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33 Cards in this Set
- Front
- Back
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What are the classes of antidepressants?
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Tricyclics, SSRI's, Serotonin/norepinephrine reuptake inhibitors (S/NRI's), MAOIs, and Atypicals
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What are some of the clinical features of depression?
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1. Depressed mood
2. Loss of pleasure or interest in normal activity 3. Insomnia (or hypersomnia) 4. Anorexia (or hyperphagia) 5. Mental slowing and poor concentration 6. Feelings of guilt, worthlessness, and helplessness 7. Suicidal thoughts or thoughts of death 8. Overt suicidal behavior |
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How long must clinical symptoms of depression be present to be classified as depression?
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Symptoms must be present most of the day, nearly every day, for at least 2 weeks.
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Describe the monoamine hypothesis of depression.
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Depression is caused by a functional insufficiency of monoamine neurotransmitters.
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What is the primary treatment modality for depression?
What are some other treatment options? |
1. Pharmacotherapy is the primary treatment
2. Other options include: CBT, electroconvulsive therapy (for suicidal patients), vagus nerve stimulation |
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T/F
Suicidal tendencies will manifest later in antidepressant treatment. |
False. These tendencies manifest early in treatment.
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What is the drug class of choice of many patients suffering from depression?
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Tricyclic antidepressants
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Match the following descriptions with a specific class of antidepressant (TCA's, SSRIs, , MAOis)
1. As effective as TCA's but do not cause hypotension, sedation, or anticholinergic effects found in TCA's. 2. Risk of suicide early in treatment; most dangerous adverse event is cardiotoxicity. 3. 2nd or 3rd choice antidepressants that are more dangerous than TCAs or SSRIs |
1. SSRIs
2. TCAs 3. MAOIs |
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What leads to the sedation, orthostatic hypotension, and anticholinergic effects?
What drug class are TCA's similar to? |
1. The tricyclic ring structure
2. Phenothiazine antipsychotics |
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Match the following Mechanisms of action to the drug class (TCA, SSRI, S/NRI, MAOI)
1. Prevents inactivation of NE and serotonin, increasing the amount of transmitter available for release. Irreversible effect that lasts 2 weeks. 2. Inhibits uptake pumps for NE and serotonin, causing these neurotransmitters to accumulate in the synaptic space. 3. Produces inhibition of serotonin reuptake 4. Produces inhibition of the reuptake of serotonin and NE |
1. MAOI
2. TCA's 3. SSRI's 4. S/NRI's |
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Match the following therapeutic uses to their drug classes (TCA, SSRI, , MAOI)
1. Treatment of major depression 2. Depression and bipolar disorder 3. depression, bulimia nervosa, OCD, panic attacks 4. OCD, bulimia nervosa, premenstrual dysphoric disorder 5. Neuropathic pain, chronic insomnia, ADHD, Panic disorder, OCD |
1. SSRI's
2. TCA's 3. MAOI's 4. SSRI's 5. TCA's |
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What are the adverse effects of the TCA's?
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1. Orthostatic hypotension
2. Anticholinergic effects 3. Cardiac toxicity 4. Seizure 5. Yawngasm |
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What other drugs do TCA's have interactions with?
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1. MAOI's
2. Direct acting sympathomimetic drugs 3. Indirect acting sympathomimetic drugs 4. Anticholinergics 5. CNS depressants |
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What are the two primary toxic concerns with TCA's?
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Anticholinergic side effects and cardiotoxic side effects.
Cardiac: can cause just about anything depending on the drug. |
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What is the treatment for TCA toxicity?
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Gastric lavage, ingestion of activated charcoal, physostigmine, propanolol, lidocaine, or pheynytoin.
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Which of the following is the most widely prescribed SSRI in the USA?
a) Sertraline b) Fluoxetine c) Paroxetine d) Fluvoxamine e) Citalopram f) Escitalopram |
b) fluoxetine
All of the other drugs are SSRI's but fluoxetine is the most commonly prescribed SSRI |
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Which of the following is not a side effect of Fluoxetine?
a) Serotonin syndrome b) Neonatal effects c) Withdrawal syndrome d) Social phobia e) Bruxism |
d) Social phobias
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A patient who started Fluoxetine 2 days ago presents to the ER with hypotension arrhythmia. What is the reason for this?
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Serotonin syndrome due to fluoxetine use.
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What is the effect of SSRI's (fluoxetine) on each of the following/effect when combined with each of the following?
1. Monoamine oxidase inhibitors 2. Warfarin 3. TCA's and lithium |
1. Increased risk of serotonin syndrome when taken with SSRI.
2. SSRI's inhibit warfarin metabolism 3. SSRI's can elevate the levels of TCA's and lithium |
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Name the SSRI that fits the following description:
1. Blocks reuptake of serotonin and dopamin; has a minimal effect on the seizure threshold. 2. Inhibits serotonin uptake; used for any of the disorders 3. Inhibits serotonin reuptake; used for OCD and is rapidly absorbed from the GI tract 4. Makes more serotonin available in the synaptic cleft; does not block receptors for serotonin, Ach, NE, or histamine 5. s-isomer of citalopram and better tolerated than citalopram |
1. Sertraline
2. Paroxetine 3. Fluvoxamine 4. Citalopram 5. Escitalopram |
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Match each of the following descriptions with one of the SSRI's:
1. Neonatal abstinence syndrome and Pulmonary hypertension when pregnant. 2. Dose dependent alteration of hepatic enzyme levels 3. Causes irregular heartbeat when administered with Pimozide 4. Interacts with MAOI's, can cause neonatal abstinence syndrome, and somnolence |
1. Sertraline
2. Fluvoxamine 3. Sertraline 4. Citalopram |
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A baby presents with mottling of skin, excessive crying and sucking, tremors, and irritability. The baby's birth weight is low and it seems to have delayed development. Which drugs for depression was the mother likely on during the pregnancy?
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This is neonatal abstinence syndrome. A side effect of Sertraline, Citalopram, Venlafaxine (S/NRI)
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T/F
Fluvoxamine has a longer half life than Citalopram |
False
The half-life of fluvoxamine is 15 hrs and the half life of citalopram is roughly 35 hours |
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Match the following statements with one of the S/NRI's:
1. Indications are major depression, GAD, and social phobia. 2. Food decreases absorption and this drug is highly bound to albumin in the blood. 3. Weakly inhibits dopamine reuptake and is used to relieve depression and pain with diabetic peripheral neuropathy. 4. Serious reactions if combined with MAOI's 5. Does not inhibit MAO 6. Side effects of this drug include weight loss/anorexia, diastolic hypertension, hyponatremia, and neonatal withdrawal syndrome 7. Drug is contraindicated in pregnancy and lactation 8. Inhibits CYP 1A2 and CYP 2D6 |
1. Venflaxine
2. Duloxetine 3. Duloxetine 4. Venflaxine 5. Duloxetine 6. Venflaxine 7. Duloxetine 8. Duloxetine |
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Describe the mechanism of action of the MAO.
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Converts monamine NT's (NE, serotonin, and dopamine) into inactive products
Inactivates tyramine and other biogenic amines Affected by other antidepressants MAOI's work by inhibiting this normal metabolic process. This leads to increased amounts of NE and serotonin, increasing the amount of transmitter available for release. |
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Which class of drugs will cause Hypertensive crisis from dietary tyramine?
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MAOI's
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What drug do MAOI's have an interaction with?
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The pain management drug Meperidine
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What is the transdermal MAOI and why is it used?
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Selegiline
Much lower risk of hypertensive crisis with transdermal route versus oral route. |
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Name the slow onset anti-depressant that acts as a stimulant (increased sexual desire and pleasure) and suppresses appetite.
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Bupropion
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What are some of the major side effects of Bupropion?
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Seizure
Tachycardia Blurred Vision Dizziness Headache Weight loss Constipation |
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What drug class increases the risk of Bupropion toxicity?
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MAOI's
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Concerning Electroconvulsive therapy:
1. Why is it desirable? 2. What types of patients is it preferred for? 3. Adverse effect? |
1. Very effective and has a rapid onset relative to antidepressant drugs.
2. Those who have failed to respond to drugs; severely depressed and suicidal patients 3. Some memory loss for events immediate surrounding treatment. |
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Concerning Vagus nerve stimulation:
1. What is it used for? 2. MOA? 3. Side Effects? |
1. Treatment of therapy resistant depression (when at least four drugs have failed)
2. Implanted device; delivers impulses to the vagus nerve 3. Hoarseness, voice alteration, cough, dyspnea |
