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44 Cards in this Set

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What are the risk factors for depression?
- gender : more women
- age - 25-40
- Family history
- postpartum
- psychosocial stressors
What is the etiology of depression?
- genetic factors
- personality and enviromental factors
- biochemical abnormalities
Reasons for choosing an antidepressant...
- anticipate adverse effects
- presence of comorbid medical or psychiatric conditions
- history of prior response
- patient preference
- cost
How many weeks do antidepressants take to reach maximal therapuetic benefits?
4-6 weeks
What is the MOA of Tricyclic Antidepressants?
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
What is the MOA of Trazodone (Desyrel)?
- weakens serotonin reuptake inhibitors and a 5HT2 receptor antagonist
- very safe in overdose
- no anticholinergic and cardiovascular side effects
What are the SE of Trazodone?
sedation
orthostatic hypotension
priapism (rare)
GI
What is the most common use of Trazodone?
sedative/ hypnotic--- rarely used for antidepressant anymore
What is the MOA of Monoamine Oxidase Inhibitors?
inhibits the enzyme of monoamine oxidase
inhibits MAO A and B nonspecific and irreversible
tyramine restricted diet
What are the Adverse Reactions to MAOIs?
sedation
insomnia
weight gain
decreased or increased blood pressure
What is the presentation of MAOIs during a hypertensive crisis?
nausea, vomiting, sweating, headache, stiff neck, chest pain, hpertension, palpitations
When does an MAIO hypertensive crisis occur...
usually develops 20 minutes - 1 hour after ingestion of the interacting food or drug > could lead to CVA or death
What is the treatment of a MAIO hypertensive crisis?
IV nicardipine
veraapamil
fenoidopam
phentolamine
Foods to avoid with MAIOs
acocados, aged cheese, dried meats, soybean products, red wine, tap beers, sauerkraut, raw yeast, pods of broad beans, pickled herring, chicken livers
What foods should be limited with MAIOs?
caffiene, chocolate, figs, meat tenderizers, raisins
MAIOs interact with what drugs?
amphetamines, antidepressants, appetite suppressants, asthma inhalers, buspirone, carbamazepine, decongestants, dextromethorphan, dopamine, ephedrine, epinephrine, levodopa, methylphenidate, stimulants, sympathomimetics, triptans
What is the MOA of Serotonin Reuptake Inhibitors?
block serotonin reuptake pump
less SE than TCAs and safer w/overdose
used for depression and anxiety
What are the AE of SSRIs
GI
headache
sexual dysfunction
insomnia
activation
discontinuation syndrome
What is the presentaion of discontinuation syndrome?
dizziness, nausea, vomiting, flulike symptoms, anxiety, irritabilty

solution - taper/ don't abruptly stop taking
What is serotonin syndrome?
overactivation of central serotonin receptors
rare- SSRI and MAIO combo
What is the presentation of Serotonin syndrome?
abdominal pain, diarrhea, sweating, fever, tachycardia, delirium, myocionus, irriability
What is the TX of serotonin syndrome?
discontinue suspected causative agents
provide support therapy for symptoms
How can you prevent serotonin syndrome?
SSRIs > MAOIs 2 week washout
Fluoxetine > 5 week washout
MAOI > SSRI 2 week washout
What is the MOA of Buproprion (Wellbutrin)?
Norepinephrine and dopamine reuptake blockade
treatment of ADHD and smoking ( not labeled uses)
increased seizures activity
does not cause sexual dysfunction
What is the AE of Buproprion ?
nausea
incomnia
agitation. anxiety
tremors
not as safe with overdose as trazodone or SSRIs
Cont > people with eating disorders
What is the MOA of Venlafaxine (Effexor)?
inhibits the reuptake of serotonin and norepinephrine > similar to the TCAs
What are the AE of Venlafaxine?
risky in overdose > seizure risk
n/h
insomnia, hypertension, nervousness, sexual dysfunction
What is the MOA of duloxetine (Cymbalta)?
inhibits the reuptake of serotonin and norepinephrine
indicated for MDD and Diabetic perpheral neuropathic pain
What are the adverse effects of duloxetine ?
n/ dry mouth
c/ sweating
tachy
hypertension
What is the MOA of nefazodone (serazone)?
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
What are the AE of Nefazodone?
somnolence
dry mouth
nausea
dizziness
What is the BLACK BOX warning on Nefazodone?
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
What is the MOA of Mirtazapine (Remeron)?
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
What are the future targets for drug development?
NMDA receptors antagonist
GABA
CRF1 antagonist
NK1 antagonist
Neurotrophic factors
Drug Interactions

Substrate
drug metabolized by a particular enzyme
Drug Interaction

Inhibitor
drug that prevents a particular enzyme from metabolizing a substrate
Drug Interaction

Inducer
drug that speeds up the metabolism of a sustrate of a particular enzyme
How do antidepressant drugs interact with CYP450 drugs?
hepatocytes in the liver
involved in metabolism
# of drug classes
Suicide risk
SSRi

Avoid: TCAs and MAOIs
Weight Gain
SSRIs and bupropion

Avoid: TCAs, mirtzapine, MAIOs
With antidepressants, what are special things to watch for with elderly?
r/o dementia, delirium, and medication
SSRIs are 1st line (esp. citalopram & sertraline)
AVOID TCAs due to anticholernergic rxn
Start low and go slow
What drug do you use for Peds antidepressants?
fluoxetine MDD
OCD- fluisetine, sertaline,& fluvooxamine
What drugs do use in pregnant women?
What is the possible side effect?
SSRIs, desipramine, and nortriphyline
Paroxetine
heart problems and pulmonary HTN
What about women and antidepressants with lactation?
setraline- seems to produce lowest serum concentration
mothers should pump milk before talking the drug