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93 Cards in this Set
- Front
- Back
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What is the DSM-IV (oh no! psych again!) criteria for major depression?
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five or more of these:
depressed mood (no kidding! **** me!) Anhedonia Weight loss Insomia psychomotor agitation (aka moving? with your mind?) feelings of worthlessness inability to think thoughts of death - these must case significant distress or impairment |
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how common is suicide in teenagers?
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this is the 3rd leading cause of death of teenagers (11%)
behind accidents (48%) and homicide (13%) |
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How do we THINK antidepressants work?
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we think they enhance monoamine function- maybe a deficit of NE and 5-HT causes depression
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What do most antidepressants do in the brain? (generally)
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effect the uptake, metabolism, or receptor interactions of 5-Ht or NE
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How long do antidepressants take to work? why?
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this takes about 2-3 weeks
may be due to neural plasticitiy |
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What is the neurotrophic hypothesis?
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this suggests that BDNF may be decreased in depression, which leads to hippocampal loss
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What is imipramine?
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a tertiary amine tricyclic antidepressant
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what is amitripyline?
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a tertiary amine tricyclic antidepressant
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what is desipramine?
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a secondary amine tricyclic antidepressant
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what is nortriptyline?
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a secondary amine tricyclic antidepressant
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What is Clomipramine?
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this is a tricyclic antidepressant
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What does Clomipramine treat?
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OCD
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How do tricyclic antidepressants affect NTs?
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inhibits NE and 5-HT
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How do tricyclic antidepressants affect receptors?
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this blocks muscarinic, alpha adrenergic, and histamine
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Are tricyclic antidepressants stimulants?
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no they are not, they are likely to cause sedation.
Low abuse potential* |
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How long do tricyclic antidepressants last?
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these have long half lives of about 8-89 hours
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Which are more sedating, tertiary or secondary amine TCAs?
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tertiary amines- like amitriptyline and imipramine
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How to TCA's cause sedation?
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this is due to blockage of histamine receptors
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How to TCA's affect memory? How?
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these impair memory and cognition, due to the anticholinergic effect**
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How to TCAs affect pain?
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they decrease pain, by direct action on spinal cord
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How do TCA's affect the heart?
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these cause cardiac depression, and increase the irritability
OVERDOSE potential** |
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How to TCA's affect BP?
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these have an alpha 1 blockade, which leads to postural hypotension**
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What are TCA's used to treat?
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depression
panic disorder PAIN**- chronic pain/headaches fibromyalgia Enuresis ADHD |
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What are the autonomic side effects of TCAs?
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Cholinergic blockade (anti parasympathetic)
constipation, dry mouth, palpitations |
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What are the cardiovascular side effects of TCA's?
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alpha 1 blockade- orthostatic hypotension
ventricular arrythmias (due to membrane stabilizing, and thus irritability increasing effects) |
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How do TCA's affect weight
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weight gain is common with these
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How do TCA's affect seizures
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this decreases the seizure threshold (which seems odd considering they have sedating effects?)
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What bad 'syndrome' can occur with TCA use?
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SIADH- leads to hyponatremia
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What is the sign of physical dependence for TCA's?
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muscle aches, malaise may occur if drug is rapidly stopped
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Can TCA's be used with pregnant people?
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no they cannot be
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What happens when you overdose on TCAs?
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pts may become dangerously depressed and suicidal (ironic again!)
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What are the clinical signs of a TCA overdose?
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Torsades de points
hypotension seizures agitations rapid coma development stop breathing |
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What do you give to treat TCA overdose?
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use Phenytoin (dilantin- class 1b antiarrythmetic) to manage arrythmias
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What are the two most important drug interactions for TCA's? **key**
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MAOI's
Fluoxetine (Prozac, an SSRI) |
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When you mix TCA's with MAOI's, what happens?
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Serotonin syndrome**
hyperpyrexia (high fever 106.7F+), convulsions, and coma |
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What does MAO-A do?
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this breaks down NE and 5-HT
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What does Phenelzine do? what drug class?
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MAOI
this is the irreversible** inhibitor of MAO-A/B |
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When should MAOI's be prescribed?
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in cases of depression that havent responded to other drugs
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What is the major dangerous side effect with MAOI's?
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a hypertensive crisis from ingesting Tyramine (which causes NT release in the body)
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What foods contain tyramine?
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red wine
beer aged cheese prepared meets |
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How do you treat a MAOI+ tyramine hypertensive crisis?
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Alpha blockers
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How do MAOI's affect weight?
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they lead to weight gain
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how do MAOI's affect BP (normally)
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these cause orthostatic hypotension
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How do MAOI's interact with amphetamine like substances?
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sever hypertension (as they cant break down NE, and amphetamine dumps a ton of NE in the body)
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How do TCAs and SSRI's affect MAOIs?
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these can cause serotonin syndrome
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What is the presentation serotonin syndrome?
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hyperpyrexia
convulsions coma tremors |
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How does Meperidine, tramadol, and DXM affect MAOIs?
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these inhibit serotonin uptake, and can lead to serotonin syndrome
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How does Buspirone affect MAOI's?
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this can lead to hypertension with co-administration
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What class is Fluoxetine the prodrug for?
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SSRI's-
(fluoxetine is Prozac) |
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What drugs are the DOC for depression treatment?
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SSRI's!
because they are effective and have few side effects |
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How long does fluoxetine last in the body? why?
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this lasts a very long time, fluoxetine itself's half life is only 2-3 days,
but its also active metabolite has a half life of 7-9 days |
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How is fluoxetine metabolized?
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in the liver by CYP2D6
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Do SSRI's affect the heart?
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no they do not
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What is the DOC for panic disorder?
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SSRI's
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What kinds of diseases can SSRI's be used to treat?
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depression
panic disorder OCD social anxiety bulimia alcoholism |
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What are the side effects of SSRI use?
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GI upset
Weight loss CNS stimulation Sexual dysfunction SIADH** photosensitivity |
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What metabolizes SSRi's?
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cytochrome P-450
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What enzymes does Fluoxetine inhibit?
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CYP3A4, and CYP2D6
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How do MAOI's affect SSRIs?
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this leads to serotonin syndrome (an with anything else that blocks serotonin uptake)
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How does warfain affect SSRIs?
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warfain metabolism is inhibited, so may cause bleeding
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How do SSRI's affect Beta Blockers?
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Beta blocker metabolism is inhibited, so concentrations will be higher
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How do SSRi's affect opioids?
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they inhibit their metabolism into the active drug
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What type of drug is Fluoxetine?
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this is prozac, and SSRI
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How long after taking Fluoxetine do you need to wait before starting new drugs? why?
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wait 5 weeks
due to the long duration of effect for prozac |
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What is the main side effect of fluoxetine?
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insomnia (it inhibits NE uptake=stimulation**)
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What type of drug is Sertraline?
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this is Zoloft, and SSRI
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How is Sertraline different than Fluoxetine?
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Zoloft is different than Prozac, because Zoloft has fewer sexual effects, fewer interactions, and shorter action
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What type of drug is paroxetine?
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this is Paxil- a SSRI
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What is Paroxetine to treat? in who?
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this is paxil- treats depression in the Elderly
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What side effect is paroxetine likely to cause?
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paxil is likely to cause sedation
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What the major contraindication for paroxetine?
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paxil is contraindicated in pregnancy
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What type of drug is Citalopram?
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this is celexa, a SSRI
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What type of drug is Escitalopram?
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this is lexapro a SSRI
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What is the onset of Celexa/Lexapro like?
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this is faster than most SSRI's, only takes 1-2 weeks
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What type of drug is Venlafaxine?
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Effexor is a SNRI
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What type of drug is desvenlafaxine?
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Pritiq is a SNRI
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What do SNRI's do?
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these inihibit both serotonin and NE reuptake
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How are the side effects of SNRI's different than SSRIs?**
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SNRI's have more side effects- like increased BP, and SIADH
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What type of drug is Duloxetine?
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cymbalta is a SNRI
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What is Duloxetine good for treating?
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cymbalta is good for improving the physical (pain) symptoms of depression**
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What two types of people is Duloxetine contraindicated in?
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Cymbalta is contraindicated in the 3rd trimester of pregnancy. And in people with liver disease
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How does Bupropion work?
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wellbutrin inhibits dopamine reuptake and NE reuptake
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What is bupropion given for?
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wellbutrin is given to drug addicted kids who smoke
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What are the side effects of bupropion?
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wellbutrin has many side effects:
seizures* anxiety, insomnia weight loss |
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How does mirtazapine work?
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remeron blocks presnyaptic alpha 2's
increasing NE and 5-HT release BLOCKS- 5-HT2a and 5-HT3 receptors |
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What are the main side effects of mirtazapine?
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remeron blocks histamine receptors= drowsy
weight gain |
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How does Atomoxetine work?
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srattera- is a NE reuptake inhibitor
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What does Atomoxetine treat?
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strattera is used to treat ADHD
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What does Trazdone treat?
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Desyrel is used to treat pain, and as a sleep aid
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What are the side effects of trazodone?
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desyrel can cause sedation, and priapism
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What is the main side effect of St john's wort?
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sensitivity to the sun
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What are the interactions of taking st john's wort?
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MOAI, SSRI, TCA's- all cause serotonin syndrome= BAD**
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What does st johns wort induce?
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this induces P450, and increases the metabolism of pretty much everything
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