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Flashcards

Antidepressants

Deleted user User has deleted their subject information English 111 cards

Cards in this deck (111)

  1. 1What is the Amine Hypothesis?Abnormally low levels of norepinephrine and/or serotonin underlie depression
  2. 2The following is the definition of what? Abnormally low levels of norepinephrine and/or serotonin underlie depressionAmine Hypothesis
  3. 3What evidence is there of the Amine Hypothesis? Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of
    norepinephrine (NE) and is associated with depressive symptoms,
     Autopsy studies of the brains of depressed suicide victims indicate a low
    level of NE and/or serotonin (5-HT) metabolism in most brain regions,
     Drugs found to be beneficial act to enhance NE or 5-HT levels.
  4. 4What are the following evidence of?  Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of norepinephrine (NE) and is associated with depressive symptoms,  Autopsy studies of the brains of depressed suicide victims indicate a low level of NE and/or serotonin (5-HT) metabolism in most brain regions,  Drugs found to be beneficial act to enhance NE or 5-HT levels.Amine Hypothesis
  5. 5What is the major weakness of the Amine Hypothesis?A major weakness to the amine hypothesis is the therapeutic lag – effects of drugs on NE or 5-HT levels are observed immediately yet therapeutic benefit takes a minimum of 1 to 4 weeks to occur
  6. 6What is the Neuroendocrine Hypothesis? Depression is associated with elevated cortisol levels
     HPA axis is dysregulated
     Abnormal (low) thyroid function is common in depression
  7. 7Which drugs are Serotonin Selective Reuptake Inhibitors (SSRIs)?Fluoxetine, paroxetine, sertraline, citalopram, escitalopram
  8. 8What are the antidepressant drug classes?SSRI, SNRI, TCA, MAO-I, Atypical
  9. 9What is the antidepressant drug class of the following? AmitriptylineTCA
  10. 10What is the antidepressant drug class of the following? ClomipramineTCA
  11. 11What is the antidepressant drug class of the following? ImipramineTCA
  12. 12What is the antidepressant drug class of the following? PhenylzineMAO-I
  13. 13What is the antidepressant drug class of the following? TranylcypromineMAO-I
  14. 14What is the antidepressant drug class of the following? SelegilineMAO-I
    Used for Parkinson’s Disease, rarely for depression
  15. 15What is the antidepressant drug class of the following? FluoxetineSSRI
  16. 16What is the antidepressant drug class of the following? ParoxetineSSRI
  17. 17What is the antidepressant drug class of the following? SertralineSSRI
  18. 18What is the antidepressant drug class of the following? CitalopramSSRI
  19. 19What is the antidepressant drug class of the following? EscitalopramSSRI
  20. 20What is the antidepressant drug class of the following? VenlafaxineSNRI
  21. 21What is the antidepressant drug class of the following? DuloxetineSNRI
  22. 22What is the antidepressant drug class of the following? TrazodoneAtypical
  23. 23What is the antidepressant drug class of the following? MirtazapineAtypical
  24. 24What is the antidepressant drug class of the following? BupropionAtypical
  25. 25What is the antidepressant drug class of the following? DesvenlafaxineSNRI
  26. 26What is the Neurotrophin Hypothesis? Laboratory research indicates that antidepressants increase BDNF production in hippocampus
    - This requires long term (weeks) not short term (days) treatment
     BDNF increases neurogenesis and synaptic connectivity
     Stress, pain and depression can reduce BDNF
     Imaging studies indicate reduced hippocampal volume (size) in depression
  27. 27What is described below?  Laboratory research indicates that antidepressants increase BDNF production in hippocampus - This requires long term (weeks) not short term (days) treatment  BDNF increases neurogenesis and synaptic connectivity  Stress, pain and depression can reduce BDNF  Imaging studies indicate reduced hippocampal volume (size) in depressionNeurotrophin Hypothesis
  28. 28Why do none of the depression hypotheses provide the full answer?Patients have different
    neurochemistry, life history, genetics, etc.
  29. 29Inhibition of serotonin transporter (SERT) is the mechanism of action for which antidepressant drug class?Serotonin Selective Reuptake Inhibitors (SSRIs)
  30. 30What is the mechanism of action of Serotonin Selective Reuptake Inhibitors (SSRIs)?Inhibition of serotonin transporter (SERT)
  31. 31Which antidepressant drug class is first line in treating depression?SSRIs with SNRIs
  32. 32Which SSRI(s) is approved for children?Fluoxetine
  33. 33Which SSRI(s) is approved in adolescents?Fluoxetine and Escitalopram
  34. 34Which antidepressant drug class (and which drugs) are used for the following? Depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimiaSSRI
    (Fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
  35. 35What are the SSRIs used for?Depression, GAD, PTSD, OCD, panic disorder, PMDD,
    bulimia
  36. 36Which SSRIs are potent inhibitors of CYP 2D6? - Interactions with tamoxifen and other CYP 2D6 substratesFluoxetine and paroxetine
  37. 37Which SSRI does the following apply to? Long half life of active metabolite; risk of serotonin syndrome if switching to MAOIFluoxetine
  38. 38Which antidepressant drug class has high selectivity for SERT (serotonin transporter)?SSRIs
  39. 39Which antidepressant drug class has a high therapeutic index?SSRIs
  40. 40What are the adverse effects of SSRIs? Nausea, GI upset, diarrhea; all improve after the first week
     Reduced sexual function; may improve over time on drug
     Headaches, insomnia or hypersomnia
     Significant weight gain in some patients
     Increased risk of bleeding by inhibiting SERT in platelets
     Discontinuation syndrome, especially paroxetine (anxiety, irritability, confusion, crying)
     Paroxetine is Category D – risk of heart defects with first trimester exposure
  41. 41Which SSRI is Category D? Risk of heart defects with first trimester exposureParoxetine
  42. 42True or False Discontinuation syndrome is an adverse effect of SSRIs and SNRIsTrue
    (anxiety, irritability, confusion, crying)
    SSRI: Especially paroxetine
    SNRI: Are common with Venlafaxine and desvenlafaxine
  43. 43True or False Significant weight loss is an adverse effect of SSRIs.False
    There is significant weight gain in some patients
  44. 44Which drugs are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?Venlafaxine, desvenlafaxine, duloxetine
  45. 45Which antidepressant drug class have high selectivity for SERT and NET (norepinephrine transporter)?Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
  46. 46Which antidepressant drug class (and drugs) are used for depression, neuropathic pain, GAD, stress urinary incontinence, and vasomotor symptoms of menopause?Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
     Venlafaxine, desvenlafaxine, duloxetine
  47. 47Venlafaxine is metabolized to what by CYP 2D6?Desvenlafaxine
    Venlafaxine is metabolized to Desvenlafaxine by CYP 2D6
  48. 48What are the uses of SNRIs?Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
  49. 49What are the adverse effects of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)? Nausea, GI upset, diarrhea; all improve after the first week
     Reduced sexual function; may improve over time on drug
     Headaches, insomnia or hypersomnia
     Significant weight gain in some patients
     Increased risk of bleeding by inhibiting SERT in platelets
     Discontinuation syndrome, common with venlafaxine and desvenlafaxine (anxiety, irritability, confusion, crying)
    Increased blood pressure and heart rate; not a problem in most
    patients
    Increased sweating, urinary retention
  50. 50Discontinuation syndrome is an adverse effect of which antidepressants?SSRI: Especially paroxetine
    SNRI: Are common with Venlafaxine and desvenlafaxine
  51. 51The adverse effects of SNRIs are similar to SSRIs but also include what?Increased blood pressure and heart rate; not a problem in most patients
    Increased sweating, urinary retention
  52. 52Which drugs are Tricyclic antidepressants (TCAs)?Amitriptyline, imipramine, chlomipramine
  53. 53The following applies to which antidepressant drug class? Dominant class of antidepressants until ~ 1990s when SSRIs took overTricyclic antidepressants (TCAs)
  54. 54What is used in depression that is unresponsive to SSRIs and SNRIs?Tricyclic antidepressants (TCAs)
  55. 55What are Tricyclic antidepressants (TCAs) used for? Used in depression that is unresponsive to SSRIs and SNRIs
     Used in neuropathic pain, enuresis
  56. 56As a class, Tricyclic antidepressants (TCAs), inhibit what?As a class, they inhibit NET and SERT but variable profiles of individual
    drugs
     Less selectivity than SSRIs, SNRIs
  57. 57The following applies to which antidepressant drug class? Narrow therapeutic index and bothersome side effects explain reduced useTricyclic antidepressants (TCAs)
     Efficacy is similar to SSRIs, SNRIs
  58. 58When are Tricyclic antidepressants (TCAs) taken?Sedating – taken at bedtime
  59. 59The following applies to which antidepressant drug class? Metabolized by CYP 2D6, serum levels are affected by inhibitors (e.g. fluoxetine)Tricyclic antidepressants (TCAs)
  60. 60The following applies to which antidepressant drug class? Potentially lethal in overdoseTricyclic antidepressants (TCAs)
    and Monoamine oxidase inhibitors
  61. 61What are the adverse effects of tricyclic antidepressants (TCAs)? Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
     Adrenergic α1 antagonism: orthostatic hypertension
     Histamine H1 antagonism: weight gain, sedation
     Sexual side effects
     Discontinuation syndrome (flulike symptoms)
     Cardiac conduction delays; arrhythmogenic: POTENTIALLY LETHAL IN OVERDOSE
  62. 62What are the drug interactions of TCAs?CNS depressants, e.g. antihistamines, alcohol, benzodiazepines
  63. 63The following are drug interactions for which antidepressant drug class? CNS depressants, e.g. antihistamines, alcohol, benzodiazepinesTCAs
  64. 64The following applies to which antidepressant? Antagonist for 5-HT2A receptorTrazodone
  65. 65The following applies to what antidepressant? Used for depression and anxiety  Seldom used as monotherapy  Adjunct with SSRI for patients with insomniaTrazodone
  66. 66What is Trazodone used for?Used for depression and anxiety
     Seldom used as monotherapy
     Adjunct with SSRI for patients with insomnia
    Used as a hypnotic – highly sedating and not associated with tolerance or dependence
  67. 67The following applies to which antidepressant? Used as a hypnotic – highly sedating and not associated with tolerance or dependenceTrazodone
  68. 68If Trazodone is used as a hypnotic, how many times a day should it be taken?One a day
  69. 69The following applies to which antidepressant? Rapid metabolism requires multiple doses per dayTrazodone
  70. 70What are the adverse effects of Trazodone?Sedation
    GI
    α1-antagonism: orthostatic hypotension
    Has been associated with priapism
  71. 71The following are the adverse effects of which antidepressant? Sedation GI α1-antagonism: orthostatic hypotension Has been associated with priapismTrazodone
  72. 72The following applies to which antidepressant? Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamineBupropion
  73. 73What is the mechanism of action of Bupropion?Has CNS stimulating effects, inhibits NE and dopamine transporters;
    increases presynaptic release of NE and dopamine
  74. 74What is the mechanism of action of Trazodone?Antagonist for 5-HT2A receptor
  75. 75The following applies to what antidepressant?  Not used for anxiety  Not sedating  Not associated with sexual side effects, bleeding or weight gainBupropion
  76. 76The following are the adverse effects of what antidepressant?  Agitation, anxiety, headache, insomnia, nausea, anorexia  Lowers seizure threshold, problem in epilepsy, alcoholism, eating disordersBupropion
  77. 77What is the pharmacology of Mirtazapine?Complex pharmacology; antagonist at adrenergic α2 and 5-HT2 receptor;
    also H1 antagonist (sedative effects, weight gain)
  78. 78The following applies to what antidepressant? Complex pharmacology; antagonist at adrenergic α2 and 5-HT2 receptor; also H1 antagonist (sedative effects, weight gain)Mirtazapine
  79. 79The following applies to which antidepressant?  Not associated with sexual side effects  Sedating – useful for depression with insomnias  Appetite stimulating – may be useful in depression plus anorexiaMirtazapine
  80. 80True or False Mirtazapine is useful for depression with insomnias.True
    Sedating – useful for depression with insomnias
  81. 81True or False Mirtazapine may be useful for depression plus anorexia.True
    Appetite stimulating – may be useful in depression plus anorexia
  82. 82Mirtazapine is sedating and appetite stimulating. This could be useful in treating people who have depression and what other two conditions?Appetite stimulating – may be useful in depression plus anorexia
    Sedating – useful for depression with insomnias
  83. 83The following are the adverse effects of what antidepressant?  Weight gain, dry mouth, constipationMirtazapine
  84. 84What are the adverse effects of Mirtazapine? Weight gain, dry mouth, constipation
  85. 85What are the drug-drug interactions of Mirtazapine?Drug interactions with alcohol, benzodiazepines (increased sedative effects)
  86. 86The following are the drug-drug interactions of what antidepressant? Drug interactions with alcohol, benzodiazepines (increased sedative effects)Mirtazapine
  87. 87What drugs are Monoamine oxidase inhibitors (MAOI)?Phenylzine, tranylcypromine
  88. 88What class of antidepressant drugs are described below?  Irreversible inhibition of MAO-A and MAO-B; long duration of effect  MAO-A: metabolizes NE, 5-HT and dopamine  MAO-B: metabolizes dopamineMonoamine oxidase inhibitors (MAOI)
  89. 89True or False Monoamine oxidase inhibitors (MAOI) lead to irreversible inhibition of MAO-A and MAO-BTrue
    Irreversible inhibition of MAO-A and MAO-B; long duration of effect
     MAO-A: metabolizes NE, 5-HT and dopamine
     MAO-B: metabolizes dopamine
  90. 90True or False  MAO-A: metabolizes dopamine  MAO-B: metabolizes NE, 5-HT and dopamineFalse (Reverse)
     MAO-A: metabolizes NE, 5-HT and dopamine
     MAO-B: metabolizes dopamine
  91. 91What class of antidepressant drugs are used in treatment resistant depression?Monoamine oxidase inhibitors (MAOI)
  92. 92What are Monoamine oxidase inhibitors (MAOI) used for?Used in treatment resistant depression
  93. 93The following are the adverse effects of what class of antidepressant drugs?  Potentially lethal in overdose (autonomic, cardiac, seizures)  Orthostatic hypotension, weight gain  Insomnia, restlessness  Discontinuation syndromeMonoamine oxidase inhibitors (MAOI)
  94. 94What are the adverse effects of Monoamine oxidase inhibitors (MAOI)? Potentially lethal in overdose (autonomic, cardiac, seizures)
     Orthostatic hypotension, weight gain
     Insomnia, restlessness
     Discontinuation syndrome
  95. 95What food interactions are possible with Monoamine oxidase inhibitors (MAOI)? Tyramine in the diet or sympathomimetic substrates of MAO
     Enhanced noradrenergic effects: hypertension, stroke, myocardial
    infarction
     Avoid foods such as aged cheese, cured meats, soy products, beer,
    pseudoephedrine
     Hypertensive crisis
  96. 96What foods should be avoided with Monoamine oxidase inhibitors? Avoid foods such as aged cheese, cured meats, soy products, beer,
    pseudoephedrine
  97. 97What classes of antidepressants are approved for PTSD, OCD, social anxiety, GAD and panic disorder?SSRIs and SNRIs
    Slower onset of benefit than benzodiazepines
  98. 98Therapeutic use of antidepressants requires how many months for benefit?1-2 months
  99. 99How long is the trial period for the therapeutic use of antidepressants? What should be done if there is inadequate response?Trial period is 4-12 weeks, if inadequate response then switch or add another agent
  100. 100What are the therapeutic uses of antidepressants for pain?Effects on pain are independent of antidepressant effects
    TCAs, SNRIs are more effective than others
  101. 101Which antidepressants are approved therapies for Premenstrual Dysphoric Disorder?Fluoxetine and Sertraline
  102. 102Which antidepressant is as effective as nicotine patches for Smoking Cessation?Bupropion
  103. 103True or False Antidepressants have more success helping anorexia than bulimia.False
    More success with bulimia than anorexia
    Mirtazapine stimulates appetite and used in anorexia
  104. 104Most antidepressants have sexual side effects. Which do not?Bupropion, Mirtazapine
  105. 105Which class of antidepressant can help with premature ejaculation?SSRIs
  106. 106Which class of antidepressant can help with “hot flashes”? SSRIs and SNRIs show benefit
  107. 107What is Serotonin Syndrome? Cognitive (delirium), autonomic (hypertension, tachycardia, sweating) and somatic (tremor), also fever, shivering
     Discontinue serotonergic antidepressants at least 2 weeks before starting MAOI; fluoxetine requires 5 weeks
     Discontinue MAOI for 2 weeks before starting a serotonergic agent
     Linezolid (antimicrobial), dextromethorphan, sumatriptan, tramadol, methadone, St. John’s wart can cause serotonin syndrome in the
    presence of SSRI or MAOI
  108. 108St. John’s wart can cause serotonin syndrome in the presence of what?SSRI or MAOI
  109. 109How do you choose an antidepressant? At the population level, efficacy is similar for all drugs
     SSRIs and SNRIs are first line therapies
     choice is often based on adverse effects, potential drug interactions, patient history
     Bupropion
  110. 110True or False At the population level, efficacy is similar for all antidepressant drugs.True
  111. 111Another treatment is augmentation of SSRI by adding another drug. What drugs could be added?Bupropion
    Antipsychotics (quetiapine, aripiprazole, olanzapine) Weight gain, metabolic adverse effects, akathisia (restlessness)
    Thyroid hormone (liothyronine, T3)
    Lithium

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User has deleted their subject information Flashcards on Antidepressants, created by Deleted user on 22/03/2017.
Created by
Deleted user · Mar 2017
Updated
Mar 22, 2017
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  • Created by Victoria Wright · Mar 20, 2017
  • Copied by Victoria Wright · Mar 22, 2017
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