Antidepressants

Front 1

What are the risk factors for depression?

Back 1

- gender : more women
- age - 25-40
- Family history
- postpartum
- psychosocial stressors

Front 2

What is the etiology of depression?

Back 2

- genetic factors
- personality and enviromental factors
- biochemical abnormalities

Front 3

Reasons for choosing an antidepressant...

Back 3

- anticipate adverse effects
- presence of comorbid medical or psychiatric conditions
- history of prior response
- patient preference
- cost

Front 4

How many weeks do antidepressants take to reach maximal therapuetic benefits?

Back 4

4-6 weeks

Front 5

What is the MOA of Tricyclic Antidepressants?

Back 5

TCAs block the reuptake pumps for serotonin and norepinephrine.
TCAs bind @ other sites which are not therapietic > extensive side effects.
TCAs can cause conduction disturbances and ECG changes > QT prolonged and can lower seizure threshold profile
overdose is fatal
2nd amines are more tolerable than tertiary amines

Front 6

What is the MOA of Trazodone (Desyrel)?

Back 6

- weakens serotonin reuptake inhibitors and a 5HT2 receptor antagonist
- very safe in overdose
- no anticholinergic and cardiovascular side effects

Front 7

What are the SE of Trazodone?

Back 7

sedation
orthostatic hypotension
priapism (rare)
GI

Front 8

What is the most common use of Trazodone?

Back 8

sedative/ hypnotic--- rarely used for antidepressant anymore

Front 9

What is the MOA of Monoamine Oxidase Inhibitors?

Back 9

inhibits the enzyme of monoamine oxidase
inhibits MAO A and B nonspecific and irreversible
tyramine restricted diet

Front 10

What are the Adverse Reactions to MAOIs?

Back 10

sedation
insomnia
weight gain
decreased or increased blood pressure

Front 11

What is the presentation of MAOIs during a hypertensive crisis?

Back 11

nausea, vomiting, sweating, headache, stiff neck, chest pain, hpertension, palpitations

Front 12

When does an MAIO hypertensive crisis occur...

Back 12

usually develops 20 minutes - 1 hour after ingestion of the interacting food or drug > could lead to CVA or death

Front 13

What is the treatment of a MAIO hypertensive crisis?

Back 13

IV nicardipine
veraapamil
fenoidopam
phentolamine

Front 14

Foods to avoid with MAIOs

Back 14

acocados, aged cheese, dried meats, soybean products, red wine, tap beers, sauerkraut, raw yeast, pods of broad beans, pickled herring, chicken livers

Front 15

What foods should be limited with MAIOs?

Back 15

caffiene, chocolate, figs, meat tenderizers, raisins

Front 16

MAIOs interact with what drugs?

Back 16

amphetamines, antidepressants, appetite suppressants, asthma inhalers, buspirone, carbamazepine, decongestants, dextromethorphan, dopamine, ephedrine, epinephrine, levodopa, methylphenidate, stimulants, sympathomimetics, triptans

Front 17

What is the MOA of Serotonin Reuptake Inhibitors?

Back 17

block serotonin reuptake pump
less SE than TCAs and safer w/overdose
used for depression and anxiety

Front 18

What are the AE of SSRIs

Back 18

GI
headache
sexual dysfunction
insomnia
activation
discontinuation syndrome

Front 19

What is the presentaion of discontinuation syndrome?

Back 19

dizziness, nausea, vomiting, flulike symptoms, anxiety, irritabilty

solution - taper/ don't abruptly stop taking

Front 20

What is serotonin syndrome?

Back 20

overactivation of central serotonin receptors
rare- SSRI and MAIO combo

Front 21

What is the presentation of Serotonin syndrome?

Back 21

abdominal pain, diarrhea, sweating, fever, tachycardia, delirium, myocionus, irriability

Front 22

What is the TX of serotonin syndrome?

Back 22

discontinue suspected causative agents
provide support therapy for symptoms

Front 23

How can you prevent serotonin syndrome?

Back 23

SSRIs > MAOIs 2 week washout
Fluoxetine > 5 week washout
MAOI > SSRI 2 week washout

Front 24

What is the MOA of Buproprion (Wellbutrin)?

Back 24

Norepinephrine and dopamine reuptake blockade
treatment of ADHD and smoking ( not labeled uses)
increased seizures activity
does not cause sexual dysfunction

Front 25

What is the AE of Buproprion ?

Back 25

nausea
incomnia
agitation. anxiety
tremors
not as safe with overdose as trazodone or SSRIs
Cont > people with eating disorders

Front 26

What is the MOA of Venlafaxine (Effexor)?

Back 26

inhibits the reuptake of serotonin and norepinephrine > similar to the TCAs

Front 27

What are the AE of Venlafaxine?

Back 27

risky in overdose > seizure risk
n/h
insomnia, hypertension, nervousness, sexual dysfunction

Front 28

What is the MOA of duloxetine (Cymbalta)?

Back 28

inhibits the reuptake of serotonin and norepinephrine
indicated for MDD and Diabetic perpheral neuropathic pain

Front 29

What are the adverse effects of duloxetine ?

Back 29

n/ dry mouth
c/ sweating
tachy
hypertension

Front 30

What is the MOA of nefazodone (serazone)?

Back 30

aan antagonist of the 5HT2 receptor and it also blocks reuptake of serotonin
well tolerated in overdose
less side effects than SSRIs
little sedation due to teh removal of antihistamine avtivity present in trazadone

Front 31

What are the AE of Nefazodone?

Back 31

somnolence
dry mouth
nausea
dizziness

Front 32

What is the BLACK BOX warning on Nefazodone?

Back 32

life threatening cases of hepatic failure have been reported
no pts with liver disease or elevated serum transaminases
No pts w/ GI comp
drugs should be discontinued with ALT or AST > 3 ULN
Monitor for signs of anorexia or jaundice

Front 33

What is the MOA of Mirtazapine (Remeron)?

Back 33

potent alpha 2 adrenergic auto and heteroreceptor antagonist
5HT2 and 5HT3 postsynaptic receptor antagonist
SE are minimized
decrease SE
potent histamine blocking effect SO wt gain, increased appetite, and sedation

Front 34

What are the future targets for drug development?

Back 34

NMDA receptors antagonist
GABA
CRF1 antagonist
NK1 antagonist
Neurotrophic factors

Front 35

Drug Interactions

Substrate

Back 35

drug metabolized by a particular enzyme

Front 36

Drug Interaction

Inhibitor

Back 36

drug that prevents a particular enzyme from metabolizing a substrate

Front 37

Drug Interaction

Inducer

Back 37

drug that speeds up the metabolism of a sustrate of a particular enzyme

Front 38

How do antidepressant drugs interact with CYP450 drugs?

Back 38

hepatocytes in the liver
involved in metabolism
# of drug classes

Front 39

Suicide risk

Back 39

SSRi

Avoid: TCAs and MAOIs

Front 40

Weight Gain

Back 40

SSRIs and bupropion

Avoid: TCAs, mirtzapine, MAIOs

Front 41

With antidepressants, what are special things to watch for with elderly?

Back 41

r/o dementia, delirium, and medication
SSRIs are 1st line (esp. citalopram & sertraline)
AVOID TCAs due to anticholernergic rxn
Start low and go slow

Front 42

What drug do you use for Peds antidepressants?

Back 42

fluoxetine MDD
OCD- fluisetine, sertaline,& fluvooxamine

Front 43

What drugs do use in pregnant women?
What is the possible side effect?

Back 43

SSRIs, desipramine, and nortriphyline
Paroxetine
heart problems and pulmonary HTN

Front 44

What about women and antidepressants with lactation?

Back 44

setraline- seems to produce lowest serum concentration
mothers should pump milk before talking the drug