Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
99 Cards in this Set
- Front
- Back
List the classes of antidepressants you should know:
|
Monoamine Oxidase Inhibitors (MAOIs)
Tricyclic Antidepressants (TCAs) Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs) |
|
Which condition is treated with lithium?
|
Bipolar disorder.
|
|
These drugs are tricyclic antidepressants (TCAs):
|
Imipramine
Amitriptyline Desipramine Nortriptyline Doxepin Clomiphene Amoxapine |
|
What are 5-HT reuptake inhibitors?
|
A fancy name for serotonin reuptake inhibitors.
If you must know, it's 5-hydroxytryptamine. |
|
What is the theraputic usage for TCAs (tricyclic antidepressants)?
|
-Major Depression
-Chronic pain -OCD |
|
This tricyclic antidepressant treats bed-wetting:
|
Imipramine
|
|
This is the least anticholinergic of the tricyclic antidepressant drugs:
|
Desipramine
|
|
This tricyclic antidepressant is used to treat OCD:
|
Clomipramine
|
|
This tricyclic antidepressant is used to treat neuropathic pain and migraine:
|
Amitryptyline
|
|
This tricyclic antidepressant involves the blockade of some types of D2 receptors:
|
Amoxapine
|
|
Which 3 important mechanistic effects are associated with TCAs?
|
Activity as a(n):
-Antimuscarinic -α1 blocker -Histamine1 blocker |
|
What results from the antimuscarinic activity of TCAs?
|
-Mydriasis
-Cycloplegia -Urinary retention -Sedation |
|
What results from the α1 blocking activity of TCAs?
|
Hypotension + Orthostasis
|
|
What results from the H1 blocking activity of TCAs?
|
Sedation + Weight gain
|
|
What happens in the case of overdose of TCAs?
|
Coma, convulsion, and cardiotoxicity.
|
|
________ polymorphism is associated with the slow metabolism of TCAs in the case of serotonin syndrome.
|
CYP2D6
|
|
One major benefit of this antidepressant drug is that it does not produce impotence:
|
Bupropion
|
|
What is used to treat TCA overdose?
|
Sodium bicarbonate (attaches to Na+ channel to decrease C/V effects)
|
|
What is the mechanism of action for bupropion?
|
-Inhibition of DA and NE reuptake
-Noncompetitive antagonism at nicotinic receptor |
|
What are the main theraputic uses for bupropion?
|
-Major Depression
-Cessation of smoking |
|
This drug is a partial nicotinic receptor agonist that has side effects of erratic behavior and suicide:
|
Varenicline
|
|
In which type of patient is bupropion contraindicated?
|
The bulimic patient.
|
|
What mechanism does bupropion follow on the M and H1 receptors?
|
Bupropion doesn't have too much muscarinic activity and doesn't really act on the histamine receptor. That's one of the benefits of the drug.
|
|
What is the mechanism of action of mirtazapine?
|
-Blockage of α2 receptors
-↑ NE and 5-HT release -Opposite mechanism to Clonidine |
|
How is mirtazapine used theraputically?
|
For:
-Major depression -Sedation |
|
What side effects (toxicity) are associated with mirazapine?
|
Sedation + Weight gain.
|
|
This class of antidepressants treats fibromyalgia:
|
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
|
|
Which drugs are classified as serotonin-norepinephrine reuptake inhibitors (SNRIs)?
|
Duloxetine
Venlafaxine Desvenlafaxine Milnacipran |
|
What is the theraputic usage for SNRIs?
|
-Major depression
-Chronic pain -Fibromyalgia -Neuropathic pain |
|
Do SNRIs act on the H1 or M receptors?
|
No.
|
|
Which class of drugs is mechanistically most similar to TCAs?
|
SNRIs
|
|
One thing about these antidepressants is that they take ~4 weeks of administration to elicit a full effect:
|
Selective Serotonin Reuptake Inhibitors (SSRIs)
|
|
Which special conditions do SSRIs treat?
|
-PTSD
-Premenstrual dysphoric disorder -Bulimia |
|
Which drugs are classified as selective serotonin reuptake inhibitors (SSRIs)?
|
-Fluoxetine
-Fluvoxamine -Citalopram -Paroxetine -Sertraline -Escitalopram |
|
Which classes of drugs are associated with serotonin syndrome?
|
TCAs, SSRIs, and MAOIs
|
|
Which drug of the SSRIs is most interactive with CYP450-2D6?
|
Fluoxetine
|
|
Which drugs of the SSRIs are the least interactive with CYP450-2D6?
|
Sertraline, Citalopram, and Escitalopram
|
|
What side effects are associated with SSRIs?
|
Insomnia
Headache Nausea Vomiting Platelet abnormalities Impotence |
|
Which drug classes have the side effect of impotence and priapism, respectively?
|
SSRIs = impotence
SARIs = priapism |
|
Which antidepressant drugs are classified as serotonin reuptake inhibitors and blockers (SARIs)?
|
Trazodone + Nefazodone
|
|
What are the mechanisms of action of trazodone and nefazodone?
|
-Serotonin reuptake inhibition / block (SARI)
-α1 block -H1 block |
|
How are SARIs used theraputically?
|
-Major depression
-Sedation -Sleep aid |
|
What mechanisms involved with SARIs permit priapism and sedation?
|
Priapism = block of α1 receptors (vasodilation)
Sedation = block of H1 |
|
This antidepressant drug is hepatotoxic:
|
Nefazodone
|
|
What should you be wary of when prescribing trazodone as an antidepressant?
|
That trazodone levels will be increased if the patient is also taking drugs that inhibit CYP3A4 metabolism.
|
|
When prescribing this type of antidepressant, you should tell your patients to avoid tyramine-containing foods such as aged cheese and meats, red wine, avocado, and chocolate.
|
Monoamine Oxidase Inhibitors (MAOIs)
|
|
What is the theraputic usage for MAOIs?
|
Refractory depression.
|
|
Which antidepressant drugs block MAOA receptors (MAOIA)?
|
Phenelzine
Tranylcypromine Isocarboxazid |
|
Which antidepressant drugs block MAOB receptors (MAOIB)?
|
Selegiline
*only dopamine |
|
How is selegiline used theraputically?
|
-Parkinson's disease
-Major depression |
|
What happens if a patient taking MAOIs decides to eat a lot of cheese and meat?
|
Hypertension
|
|
Which drugs would elicit Serotonin syndrome when interacting with MAOIs?
|
-SSRIs
-TCAs -Meperidine -Dextromethorphan -Triptans -Linezolid -St. John's Wort |
|
What would happen if a patient takes St. John's Wort with MAOIs?
|
Serotonin Syndrome
|
|
What is the mechanism of action of lithium?
|
Blocking the anenylyl cyclase signaling for NE.
|
|
What side effects are associated with lithium?
|
-Tremors
-Leukocytosis -Polyuria / Polydipsia -Hypothyroidism -Ebstein anomaly |
|
How can the side effect of tremors be avoided when administering lithium?
|
Using beta-blockers.
|
|
Which mechanism is responsible for causing polyuria and polydipsia when administering lithium?
|
When using lithium, ADH response is lost.
|
|
What is ADH?
|
Anti-diuretic hormone.
|
|
What is the benefit of administering amiloride with lithium?
|
Amiloride prevents the diabetes insipitus symptoms induced by lithium.
|
|
What is the mechanism by which amiloride attenuates polyuria and polydipsia caused by lithium?
|
Blocking lithium entry through the sodium channel.
|
|
What is Ebstein's anomaly?
|
When the tricuspid valve leaflets extend into the apex of the right ventricle, causing murmur, regurgitation, and hypertrophy.
|
|
What is an alternative to lithium treatment during pregnancy?
|
lamotrigine
|
|
What can happen if a patient takes lithium while pregnant?
|
The child has an increased risk of developing Ebstein's anomaly.
|
|
What are 4 important drugs used to treat bipolar mania / bipolar syndrome?
|
Lithium
Valproate Carbamazepine Lamotrigine |
|
Valproic acid, carbamazepine, and lamotrigine are all used to treat...
|
Partial and tonic-clonic seizures.
|
|
These drugs are associated with Stevens-Johnson syndrome:
|
Carbamazepine + Lamotrigine
|
|
What is the mechanism of action of valproic acid?
|
-Blocks Na+ & T-type Ca2+ channels
-↓ glutamate at NMDA receptors -↑ GABA receptor action -↑ GABA synthesis -Blocks GABA degradation |
|
What is the mechanism of action of carbamazepine?
|
-Blocks Na+ channels
-Blocks NE reuptake |
|
What is the mechanism of action of lamotrigine?
|
-Potentiation (↑) of GABA
-Blocks VG Na+ channels -Blocks glutamate |
|
Which drug is used to treat Lennox-Gastaut syndrome?
|
lamotrigine
|
|
Which drug is used to treat trigeminal neuralgia?
|
Carbamazepine
|
|
Which drug is used to treat migrane prophylaxis (in addition to bipolar syndrome)?
|
Valproic Acid
|
|
Which drugs cause neural tube defects?
|
Valproic Acid + Carbamazepine
|
|
Which drug has a Black Box Warning?
|
Lamotrigine (for SJS syndrome)
|
|
What is a Black Box Warning?
|
The strictest warning label that can be placed on prescription drugs (by the FDA).
|
|
Which 2 drugs treat absence seizures (in addition to bipolar disorder)?
|
Valproic Acid + Lamotrigine
|
|
This drug has a side effect of hepatitis:
|
Valproic Acid
|
|
What is the action of valproic acid and carbamazepine on CYP2D6 and CYP3A4?
|
Valproic acid = Inhibitor of CYP2D6 and CYP3A4
Carbamazepine = Inducer of CYP3A4 |
|
What side effects are associated with carbamazepine?
|
-Drowsiness
-Ataxia -Diplopia |
|
What is SIADH?
|
Syndrome of Inappropriate Antidiuretic Hormone Secretion (water intoxication)
|
|
Which mood stabilizing drug is associated with aplastic anemia?
|
Carbamazepine
|
|
Which mood stabilizing drug is associated with SIADH?
|
Carbamazepine
|
|
What about lithium treatment can be especially dangerous?
|
Its narrow theraputic index (toxicity ≥ 1.5 mEq).
|
|
Which atypical antipsychotics should you know?
|
Risperidone
Olanzapine Quetiapine Aripiprazole Ziprasidone |
|
What is the general mechanistic goal for atypical antipsychotics?
|
To increase DA.
|
|
What is the mechanism of action of risperidone?
|
Blockade of:
-5-HT2A >>> D2 -D3 -D4 |
|
All atypical antipsychotics prolong the _______ interval.
|
QT
|
|
What is the QT interval?
|
The interval of electrical impulses in the heart. (Q and T-waves)
|
|
What is the mechanism of action of olanzapine?
|
Blockade of:
5-HT2A > H1 > D4 > D2 > α1 > D1 |
|
What is the mechanism of action of quetiapine?
|
Blockade of:
H1 > α1 > M1,3 > D2 (short) > 5-HT2A |
|
What is the mechanism of action of aripiprazole?
|
-Partial D2 agonist
-5-HT2A antagonist |
|
What is the mechanism of action of ziprasidone?
|
-Blocks 5-HT reuptake
-Blocks NE reuptake |
|
Which atypical antipsychotic drug has few ANS and extrapyramidal effects?
|
Olanzapine.
|
|
Which atypical antipsychotic drug has the side effect of hyperlipidemia and hyperglycemia due to increased prolactin?
|
Risperidone.
|
|
Which atypical antpsychotic drug has a side effect of hypotension (from blocking α1 receptor)?
|
Risperidone.
|
|
Which atypical antipsychotic drug has a side effect of akathisia?
|
Aripiprazole.
|
|
Which atypical antipsychotic drug has side effects including skin reactions and eosinophilia?
|
Ziprasidone.
|
|
What is akathisia?
|
A state of agitation or distress (resulting from antipsychotics).
|
|
What is eosinophilia?
|
Increased eosinophils in the blood, often due to allergic reaction.
|