Psychopharm > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

What are the 3 advantages of SSRIs?

A
  1. Low incidence of side effects, most of which resolve w/ time
  2. No food restrictions
  3. Much safer in overdose
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2
Q

What are the 6 SSRIs?

A
  1. Fluoxetine (Prozac)
  2. Paroxetine (Paxil)
  3. Sertraline (Zoloft)
  4. Fluvoxamine (Luvox)
  5. Citalopram (Celexa)
  6. Escitalopram (Lexapro)
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3
Q

Which SSRI has the longest half-life?

A

Fluoxetine

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4
Q

What is benefit of a drug with long half life?

A
  1. Good for non-compliant pts

2. No need to taper

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5
Q

Which SSRI is safe in pregnancy and approved for use in children?

A

Fluoxetine

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6
Q

What are the side effects from over-stimulation of 5HT3 receptor? (3)

A

5HT3 = GI system (diarrhea, nausea, vomiting)

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7
Q

What are the side effects from over-stimulation of 5HT2C receptor? (2)

A

5HT2C = CNS (anxiety, mental agitation)

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8
Q

What are the side effects from over-stimulation of 5HT2A receptor? (6)

A

5HT2A = CNS, spinal cord (anxiety, mental agitation, akathisia, insomnia, myoclonus (rate of 0.2%), sexual dysfunction)

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9
Q

What is serotonin discontinuation/withdrawal syndrome? (4)

A

headache, dizziness, irritability, fatigue (upon abrupt discontinuation)

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10
Q

Which SSRI has the fewest drug-drug interactions?

A

Citalopram

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11
Q

Which SSRI has highest risk for GI disturbances?

A

Sertraline

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12
Q

Which SSRI can elevate levels of neuroleptics, leading to increased side effects?

A

Fluoxetine

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13
Q

What is fluoxetine also used for?

A

Bulimia

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14
Q

Which SSRI is indicated for OCD?

A

Fluvoxamine (Luvox)

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15
Q

When does therapeutic effect of SSRIs take place?

A

3-4 wks after administration

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16
Q

Other than Citalopram and Escitalopram, which SSRI has very few drug interactions?

A

Sertraline

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17
Q

Which SSRI has more anticholinergic effects (ex. sedation, constipation, wt gain)?

A

Paroxetine

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18
Q

Which SSRI has shorter half-life, thus leading to withdrawal syndrome if not taken consistently?

A

Paroxetine

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19
Q

How can the sexual s/e of SSRIs be treated? (3)

A
  1. Augmenting the regiment with buproprion
  2. Change to non-SSRI antidepressant
  3. Add medications like Sildenafil (Viagra) for men
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20
Q

What is the serotonin syndrome? (6)

A

Caused by taking 2 drugs, both of which increase serotonin

  • Hyperthermia
  • myoclonus
  • autonomic instability (diaphoresis, shivering, tachycardia, htn)
  • rigidity (neuromuscular excitability)
  • delirium
  • coma –> death
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21
Q

Which other medication is contraindicated with SSRIs and why?

A

MAOIs = need washout of 2 wks prior to initiation of SSRI treatment

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22
Q

How long do the side effects of SSRIs last?

A

resolve within a few wks

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23
Q

What are the different classes of anti-depressants? (8)

A
  1. SSRI
  2. SNRI
  3. TCA
  4. MAOI
  5. NaSSAs (Norad + specific serotonergic antidep.)
  6. SARI (serotonin antagonist + reuptake inhibitors)
  7. NDRI (norad + dopamine reuptake inhibitors)
  8. SSRI + SPA (serotonin partial agonist)
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24
Q

What are the 4 SNRIs?

A
  1. Venlafaxine (Effexor)
  2. Duloxetine (Cymbalta)
  3. Desvenlafaxine (Pristiq)
  4. Levomilnacipran (Fetzima)
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25
What is duloxetine used for?
Diabetic neuropathy, fibromyalgia, neuropathic pain
26
What additional s/e are seen in SNRIs?
Norepi s/e = Agitation, tremor, tachycardia, HTN
27
Mechanism of action of NDRI?
Norepi-dopamine reuptake inhibitors
28
What is the 1 example of NDRI? (1)
Bupropion (Wellbutrin)
29
What is bupropion indicated for? (2)
adult ADHD, smoking cessation
30
What is bupropion NOT indicated for? (2)
- pts w/ seizure d/o | - pts w/ active eating disorders
31
Why is bupropion not indicated for pts w/ seizures?
b/c bupropion can lower seizure threshold
32
What are the s/es of bupropion? (NDRI) (5)
- activation - insomnia - nausea - tremor - increased anxiety (b/c not serotonergic at all) - note: NO WEIGHT GAIN OR SEXUAL DYSFX (b/c no serotonin)
33
Mechanism of action of SARI?
Serotonin antagonist and reuptake inhibitors | - blocks reuptake pumps with simultaneous 5HT2A blockade
34
What is a benefit of using SARI?
no 5HT2A s/es = CNS, spinal cord (anxiety, mental agitation, akathisia, insomnia, myoclonus (rate of 0.2%), sexual dysfunction) - thus, can use in pts w/ anxiety and insomnia - also, no sexual dysfunction
35
What are the general side effects of SARI? (4)
- sedation - nausea - dizziness - orthostatic hypotension
36
What are the example of SARI? (2)
1. Trazodone | 2. Nefazodone
37
Serious adverse effect of trazodone?
Priapism (rare)
38
Serious adverse effect of nefazodone?
Rare Liver toxicity (black box warning)
39
What are the indications for SARI (3)
1. Refractory major depression 2. Major depression w/ anxiety 3. Major depression w/ insomnia
40
What is an example of NaSSA?
Mirtazapine (Remeron)
41
Mechanism of action of NaSSA? (2)
Noradrenergic and specific serotonergic antidepressants 1. antagonism at central alpha 2 autoreceptors --> disinhibition of NE and 5HT --> increase NE (leading to stimulation of serotonin neuron) 2. Stimulation of alpha 1 receptors on serotonin neurons --> boost 5HT release
42
Do not use venlafaxine in pts with---?
Untreated or labile BP (b/c it can raise blood pressure)
43
What is mirtazapine useful for? (2)
Refractory major depression, esp in pts who need to 1. GAIN weight and 2. helps with sleep
44
What are the 2 SSRI + SPA
1. Vilazodone | 2. Vortioxetine
45
Mechanism of TCAs?
- antagonism at serotonin, NE reuptake pumps | - blocks HAM receptors
46
Tertiary amines vs. secondary amines?
- tertiary = more HAM blockade | - secondary = fewer s/es, less sedating, safer in overdose
47
Examples of tertiary amines TCAs? (5)
1. Amitriptyline 2. Clomipramine 3. Doxepin 4. Trimipramine 5. Imipramine (Tofranil)
48
Examples of secondary amine TCAs? (3)
1. Desipramine 2. Nortriptyline 3. Protriptyline
49
What is amitriptyline useful for? (3)
pain, headache/migraine, insomnia
50
Which TCA is indicated for tx of OCD?
Clomipramine (most serotonin specific)
51
Which TCA is indicated for panic d/o and enuresis?
Imipramine
52
What is Doxepin useful for? (2)
Treating chronic pain and insomnia
53
Which TCA is least likely to cause orthostatic hypotension?
Nortriptyline
54
Which TCA is least sedating and least anticholinergic?
Desipramine
55
What is the treatment of TCA overdose?
Sodium bicarb
56
What are the serious adverse effects of TCAs? (3)
3Cs --> convulsions, coma, cardiotoxicity (QTc prolongation)
57
What are the symptoms of TCA overdose? (9)
agitation, tremors, ataxia, delirium, hypoventilation (from CNS depression), myoclonus, hyperreflexia, seizures, coma
58
MAOIs are considered more effective in ---?
Atypical depression, refractory depression
59
What are the characteristics of atypical depression? (3)
1. hypersomnia 2. increased appetite 3. increased sensitivity to interpersonal rejection
60
Mechanism of action of MAOIs?
- irreversible monoamine oxidase inhibitors = prevents degredation of biogenic amines (NE, serotonin, dopamine, tyramine)
61
Examples of MAOIs? (3)
1. Phenelzine 2. Tranylcypromine 3. Transdermal selegiline
62
Pros of using transdermal selegiline (EMSAM patch)?
does not require following the dietary restriction when used in low dosages - but still have to avoid decongestants, opiates, and serotonergic drugs
63
What must you be careful of when using MAOIs?
Tyramine-induced hypertensive crisis
64
What are tyramine-rich foods? (5)
Red wine, cheese, chicken liver, fava beans, cured meats
65
Mechanism of tyramine-induced hypertensive crisis?
Buildup of stored catecholamines
66
Symptoms of hypertensive crisis? (8)
- HTN - headache - sweating - nausea/vomiting - photophobia - autonomic instability - chest pain - arrhythmias
67
Treatment of hypertensive crisis?
Use anti-alpha (phentolamine)
68
Which antidepressants (specific) for OCD? (2)
Fluvoxamine (SSRI) | Clomipramine (TCA)
69
Which antidepressants (2 class + 1 spec) for panic disorders
SSRIs MAOIs Imipramine (TCA)
70
Which antidepressant for bulimia? (1)
Fluoxetine (SSRI)
71
Which antidepressant for enuresis? (1)
Imipramine (TCA)
72
Which antidepressant class for PTSD? (1)
SSRIs
73
Which antidepressant (2 class, 1 spec) for GAD?
SSRI, SNRI (venlafaxine), TCAs
74
Which antidepressant for migraine headaches? (1)
Amitriptyline (TCA)
75
Which antidepressants for insomnia? (2)
Mirtazapine, amitriptyline (TCA)
76
Which antidepressants for neuropathic pain? (3)
Amitriptyline, nortriptyline, duloxetine (SNRI)
77
Which antidepressant for smoking cessation? (1)
Bupropion
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