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Pharm II > Test 4- Cara > Flashcards

Test 4- Cara Flashcards

1
Q

receptors for this monoamine NT are found in the gut, blood vessel walls, and brain

A

Serotonin

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2
Q

when concentrations of this NT are lowered, concentration and focus can be decreased

A

Norepinephrine (NE)

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3
Q

this NT plays a role in cognition and alertness

A

dopamine

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4
Q

How can NT deficits result?

A
  1. ) not enough made
  2. ) chemical precursors (ingredients) are in short supply
  3. ) not enough receptor sites
  4. ) NT being taken up too quickly
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5
Q

GOLD STANDARD of antidepressants due to decreased SE’s and increased safety

A

SSRI’s

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6
Q

increased availability of serotonin is available where?

A

to post synaptic serotonin receptors

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7
Q

Do SSRI’s affect histamine and Ach like TCA’s?

A

NO

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8
Q

All SSRI’s are pregnancy category C except….

A

Paroxetine (Paxil)

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9
Q

Neonatal complications due to an SSRI include…

A
  • cardiac issues/pulmonary HTN
  • LOW birth weight
  • premature delivery
  • poor neonatal adjustment
  • risks of developmental issues
  • SSRIs are NOT safe in nursing moms
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10
Q

What are some SE’s of SSRIs?

A
  • weight gain (5 lbs. in a year)
  • nausea
  • vertigo
  • sexual dysfunction
  • suicidal risk
  • sleep disturbance
  • dry mouth and other anti-Ach SE’s
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11
Q

Patient Treatment on an SSRI

A
  • follow up at 4 weeks
  • goal is 70% better in the first month
  • tell patient that treatment is for 6 mo. to 1 year
  • March/April from Sept/October is the best time to taper
  • don’t taper on anniversary of tough event
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12
Q

used for bulimia, panic disorder, depression, and OCD (give Sarafem)

first SSRI on the market

long half life

10-60mg daily

A

(Fluozetine) Prozac

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13
Q

used for depression

results in QT prolongation at 40mg

don’t give more than 20mg to the elderly/OCP/PPI patients (increased arrhythmias)

*stronger anti-cholinergic properties

10-40 mg

A

(Citalopram) Celexa

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14
Q

used for general anxiety anxiety and depression

less of a tapering, start on 10mg and go with it

may notice relief of symptoms within 1 week

works faster than other SSRIs

dosed 10-20mg daily

A

Escitalopram (Lexapro)

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15
Q

used for depression, PMDD, OCD (high doses), panic/social anxiety, and PTSD

dosing can be difficult

dosed 25-200mg daily

A

Sertraline (Zoloft)

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16
Q

dosed 10-40 daily

A

Parozetine (Paxil)

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17
Q

used for depression, PMDD, panic disorder, social anxiety, OCD, GAD, PTSD

very sedating and causes weight gain

dosed 12.5-37.5mg daily

A

Paxil CR

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18
Q

used for OCD

minimial anti-Ach side effects

dosed 100-300mg daily

A

Fluvoxamine (Luvox)

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19
Q

What drugs do SSRIs interact with?

A

other drugs that increase serotonin

St. John’s Wort

drugs that affect QT intervals

warfarin/digoxin

drugs with CNS affects

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20
Q

SSRI + diuretics =

A

HYPOnatremia

**older patients on an SSRI need to get a sodium reading

21
Q

What drugs result in QT prolongation?

A

Macrolides/Quinolones

Sulfa agents

TCA’s

anti-fungals

anti-arrhythmics

anti-psychotics

22
Q

What are the symptoms of serotonin syndrome?

A

agitation

hyperthermia

hyperactivity

delirium

seizures

HTN

myoclonus

23
Q

How do you treat a patient who is experiencing serotonin syndrome?

A

fluids, hydration, and educate patients on these symptoms

24
Q

an SNRI that is used for depression and GAD

Serotonin affect in low doses, NE affect in high doses

dose from 37.5-300mg

Pregnancy category C and works after 2 weeks

A

Venlafaxine (Effexor, Effexor XR)

25
Q

What are the warning/precautions/SE’s associated with Effexor?

A

**associated with sustained HTN

may lower seizure threshold

suicide risk in teens

overall benefits>risks in patients (especially with recent MI)

Adverse Reactions: dizzy, bad dreams, tremor, nervousness, weight changes

26
Q

All SSRI/SNRI patients need to be careful with _______ intake and not be on a __________

A

alcohol

MAOI

27
Q

What special issues must be considered with a patient on Effexor?

A

take with or w/o food

caution with alcohol

***monitor BP regularly

titrate up and down

28
Q

SNRI dosed 20mg (60 max) PO BID

often used for Fibromyalgia too

A

Cymbalta (Duloxetine)

29
Q

a newer and more costly SNRI that does NOT need titration

taken as 50mg daily

A

Pristiq (Desvenlafaxine)

30
Q

Venlafaxine off label is used for….

A
  1. ) hot flashes
  2. ) neuropathy
  3. ) insomnia
31
Q

SNRI for FIBROMYALGIA, not depression

CI in HTN, liver/renal patients, alcohol abuse, suicidality, seizures, and bleeding disorders

nausea is the MC side effects, increased HR and palpitations too

interacts with diuretics, NSAIDs, and other anti-depressants

A

Milnacipran (Savella)

32
Q

indicated for depression and SAD

**inhibitor of NE and dopamine reuptake

pregnancy category C that takes greater than 2 weeks via a tablet, sustained, or extended release tablet

Zyban is used for smoking cessation

A

(Buproprion) Wellbutrin

33
Q

What are the contraindications for Wellbutrin?

A

***seizure disorder

use with MAOIs

prior diagnosis of bulimia or anorexia

34
Q

What are the SE’s associated with Wellbutrin?

A

agitation/insomnia

N/V/C

weight loss

tremor/hallucinations/fatigue

35
Q

the effect of Wellbutrin is increased with __________

A

Levodopa

36
Q

What special issues go along with Wellbutrin?

A

do not D/C drug without calling provider

no excessive alcohol

monitor body weight

used in same doses for smoking cessation (caution if on nicotine)

37
Q

What are the benefits of Wellbutrin?

A

weight loss

no anti-Ach SE’s

no sexual SE’s

no orthostasis/BP problems

more elevating that sedating

38
Q

a tetracyclic that is dosed 15-45 mg at BEDTIME

impacts Histamine, Serotonin/NE receptors

Preg Cat. C

SEs: weight gain, fatigue, dizziness (worry about falls), dry mouth, constipation, BP changes

A

Mirtazapine (Remeron)

39
Q

serotonin modulator that acts PREsynaptically

indicated for depression and commonly used for insomnia

SE: hypotension, N/V, mild anti-Ach, sedation, nightmares

warnings regarding suicidality in teens and post MI

**ADVERSE RXN: arrhythmias and priapism

A

Trazodone

40
Q

approved for major depression

has a duel mechanism

less sexual SE’s, more GI SE’s, weight neutral

tapering schedule of 10mg, 20mg, and 40mg

A

Vilazodone (Viibryd)

41
Q

serotonergic antidepressant with an unclear MOA

may work pre and post synaptically

warning for suicidality under age 24 and serotonin syndrome risk

A

Vortiozetine (Brintellix)

42
Q

known as heterocyclics

inhibit a nerves ability to reuptake a neurotransmitter

some histamine and serotonin impact

HUGE anti-Ach SE’s (dry mouth, blurred vision, sedation)

adverse reaction of ORTHOSTATIC HYPOTENSION, palpitations, and lowering of the seizure threshold

A

Tricyclic Antidepressants

TCA’s

43
Q

(Amitriptyline) Elavil and (Imipramine) Tofranil are both examples of…

A

TCA’s

44
Q

injection or tablet

Preg. Cat. D

take 7-21 for MOA to kick in

CI’s: narrow angle glaucoma

alternatively used for: migraine prophylaxis, IBS, chronic pain, sleep

A

TCA’s

45
Q

What are warnings associated with TCA’s?

A

cardiac disturbances

renal/hepatic impairment

***may give pronounced HYPOtension (fatal)

***arrhythmia (may be fatal)

try to avoid in elderly

46
Q

Adverse Reactions of TCA’s

A

drowsiness

dizziness

HA

HYPOtension/palpitations

constipation

weight gain

weakness

47
Q

What drugs should TCA’s never be combined with due to increased toxicity?

A

Clonidine

Warfarin

***AntiAch Drugs

CNS Depressants

SSRI’s

48
Q

Special Issues of TCA’s

A

avoid alcohol and caffeine

may turn urine blue-green

photosensitivity can occur

altered sex drive or ability (reversible)

***NEVER ABRUPTLY DISCONTINUE

Pharm II (7 decks)

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