Antidepressants Flashcards

1
Q

what are the MAOI inhibitors

A

MAO Take Pride In Shanghai

Tranylcypromine (non hydrazine)
Phenelzine (hydrazine)
Isocarboxazid (hydrazine)
Selegiline (non hydrazine)

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2
Q

mechanism of MAO inhibitors (name them)

A

tranylcypromine, phenelzine, isocarboxazid, selegiline

  • prevent the breakdown of serotonin, dopamine, norepinephrine
  • PIT bind irreversibly and nonselectively to MAO-A and MAO-B
  • Selegiline binds to MAO-B
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3
Q

use of MAOI

A
  • depression unresponsive to other antidepressants

- Selegiline for early Parkinson’s

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4
Q

AE of MAOI

A

tranylcypromine, phenelzine, isocarboxazid, selegiline

drowsiness, insomnia, orthostatic hypotension, weight gain, muscle pain, sexual dysfunction

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5
Q

contraindication of MAOI (name them)

A

tranylcypromine, phenelzine, isocarbaxozid, selegiline

  • serotonin agents: SSRI, SNRIs, or TCAs –> serotonin syndrome due to excess stimulation –> hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vitals (so they must be stopped 2 weeks before administering MAOIs)
  • tyramine containing food such as aged wine and cheese: they are broken down by MAO –> large release of catecholamines –> hypertension, tachycardia, arrhythmias, headache, stiff neck
  • sympathomimetic drugs: pseudoephedrine and phenylpropanolamine (both in cold meds)
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6
Q

what is used to control or manage tyramine induce hypertension

A

Phentolamine

Prazosin

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7
Q

what happens if overdose on MAOI

A

tranylcypromine, phenelzine, isocarboxazid, selegeline

autonomic instability, hyperadrenergic symptoms, psychotic symptoms, confusion, delirium, fever

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8
Q

what happens with discontinuation of MAOI

A

discontinuation syndrome (seen with all antidepressants) –> worsening of depressive symptoms, confusion, disorientation, psychosis, anxiety

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9
Q

what are the TCAs

A

DANI and CAM

Desipramine
Amitriptyline
Nortriptyline
Imipramine

Clomipramine
Amoxapine
Maprotiline

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10
Q

mechanism of action of TCAs (name them)

A

desipramine, amitripyline, nortriptyline, imipramine, clomipramine, amoxapine, maprotiline

blocks reuptake of serotonin and NE by competitively binding their carrier protein –> increased monoamine in the cleft

block alpha adrenergic, muscarinic, histamine, and cardiac fast Na channels

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11
Q

AE of TCAs (name them)

A

desipramine, amitriptyline, nortriptyline, imipramine, clomipramine, amoxapaine, maprotiline

  • block muscarinic receptors –> blurred vision, xerostomia, urinary retention, constipation, narrow angle glaucoma
  • increase catecholamine receptors –> increased cardiac stimulation
  • inhibit cardiac fast Na channel –> arrhythmias
  • block alpha 1 receptor: orthostatic hypotension with rebound tachycardia
  • H1 blocker: sedation and weight gain
  • sexual effects
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12
Q

what metabolizes TCAs and how does it affect the population

A

CYP2D6 so those (esp whites) with polymorphism are associated with slow metabolism of TCAs

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13
Q

what occurs with overdose of TCAs

A

lethal arrhythmias –> v-tach and v-fib

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14
Q

what reverses the cardiac block caused by overdose of TCAs

A

sodium bicarbonate

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15
Q

what are the SSRIs

A

SEP of FFC

Sertraline
Escitalopram
Paroxetine
Fluoxetine
Fluvoxamine
Citalopram
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16
Q

mechanism of SSRIs (name them)

A

Sertraline, Escitalopram, Paroxetine, Fluoxetine, Fluvoxamine, Citalopram

  • inhibit the reuptake of serotonin
  • unlike TCAs, they have little blocking activity at muscaranic, histamine H1, and alpha adrenergic receptors
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17
Q

SSRIs are first line treatment for what conditions

A

Depression and Premature Ejaculation

SSRIs because of few sider effects

SEP of FFC
Sertraline
Escitalopram (S enantiomer of Citalopram)
Paroxetine
Fluoxetine
Fluvoxamine
Citalopram
18
Q

what else are SSRIs used for

A

OCD, panic disorder, generalized anxiety disorder, PTSD, Social anxiety disorder, premenstrual dysphoric disorder, bulimia nervosa

19
Q

AE of SSRIs (name them)

A

sertraline, escitalopram, paroxetine, fluoxetine, fluvoxamine, citralopram

Increased serotonergic activity in the gut
Diminished sexual interest and function
Weight gain

20
Q

drug interaction of SSRIs

A
  • Fluoxetine and Paroxetine are inhibitors of CYP2D6 needed for metabolism of TCAs
  • Fluvoxamine is inhibitor of CYP1A2, CYP2C19, and CYP3A4
  • Serotonin Syndrome
21
Q

what occurs with overdose of SSRIs

A

seizures

22
Q

what are the SNRIs

A

Venlafaxine

Duloxetine

23
Q

mechanism of SNRIs (name them)

A

Venlafaxine and Duloxetine

inhibit the reuptake of serotonin and NE but differ from TCAs in that they do not block the muscarinic, H1, and alpha adrenergic 1 receptors

24
Q

which of the SNRIs behaves like an SSRI and why

A

Venlafaxine at low doses only inhibits uptake of serotonin but at high doses also inhibits uptake of NE

25
Q

adverse of SNRIs

A

dry mouth, constipation, decreased appetite, fatigue, somnolence, sweating, asthenia, dizziness, sexual dysfunction

26
Q

name and mechanism of NDRI

A

Bupropion

norepinephrine and dopamine reuptake inhibitor

27
Q

use of NDRI

A

bupropion

decrease the craving and attenuating the withdrawal symptoms of nicotine in tobacco users

28
Q

overdose and contraindication of bupropion

A

seizures

29
Q

name and mechanism of SARIs

A

5HT2 (serotonin) antagonist and 5-HT reuptake inhibitor

Nefazodone
Trazodone

30
Q

use of SARIs

A

nefazodone and trazodone

  • since 5-HT2 is inhibited –> no agitation, anxiety, or sexual dysfunction
  • actions of 5-HT with blockade of 5-HT2 –> antidepressive, antianxiety, antipsychotic
31
Q

AE of nefazodone

A

hepatotoxicity

32
Q

AE of trazodone

A

block alpha 1 and H1 –> extreme sedation and hypnotic hence why it is used as an off label hypnotic

33
Q

example and mechanism of NASSAs

A

noradrenergic and specific serotonergic antidepressant –> alpha 2, 5-HT2, and 5-HT3 antagonist

also H1 antagonist

Mirtazapine

34
Q

AE of NASSA

A

Mirtazapine

sedation
weight gain

35
Q

first choice for depression in adults and children not taking any drug that can antagonize it

A

Fluoxetine

36
Q

first choice for depression in adults taking medication that can antagonize fluoxetine

A

Citaprolam or Sertraline

37
Q

since SSRI are first choice for depression, what are TCAs used for

A

neuropathic and other pain conditions

38
Q

antidepressants that is approved for pain associated with diabetic neuropathy and fibromyalgia

A

SNRI Duloxetine

39
Q

antidepressant approved for treatment of bulimia

A

Fluoxetine

40
Q

antidepressant approved for premenstrual dysphoric disorder

A

Fluoxetine and Sertraline