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NURS 424 > Week 13 - Antidepressants (broad brush) > Flashcards

Week 13 - Antidepressants (broad brush) Flashcards

1
Q

Examples of selective serotonin reuptake inhibitor (SSRI)

A
  • Fluoxetine
  • Sertraline
  • Citalopram
  • Escitalopram
  • Paroxetine
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2
Q

Example of serotonin partial agonist reuptake inhibitor (SPARI)

A

Vilazodone

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3
Q

Examples of selective norepinephrine reuptake inhibitor (SNRI)

A
  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine
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4
Q

Examples of TCAs

A
  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Doxepin
  • Despiramine
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5
Q

Examples of atypical antidepressants

A
  • Buproprion
  • Mirtazapine
  • Nefazodone
  • Trazodone
  • Vortioxetine
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6
Q

Off-label uses for antidepressants

A
  • Anxiety
  • Bulimia
  • Fibromyalgia
  • Smoking cessation
  • Migraine prophylaxis
  • ADHD in adults
  • IBS
  • Premature ejaculation
  • Diabetic peripheral neuropathy
  • Postherpetic neuralgia
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7
Q

True/False: Clinically relevant improvement for depression w/ antidepressants might only occur in patients w/ severe depression

A

True

  • May be effective in first two weeks of treatment (most often takes 4-8 weeks to see improvement)
  • Sertraline, escitalopram, venlafaxine, and mirtazapine more effective in reducing depression symptoms other than non-TCAs
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8
Q

Efficacy of antidepressants in children and adolescents

A

Children - antidepressants do not appear effective

Adolescent - SSRIs, not TCAs, more effective

  • SSRIs associated with increased SI
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9
Q

Fluoxetine (SSRI): medication pearls

A
  • LEAST likely to cause weight gain
  • Can be activating (start low, go slow)
  • Long half-life
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10
Q

Paroxetine (SSRI): medication pearls

A
  • Interacts w/ a lot of other medications
  • BAD withdrawal symptoms
  • Causes weight gain
  • Sedating (not for the elderly)
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11
Q

Citalopram (SSRI): medication pearls

A
  • Black box warning: QT prolongation
    • Max dose 40mg daily
    • 20mg daily if over 60 years old
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12
Q

Escitalopram (SSRI): medication pearls

A
  • Weight neutral
  • Neither sedating nor activating
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13
Q

Venlafaxine and desvenlafaxine (SNRI): medication pearls

A

Monitor HR and BP (increases are dose dependent)

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14
Q

Mirtazapine (atypical): medication pearls

A
  • Low dose causes sedation
    • As dose increases, sedative factor diminishes
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15
Q

Bupropion (atypical): medication pearls

A
  • Avoid in seizure-risk patients
  • Avoid in those w/ anxiety
    • Causes increase in norepinephrine
  • May be helpful for ADHD
  • Eeyore depression
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16
Q

TCAS: medication pearls

A
  • Highly cardiotoxic
  • Fatal in OD
  • Secondary to life-threatening arrhythmias
  • Narrow TI
  • Weight gain
  • Orthostatic hypotension
17
Q

MAOIs: medication pearls

A
  • Interacts w/ tyramine to cause HTN crisis
  • Dangerous in OD
  • Many drug-to-drug interactions
    • Requires washout period from other medications
18
Q

SSRIs and SNRIs: general ADRs

A
  • N/V/D
  • Agitation
  • Insomnia
  • Sexual side effects
  • Serotonin syndrome
  • Increased risk for upper GI bleeding
  • Hyponatremia
  • QT prolongation w/ citalopram
19
Q

SNRIs: general ADRs

A

Noradrenergic side effects of tachycardia, dry mouth, diaphoresis, constipation

20
Q

TCAs: general ADRs

A
  • Cardiovascular disease, arrhythmias
  • Orthostatic hypotension
  • Anticholinergic side effects
    • Dry mouth, blurred vision, constipation, urinary hesitancy, memory impairment, confusion, aggravation of angle closure glaucoma
  • Sedation
21
Q

MAOIs: general ADRs

A
  • HTN crisis
  • Orthostatic hypotension
  • Serotonin syndrome
22
Q

Which three medications cause weight gain?

A
  1. Paroxetine
  2. Mirtazapine
  3. Amitriptyline
23
Q

If no response is seen in 4-8 weeks with the maximally tolerated dose, what should the prescriber do?

A

Switch to a different antidepressant within the same or different class

24
Q

How long should therapy continue after a patients complete remission of symptoms?

A

Antidepressant therapy should continue for at least 4-9 months

25
Q

True/False: Individuals who had 3+ episodes of depression most likely will need continuous maintenance therapy

A

True

26
Q

Antidepressants during pregnancy and lactation

A

Pregnancy

  • D/c of antidepressants during pregnancy will increase risk of relapse of major depression
  • Associated w/ increased risk of spontaneous abortion
  • SSRI use in late pregnancy may cause self-limiting neonatal behavorial syndrome (neonatal withdrawal)

Lactation

  • Nortriptyline, paroxetine, sertraline produces undetectable levels in infant plasma

NURS 424 (35 decks)

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