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Phar 507 > Therapeutics of Depression > Flashcards

Therapeutics of Depression Flashcards

1
Q

What are the two (at least ONE) symptoms of depression that must be present

A

Depressed mood and anhedonia

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2
Q

When would pyschotherapy be used for a patient with depression

A

Less severe disorder with NO PSYCHOTIC presentation (NOT for SEVERE)

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3
Q

T/F: Electroconvulsive therapy is effective for severe depression refactory to drugs, depression with psychosis, or severe suicidal ideation

A

True

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4
Q

T/F: Electroconvulsive therapy can be used in pregnant and old frail patients

A

True

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5
Q

What are the TCAs used in depression

A

Impiramine, despiramine, nortriptyline, amitryptiline

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6
Q

What are the MAOIs used in depression

A

Isocarboxazid, phenelzine, tranylcypromine

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7
Q

What are the SSRIs used in depression

A

Fluoxetine,Sertraline, Paroxetine, citalopram, escitalopram

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8
Q

What are the atypical antidepressants

A

Bupropion, mirtazapine, nefazodone, vilazadone, vortioextine

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9
Q

What is norepinephrine associated with

A

FOCUSED ATTENTION,elevated energy, motivation to win a reward

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10
Q

What is serotonin (5-HT) associated with

A

Anxiety, obsessional therapy, mood, sleep, apetite

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11
Q

What is the reward neurotransmitter, what is associated with it

A

Dopamine/ joy for life, pleasure and euphoria

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12
Q

What serotonin receptor is known for causing nausea and vomitting, why, how can this be reversed

A

5-HT3, 95% of serotonin is in the gut, antagonists have anti-emetic properties

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13
Q

What are properties are associated with 5-HT2 receptors

A

anixety and sexual dysfunction (antagonist will improve)

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14
Q

What happens when histamine-1 receptors are ANTAGONIZED

A

Increased appetite (weight gain), sedation

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15
Q

What are side effects of muscarinic antagonism

A

constipation, dry mouth, drowsiness, confusion, poor memory

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16
Q

What happens with alpha-1 antagonism

A

orthostatic hypotension

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17
Q

T/F: TCA block the reuptake of serotonin and norepinephrine

A

True

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18
Q

What are the side effects of TCAs

A

orthostatic hypotension (alpha-1 antagonist), weight gain, sedation( histamine-1 antagonism), urinary retention, constipation, dry mouth, memory impairment (anti muscarinic)

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19
Q

What serious side effect of TCA cause Torsade De pointes, how, resolved

A

Cardiarrhythmias (with seizures), Na channel blockade, sodium bicarbonate

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20
Q

What patients have ABSOLUTE Contraindications to TCA

A

Cardiovascular disease and history of seizures

21
Q

T/F: If pain is to be blocked then serotonin blockage is required

A

False: If pain is to be blocked then NOREPINEPHRINE should be blocked

22
Q

Which TCAs are active metabolites causing lower incidence of side effects

A

Despiramine and nortriptyline

23
Q

What is the side effects of MAOIs

A

sleep disturbance, ORTHOSTATIC HYPOTENSION, sexual dysfunction, weight gain

24
Q

What are drug-drug interaction consequences when MAO-I are used with other medications, what antibotic can cause this syndrome when administered with MAOI

A

Serotonin syndrome, linezolid

25
Q

Which SSRI adverse effects are transient, not transient

A

jitteriness, insomnia, GI disturbances/ sexual dysfunction

26
Q

Which SSRI is the safest in pregnancy

A

Sertraline

27
Q

What can be used as an antidote in serotonin syndrome

A

Cyproheptadine

28
Q

Since sexual dysfunction is associated with SSRIs what other antidepressants can be given

A

Bupropion (possible add-on), nefazodone, mirtazipine

29
Q

What are the consequences of abruptly stopping an SSRI, what are the symptoms (Hint: FINISH)

A 
Discontinuation Syndrome
F: Flu-like syndrome
I: Insomnia
N: Nausea
I: Imbalance
S: Sensation of shock in the arms, legs or head
H: Hyperarousal
30
Q

What are the two antidepressants that MUST be tapered, which SSRI doesn’t need to and why

A

Paroxetine and Venlafaxine, Fluoxetine due to the long half life of the drug and its metabolite (best if adherence is bad)

31
Q

What is the hierachy among SSRIs with regards to insomnia

A

Fluoxetine (minimize insomnia) -> sertraline -> citalopram -> paroxetine (causes insomnia)

32
Q

Which SSRI have the least amount of drug-drug interactions

A

Sertraline and Citalopram

33
Q

T/F: SSRIs can work in depression and anxiety

A

True

34
Q

What class of antidepressants have serotonin reuptake at low doses and more prenounced norepinephrine reuptake inhibition at high doses

A

Seortonin Norepinephrine Receptor inhibitors (SNRIs)

35
Q

What are adverse effects of Venlafaxine

A

Increase in blood pressure that isn’t clinically significant (unless uncontrolled hypertension), abrupt discontinuation can lead to withdrawal similar to SSRIs. Nausea

36
Q

What is the active metabolite of venlafaxine, what is the advantage of giving it over venlafaxine

A

Desvenlafaxine, No significant Drug interactions

37
Q

Which SNRI is also used for pain in other diseases (osteoarthritis, diabetic neuropathy)

A

Duloxetine

38
Q

What are the key points about Trazodone

A

Little to no sexual dysfunction (antagonist of 5HT-2), orthostatic hypotension, VERY SEDATING, priapism (rare)

39
Q

What atypical antidepressant is associated with heptatoxicity, other facts

A

Nefazadone/ effective in anxiety and insomnia, LESS sexual dysfucntion

40
Q

What class of medication is an inhibitor of presynaptic dopmamine and NE reuptake, common side effects, contraindication

A

Bupropion, MOST activation, insomnia, loss of appetite (weight loss), SEIZURES and anorexia

41
Q

T/F:Bupropion improves sexual dysfunction and is effective for treatment of anxiety

A

False: Bupropion does improve sexual dysfunction BUT is NOT EFFECTIVE for treatment of anxiety due to no interaction with serotonin

42
Q

What receptors does mirtazipine antagonize, what are the effects

A

5-HT2 receptor antagonism: less AD-induced sexual dysfunction and anxiety
5-HT3 receptor antagonism: improves GI problems such as nausea
H1 antagonism: Increased appetite and SEDATION (side effects)

43
Q

T/F: SSRIs and SNRIs have are equally efficacious and are effective for anxiety disorders

A

True

44
Q

What medications can be used for chronic pain

A

Duloxetine and TCAs

45
Q

What are the energizing antidepressants

A

Bupropion, fluoxetine, venlafaxine

46
Q

How long should antidepressants be taken to see a response, full effect

A

At least 2 weeks, 6 to 12 weeks

47
Q

What are the most sedating antidepressants

A

Paroxetine and mirtazapine

48
Q

If a patient has CAD what antidepressants should be avoided, SNRIs

A

TCA, SNRIs

Phar 507 (33 decks)

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