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25 Cards in this Set
- Front
- Back
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55. What class of drugs are Trazodone (Desyrel) and Nefazodone (Serzone)?
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a. Serotonin Receptor Antagonists and agonists
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56. Use of Trazodone (Desyrel) and Nefazodone (Serzone)
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a. Refractory major depression
b. Major depression w/anxiety c. Insomnia (secondary to its sedative effects). |
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57. Side effects of Trazodone (Desyrel) and Nefazodone (Serzone)?
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a. They do not have the sexual side effects of SSRIs and do not affect rapid eye movement (REM) sleep.
b. Sedation! c. Priapism!!! (esp. w/Trazodone). d. Nausea e. Dizziness f. Orthostatic hypotension g. Cardiac arrhythmias. |
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58. Black box warning for nefazodone?
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a. Rare but serious Liver failure 1/250,000-300,000.
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59. α2-Adrenergic Receptor antagonist?
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a. Mirtazapine (Remeron)
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60. Use of Mirtazapine (Remeron)?
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a. Refractory major depression, especially in pts who need to gain weight.
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61. Side effects of Mirtazapine (Remeron)?
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a. Sedation
b. Weight gain!!!! c. Dizziness d. Somnolence e. Tremor f. Dry mouth g. Constipation h. Rare agranulocytosis |
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62. Side effect benefits of Mirtazapine (Remeron)?
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a. No sexual side effects and few drug interactions.
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63. Use of Remeron for depression in elderly?
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a. Helps w/sleep and appetite.
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64. MOA of Heterocyclic antidepressants: TCAs?
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a. TCAs inhibit the reuptake of NE and 5-HT.
b. ↑ availability of monoamines in the synapse. c. Bc of the long half-lives, most are dosed once daily. d. They are rarely used first-line bc they have a higher incidence of side effects, require greater monitoring of dosing, and can be LETHAL in Overdose. |
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65. What are the 4 tertiary amine TCAs and what general side effects do they have?
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1. Amitriptyline (Elavil)
2. Imipramine (Tofranil) 3. Clomipramine (Anafranil) 4. Doxepin (Sinequan) b. The tertiary amines are highly anticholinergic, more sedating, and have greater lethality in overdose. |
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66. Use of Amitriptyline (Elavil) [A tertiary amine TCA]?
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a. Chronic Pain
b. Migraines c. Insomnia |
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67. Use of Imipramine (Tofranil) [A tertiary amine TCA]?
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a. Has intramuscular form
b. Useful in enuresis and panic disorder. |
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68. Use of Clomipramine (Anafranil) [A tertiary amine TCA]?
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a. Most serotonin specific
b. Useful in tx of OCD! |
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69. Use of Doxepin (Sinequan) [A tertiary amine TCA]?
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a. Chronic Pain
b. Emerging use as a sleep aid in low doses. |
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70. 2 Secondary amine TCAs and their general side effect profile?
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1. Nortriptyline (Pamelor, Aventyl)
2. Desipramine (Norpramin) b. Metabolites of tertiary amines (less anticholinergic and less sedating). |
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71. Use of Nortriptyline (Pamelor, Aventyl) [A secondary amine TCA]?
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a. Least likely to cause orthostatic hypotension.
b. Useful in therapeutic blood levels c. Useful in treating chronic pain. |
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72. Effects/SE of Desipramine (Norpramin) [A secondary amine TCA]?
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a. More activating; least sedating
b. Least cholinergic. |
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73. Mainstay of tx for TCA overdose?
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a. IV Sodium bicarbonate.
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74. 2 Tetracyclic antidepressants?
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a. Amoxapine (Asendin)
b. Maprotiline (Ludiomil) |
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75. Amoxapine (Asendin) SE?
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a. Metabolite of antipsychotic loxapine
b. May cause EPS and has similar SE profile to typical antipsychotics. |
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76. Maprotiline (Ludiomil) SE?
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a. Higher rates of seizure, arrhythmia, and fatality in overdose.
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77. What dose of TCAs can be lethal in overdose?
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a. A 1-week supply (as little as 1-2g).
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78. TCA binding in blood?
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a. TCAs are highly protein bound and lipid soluble.
b. They therefore interact w/other meds that have high protein binding. |
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79. What are the SE of TCAs mostly due to?
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a. Their lack of specificity and interaction w/other receptors.
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