropion

A

bipolar depression
ADHD
sexual dysfunction

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30
Q

geriatric considerations for bupropion

A

lower doses

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31
Q

pregnancy risk for bupropion

A

risk v. benefit

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32
Q

what dosage of bupropion increases seizure risk

A

> 450mg

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33
Q

contrindications for bupropion

A

hx of seizures
anorexia/bulimia
recent head injury
nervous system tumor

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34
Q

what is something important to remember about bupropion

A

can be abused by crushing/snorting or injecting

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35
Q

bupropion dose with renal/hepatic impairment

A

75mg

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36
Q

dose of bupropion with severe cirrhosis

A

150mg every other day

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37
Q

interaction of bupropion with narcotic pain relievers

A

bupropion decreases their effectiveness

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38
Q

is bupropion associated with discontinuation syndrome

A

no

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39
Q

therapeutic indications for bupropion

A

MDD
smoking cessation
bipolar disorders
ADHD
cocaine detox
hypoactive sexual desire disorder

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40
Q

does bupropion precipitate mania

A

less likely to than TCAs or other antidepressants

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41
Q

why is bupropion contraindicated w/ substance abuse

A

potential euphoric effects

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42
Q

what type of patients should not be prescribed bupropion

A

those with severe anxiety or panic disorder

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43
Q

bupropion in pregnancy

A

safe

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44
Q

bupropion/fluoxetine combo

A

can cause panic, delirium, and seizures

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45
Q

bupropion/lithium combo

A

may cause CNS toxicity (including seizures)

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46
Q

bupropion administration with dopaminergic drugs (antiparkinson drugs)

A

increased risk of psychotic sx

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47
Q

lab interference with bupropion

A

false positive for amphetamines

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48
Q

bupropion and metoprolol

A

sinus bradycardia

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49
Q

max amount for single dose of IR bupropion

A

150mg

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50
Q

dose increases of IR bupropion should never exceed what

A

100mg in 3 days d/t increased risk of seizures

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51
Q

max single dose for SR bupropion

A

300mg

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52
Q

max single dose of ER bupropion

A

450mg

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53
Q

bupropion dosage for smoking cessation

A

150mg BID

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54
Q

how long does bupropion therapy continue for smoking cessation

A

usually 7-12 weeks

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55
Q

mechanism of action for mirtazapine

A

increases firing of norepinephrine and serotonin neurons d/t antagonism of a2-adrenergic receptors

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56
Q

half-life of mirtazapine

A

30 hours

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57
Q

major side effects of mirtazapine

A

sedation
appetite stimulation
somnolence

58
Q

what is mirtazapine often combined with

A

SSRIs or venlafaxine

59
Q

mirtazapine in pregnancy

A

not studied (avoid)
cannot take while breast feeding

60
Q

initial dose of mirtazapine

A

15mg

61
Q

therapeutic indications for nefazodone

A

MDD
panic disorder
GAD
PMDD
chronic pain
increased REM sleep
PTSD
chronic fatigue syndrome

62
Q

nefazodone’s relationship to trazodone

A

nefazodone is an analogue of trazodone

63
Q

which antidepressant can cause tracers

A

nefazodone

64
Q

why must you monitor hepatic enzymes with nefazodone

A

can cause severe elevation in hepatic enzymes leading to failure

65
Q

metabolism of which medications are slowed by nefazodone

A

digoxin
haldol

66
Q

which benzodiazepines have significant interactions with nefazodone

A

triazolam
alprazolam

67
Q

half-life of trazodone

A

5-9 hours

68
Q

excretion of trazodone

A

75% of metabolites excreted in urine

69
Q

therapeutic indications for trazodone

A

depression
insomnia
erectile disorder

70
Q

trazodone dose for depression

A

250-600mg

71
Q

trazodone dose for insomnia

A

25-100mg

72
Q

trazodone dose for ED

A

150-200mg

73
Q

trazodone comes with an increased risk of what

A

priapism

74
Q

low doses of trazodone useful in treating agitation in what 2 subsets of patients

A

children w/ developmental disabilities
elderly patients w/ dementia

75
Q

most common side effects of trazodone

A

-sedation
orthostatic hypotension
dizziness
HA
nausea

76
Q

trazodone and food

A

slows absorption and decreases peak plasma concentrations

77
Q

trazodone in pregnancy

A

contraindicated

78
Q

can trazodone be used to tx MAOI-induced insomnia

A

yes, without HTN crisis

79
Q

usual starting dose of trazodone for insomnia

A

50mg

80
Q

which TCA is the least anticholinergic

A

desipramine

81
Q

which TCAs have longer half-lives allowing for daily dosing

A

nortriptyline
protriptyline
maprotiline

82
Q

main mechanism of action for TCAs

A

blocks transporters for norepinephrine and serotonin
-receptor affinity varies by agent

83
Q

most serotonin-selective TCA

A

clomipramine

84
Q

most norepinephrine-selective TCA

A

desipramine

85
Q

TCA with the most antihistaminic activity

A

doxepin

86
Q

advantages of TCAs over SSRIs

A

less sexual side effects, significant long-term weight gain, and sleep disturbances

87
Q

Therapeutic Indications for TCAs

A

MDD
panic disorder w/ agorophobia
GAD
OCD
pain

88
Q

what is clomipramine approved for in US

A

only OCD

89
Q

which is the most studied TCA for panic disorder

A

imipramine
small starting dose w/ slow titration

90
Q

which TCA is approved for GAD

A

doxepin

91
Q

what types of pain are TCAs used for

A

neuropathic pain
migraine prophylaxis

92
Q

most frequently used TCA for pain

A

amitriptyline

93
Q

are amitriptyline doses for pain higher or lower than for MDD

A

lower

94
Q

which TCA is used for childhood enuresis

A

imipramine

95
Q

which TCA is used for premature ejaculation

A

clomipramine

96
Q

psychiatric adverse effects of TCAs

A

induction of mania/hypomania
exacerbation of psychotic disorders

97
Q

most common reasons for TCA discontinuation

A

tachycardia
orthostatic hypotension

98
Q

treatment for orthostatic hypotension d/t TCA

A

caffeine avoidance
2L fluid/day
increase dietary salt intake

99
Q

most sedating TCAs

A

amitriptyline
trimipramine
doxepin

100
Q

least sedating TCAs

A

desipramine
protriptyline

101
Q

other adverse effects of TCAs

A

weight gain
gynecomastia
amenorrhea
SIADH

102
Q

TCAs and pregnancy

A

neonatal withdrawal may occur
excreted in breast milk

103
Q

TCAs and ECT

A

increased risk of cardiac effects if administered during ECT treatment

104
Q

TCAs and antihypertensives

A

TCA bloks therapeutic effect of antihypertensives

105
Q

TCAs and oral birth control

A

may decrease TCA plasma concentrations

106
Q

routine lab monitoring for TCAs

A

CBC w/ diff
electrolytes
serum LFTs

107
Q

when to obtain ECG for TCA use

A

women 40+
men 30+

108
Q

starting dose for all TCAs

A

25mg
EXCEPT protriptyline

109
Q

starting dose of protriptyline

A

15mg

110
Q

discontinuation taper for TCAS

A

decrease to 3/4 max dose x2 months
then taper by 25mg q4-7 days

111
Q

treatment of cholinergic rebound during dc of TCAs

A

add back small amount and then taper slower

112
Q

TCA OD

A

severe and often fatal

113
Q

TCA prescriptions in suicidal patients

A

scripts are nonrefillable and not for more than 1 week at a time

114
Q

medication class of nefazodone and trazodone

A

Serotonin antagonist/reuptake inhibitor
SARI

115
Q

name the 10 tricyclics

A

amitriptyline
nortriptyline
protriptyline
doxepin
amoxepine
desipramine
imipramine
trimipramine
chlomipramine
maprotiline

116
Q

brand name for imipramine

A

tofranil

117
Q

brand name for protriptyline

A

vivactil

118
Q

brand name for clomipramine

A

anafril

119
Q

most commonly used TCA for panic disorder with agoraphobia

A

imipramine

120
Q

TCA used for OCD

A

clomipramine

121
Q

main drug classes that interact with TCAs

A

MAOIs
antihypertensives
antiarrythmics
DRAs
CNS depressants
sympathomimetics
oral contraceptives

122
Q

interaction between TCAs and antihypertensives

A

TCAs block action of antihypertensives

123
Q

interaction between TCAs and antiarrhythmics

A

additive effects to quinidine

124
Q

TCA and DRA interaction

A

increases plasma concentration of both drugs

125
Q

TCA and CNS depressant interactions

A

additive effects

126
Q

TCA and sympathomimetic interaction

A

serious cardio effects

127
Q

TCA and birth control interaction

A

birth control can decrease TCAs

128
Q

what CYP enzyme is inhibited by bupropion

A

2D6

129
Q

Trazadone with antihypertensives

A

may cause hypotension

130
Q

which TCA is least likely to cause orthostatic hypotension

A

nortriptyline

131
Q

what are some typical psych meds that interact w/ TCAs d/t competition for enzyme 2D6

A

fluoxetine
sertraline
paroxetine
carbamazepine

132
Q

which TCAs have the least anticholinergic activity

A

amoxapine
nortriptyline
desipramine
maprotiline

133
Q

most studied TCA for panic disorder with agorophobia

A

imipramine

134
Q

which TCA is approved for GAD

A

doxepin

135
Q

which TCA is approved for OCD

A

clomipramine

136
Q

which TCA is used for childhood enuresis

A

imipramine

137
Q

what is the most common reasons for TCA discontinuation

A

tachycardia and orthostatic hypotension

138
Q

most sedating TCAs

A

amitriptyline
trimipramine
doxepin

139
Q

moderately sedating TCAs

A

imipramine
amoxapine
nortriptyline
maprotiline

140
Q

least sedating TCAs

A

desipramine
protriptyline

141
Q

which TCAs lower the seizure threshold the most

A

clomipramine and amoxapine

Meds (12 decks)

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