Pharm -- Depression

Front 1

Drugs that can cause depression

Back 1

- Alcohol
- Antihypertensives
- Oral contraceptives
- Steroids, corticosteroids
- Interferon-beta-1a

Front 2

Which SSRI has the "worst" side effect profile

Back 2

Paroxetine (Paxil): weight gain, sedation, sexual dysfunction, in addition to normal SSRI side effects like nausea, headache, dizziness

Front 3

Signs/symptoms of Serotonin Withdrawal Syndrome

Back 3

- Headache
- N/V
- Diarrhea
- Insomnia
- Movement disorders (rare)

Therefore -- taper SSRIs!!!

Front 4

Signs/symptoms of Serotonin Syndrome

Back 4

- Mental status changes
- Hyperreflexia
- Clonus
- Autonomic disregulation

Front 5

Which SSRI has the "most" drug interactions?

Back 5

Fluoxetine (Prozac)

Fluoxetine has the longest half-life and an active metabolite that can build up in the system. Do not give to elderly and do not give in hepatic disease.

Front 6

Which SSRI(s) have the "least" drug interactions?

Back 6

Citalopram and Sertraline have the least problems with drug interactions; considered "Pure SSRIs" (so is escitalopram)

Front 7

Which SSRI is most sedating?

Back 7

Paroxetine (Paxil) -- worst SE profile!

Front 8

Examples of SNRI's

Back 8

- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)

Front 9

Which SNRI has greater serotonergic action than NE action?

Back 9

Venlafaxine

Front 10

Which SNRI has equal action on both serotonin and NE receptors?

Back 10

Duloxetine

Front 11

SE of Venlafaxine

Back 11

- Increased BP -- need to worry about potential hypertensive crisis
- Sexual dysfunction

Front 12

SE of Duloxetine

Back 12

- Increased LFTs
- Nausea

Front 13

MOA of Buproprion

Back 13

Mixed NE and Dopamine Reuptake Inhibitors

Front 14

Indications for Buproprion

Back 14

Depression AND smoking cessation

Front 15

Can Buproprion cause seizures?

Back 15

Potentially -- it can lower the seizure threshold, esp in patients with eating disoders

Front 16

Strict contraindication in Buproprion

Back 16

Do not give to patients with eating disorders (due to seizure potential)

Front 17

What is the most activating agent of all antidepressants?

Back 17

Buproprion

Front 18

SE of Buproprion

Back 18

Insomnia, dry mouth, nausea, sweating, poss. tinnitus

**Least sexual dysfunction problems, which is good!

Front 19

MOA of Mirtazapine

Back 19

SNRI. It has both antihistamine and serotonergic properties.

Front 20

SE of Mirtazapine

Back 20

- Increased appetite --> weight gain, sedation
- Less sexual dysfunction than SSRIs due to less direct serotonin inhbition (since it's a mixed MOA)

Front 21

MOA of Trazodone

Back 21

- Increases serotonergic transmission, but less intensely than SSRIs do

Front 22

SE of Trazodone

Back 22

- Priapism
- EXTREME SEDATION (The pharmacist said this drug is really just a sleep pill, and should be coupled with an SSRI for better antidepression therapy)

Front 23

MOA of Nefazodone

Back 23

- Increases serotonergic transmission, but to a lesser extent than SSRIs

Front 24

SE of Nefazodone

Back 24

- Hepatotoxicity and hepatic failure
- Monitor LFTs

Front 25

MOA of TCAs

Back 25

Serotonin/NE reuptake inhibitors (SNRIs)

Front 26

SE of TCAs

Back 26

Since these drugs are so non-selective, they have a lot of side effects:
- Sedation
- Anticholinergic (SLUD)
- Orthostatic hypotension
- Very high potential of overdose

Front 27

Other off-labeled uses of TCAs

Back 27

Neuropathic pain
Sleep aid

Front 28

Examples of MOAI drugs used in depression

Back 28

- Phenelzine
- Tranylcypromine

Front 29

Downside of using MOAIs

Back 29

Food and drug restrictions are necessary to prevent HTN-crisis

Front 30

MOA of Selegiline

Back 30

Monoamine oxidase-B inhibitor

Front 31

How is selegiline given for depression? (PO, IM, IV, TD, PR, etc.)

Back 31

Transdermal for depression
(Oral for Parkinson's Disease)

Front 32

How long should you wait to see if an antidepressant drug is working, before you make changes?

Back 32

Wait at least 6-8 weeks, most drugs need that amount of time to reach steady state and have an impact on the patient.

Front 33

If you wait 6-8 weeks and pt doesn't feel depression relief, what are appropriate options?

Back 33

1. Increase dose
2. Switch to another SSRI
3. Switch to a different class
4. Combine SSRI with another drug (SSRI + Mirtazapine is popular and makes sense) -- watch for Serotonin Syndrome!
5. Can give an augment drug -- lithium is gold standard, but usually we leave this up to trained psychiatrists

Front 34

Three most activating antidepressant drugs (on pharmacist's "teeter-totter" scale)

Back 34

1. Buproprion
2. Venlafaxine
3. Duloxetine (Not as badly)

Front 35

Three most sedating antidepressant drugs (on pharmacist's "teeter-totter" scale)

Back 35

Trazadone
TCAs
Mirtazapine

Front 36

Most activating SSRI

Back 36

Fluoxetine

Front 37

Most sedating SSRI

Back 37

Paroxetine

Front 38

What is the only approved antidepression agent for children?

Back 38

Fluoxetine
(Children need both pharmacotherapy and psychotherapy together, especially due to the black box warning of increased suicide with initial SSRI use)

Front 39

What is a popular adjunct antidepressant agent that is actually an atypical antipsychotic?

Back 39

Aripiprazole (Abilify)