Term
| How long does it take for treatment to be affective for antidepressants? |
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Definition
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Term
| Antidepressants lead to remission of depressive symptoms in __% of patients. |
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Definition
|
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Term
| Chemical imbalance of what neurotransmitters is thought to cause affective disorders? |
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Definition
| norepinephrine, serotonin, and perhaps dopamine (beta adrenergic receptors may also be involved) |
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Term
| What percent of antidepressants are bound to plasma proteins? |
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Definition
|
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Term
| How are antidepressants metabolized/excreted? |
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Definition
| metabolized by the liver, metabolites excreted in urine |
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Term
| T/F Antidepressants generally have a relatively small therapeutic index. |
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Definition
|
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Term
| What is the half life like of most antidepressants? |
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Definition
|
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Term
| What are the four prominent classes of antidepressant drugs? |
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Definition
| TCAs,SSRIs, SNRIs, atypicals |
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Term
| Why does it take antidepressants so long to work? |
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Definition
| they have a long half life and it takes 4-5 t1/2s before you get to therpeutic blood levels. Then, you have to be at therapeutic blood levels for a while for the neurotransmitter imbalances to be corrected |
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Term
| What is the MOA of tricyclics? |
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Definition
| inactivate the "amine" pump on the presynaptic nerve terminal and thus limit the reputake of both norepinephrine and serotonin. |
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Term
| TCAs are nonspecific because in addition to working on NE and serotonin they also affect... |
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Definition
| muscarinic receptors, histamine type 1 receptors and alph-1 receptors |
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Term
| What are the two general types of tricyclics? |
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Definition
| tertiary amine tricyclics, secondary amine tricyclics |
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Term
| Name the tertiary amine tricyclics? |
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Definition
| amitryptyline, clomipramine, doxepin, imipramine, trimipramine |
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Term
| What are the effects of increased serotonin? |
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Definition
| decrease appetite, decrease libido, increase mood, increase sedation |
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Term
| What are some side effects of TCAs? |
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Definition
| decrease appetite, increase sedation, decrease libido, orthostatic hypotension, anti-SLUDE |
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Term
| Patient's complaining of "sleepy all day but can't sleep at night" might be taking what kind of drug? |
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Definition
| one that messes with their serotonin stores like TCAs |
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Term
| What're the general differences between tertiary vs. secondary amines? |
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Definition
tertiary= NE and 5HT transporter affected, failrly long acting;
secondary= predominantly NE that is a little bit shorter acting |
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Term
| For a depressed person who has hypersomnia, what kind of TCA should you perscribe them? |
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Definition
| probably secondary amines because they work predominantly on NE not 5HT |
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Term
| TCAs are antagonists of histamine receptors which means that one of the side effects is... |
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Definition
|
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Term
| What tertiary amine tricyclics can be given IM? |
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Definition
| amitryptyline, imipramine |
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|
Term
| Which tertiary amine TCA is usually given for OCD? |
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Definition
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Term
| Name an adverse effect of clomipramine. |
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Definition
|
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Term
| What are the distinguishing characteristics of doxepin compared to other tertiary amines? |
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Definition
| increased sedation but absence of cardiovascular side effects |
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Term
| How is imipramine administered? |
|
Definition
| IM or pamoate formulations |
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Term
| What characteristics are specific to trimipramine? |
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Definition
| very sedating and moderately anticholinergic |
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|
Term
| Name the secondary amine tricyclics? |
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Definition
| amoxapine, desipramine, maprotiline, nortryptyline, protryptyline |
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Term
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Definition
| a secondary amine tricyclic= a dibenzodiazepine that is a metabolite of the antipsychotic loxapine; therefore it has a dopaminergic as well as adrenergic component |
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Term
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Definition
| secondary amine tricyclic that is a naturally occuring metabolite of imipramine |
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Term
|
Definition
| secondary amine tricyclic that is very new and has increased potential for seizures |
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Term
|
Definition
| a secondary amine tricyclic that is a metabolite of amitryptyline and indicated for elderly patients |
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Term
| What secondary amine trycyclic lacks sedative properties and is therefore indicated for "sleepy" depressives? |
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Definition
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Term
| What are the most effective agents in the treatment of premenstrualdysphoric disorder? |
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Definition
| citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline |
|
|
Term
| Name an SSRI approved for adolescents? |
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Definition
|
|
Term
| Which SSRIs are notable for their long half lives? |
|
Definition
fluoxetine = 72 hours
sertraline= 36 hours |
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|
Term
| Which SSRI has been recently approved for social phobia? |
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Definition
|
|
Term
| Which SSRI has anticholinergic side effects? |
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Definition
|
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Term
| What are the advantages to using a SNRI over a TCA? |
|
Definition
| SNRIs have fewer antimuscarinic effects |
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|
Term
| Besides depression, SNRIs also treat _____. |
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Definition
|
|
Term
| What kind of depression are SNRIs good for treating? |
|
Definition
| those with hypersomnia as a symptom |
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Term
| Which SNRIs are FDA approved for treating fibromyalgia? |
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Definition
|
|
Term
| What type of compound is venlafaxine? |
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Definition
|
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Term
| Which SNRI has been shown to produce withdrawal following chronic treatment and rebound effect? |
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Definition
|
|
Term
|
Definition
| duloxetine, venlafaxine, milnacipran |
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Term
| Name some atypical antidepressants? |
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Definition
| bupropion, nefazodone, mirtazapine, reboxetine, trazadone |
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Term
| What antidepressant is approved to help with smoking cessation? |
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Definition
|
|
Term
| What is the MOA of bupropion? |
|
Definition
| block reuptake of dopamine and possibly norepinephrine |
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Term
| What atypical antidepressant is notable for the increased risk of seizures? |
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Definition
|
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Term
| What antidepressant rarely can cause a life-threatening liver failure? |
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Definition
|
|
Term
| What is the MOA of nefazodone? |
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Definition
|
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Term
| What antidepressant has no sexual side effects? |
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Definition
|
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Term
| What are the side effects of mirtazapine? |
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Definition
| sedation is the most prominent side effect because this drug blocks histamine receptors |
|
|
Term
| What is the MOA of mirtazapine? |
|
Definition
| blocks 5-HT2A receptors, alpha-1 receptors and alpha-2 autoreceptors centrally, and histamine receptors |
|
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Term
| What are the side effects of trazadone? |
|
Definition
| virtual absence of cardiac and anticholinergic side effects owing to its prominent serotonergic properties; priapism has been reported |
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Term
|
Definition
|
|
Term
| What is the MOA of MAOIs? |
|
Definition
| inactivate monoamine oxidase which metabolizes norepinephrine and serotonin |
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Term
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Definition
| isocarbaxazid, phenelzine, tranylcypromine |
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Term
| Of the adverse effects that can occur from taking antidepressants, _____ is the largest initial problem. |
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Definition
|
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Term
| Besides sedation, what other types of side effects do antidepressants have? |
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Definition
| cardiovascular effects, seizures, blood abnormalities |
|
|
Term
| What are the cardiovascular effects of antidepressants? |
|
Definition
| orthostatic hypotension which can lead to tachycardia; antimuscarinic effects at the sinoatrial node that can unmask sympathetic influences |
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|
Term
| T/F Many antidepressants lower the seizure threshold. |
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Definition
|
|
Term
| What types of blood abnormalities can be caused by antidepressants? |
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Definition
| although agranulocytosis is rare, these drugs can cause bone marrow depression, thrombocytopenia, or eosinophilia |
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|
Term
| What are teh drug interactions associated with antidepressants? |
|
Definition
| antidepressants should not be given with other CNS depressants, any antimuscarinic agent, or an MAOI; should not be given with indirect-acting or mixed-acting sympathomimetics; tamoxifen should not be given with certain SSRIs |
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|
Term
| Antidepressants can have drug interaction with indirect-acting sympathomimetics such as... |
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Definition
|
|
Term
| Antidepressants can have interactions with mixed-acting sympathomimetics like... |
|
Definition
| psuedoephedrine and phenylpropanolamine (often found OTC) |
|
|
Term
| Why might an SSRI be given to a patient on tamoxifen? |
|
Definition
| to treat depression and to decrease hot flashes |
|
|
Term
| What is the interaction between tamoxifen and SSRIs? |
|
Definition
| tamoxifen must be metabolized by CYP2D6 in order to become pharmacologically active and the SSRIs fluoxetine, paroxetine, and sertraline inhibit CYP2D6 |
|
|
Term
| If you need to use an SSRI for a women taking tamoxifen, what should you use? |
|
Definition
| citalopram and escitalopram because they are only weak inhibitors of CYP2D6 |
|
|
Term
| How is lithium administered? |
|
Definition
|
|
Term
| What is the t1/2 of lithium? |
|
Definition
| 24 hours, considered long-acting |
|
|
Term
| How is lithium metabolized and excreted? |
|
Definition
| excreted 95% unchanged in urine; does not bind to plasma proteins; excreted in human milk so women on lithium should not breast feed |
|
|
Term
| What percent of lithium is bound to plasma proteins? |
|
Definition
|
|
Term
| Lithium is ineffective in approximately ___% of the patients who take it. |
|
Definition
|
|
Term
| What is the MOA of lithium? |
|
Definition
| has not been firmly established, although we do know that it inhibits nerve metabolism, alters reuptake of serotonin, norepinephrine and dopamine, and decreases release; we also know that it decreases protein kinases in brain tissue such as PKC and directly affects neuronal inositol levels by directly inhibiting inositol monophophatase |
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|
Term
| T/F THe therapuetic dose of lithium is very near the toxic dose. |
|
Definition
| true; side effects frequently cause a problem with compliance |
|
|
Term
| What are the side effects of lithium? |
|
Definition
| GI (nausea/diarrhea), drowsiness, polyuria, dry mouth and thirst, acquired nephrogenic diabetes, weight gain, insomnia, enlarged thyroid, neutrophilia |
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|
Term
| GI problems caused by lithium can be an indication of... |
|
Definition
| toxicity or simple peak absorption |
|
|
Term
| Why does Li+ cause polyuria? |
|
Definition
| 80% of filtered Li+ is reabsorbed by the proximal renal tubules |
|
|
Term
| What effect does lithium have on teh thyroid gland? |
|
Definition
| benign, diffuse, nontender thyroid enlargement suggestive of thyroid dysfunction; however, most patients remain euthyroid and over hypothyroidism is rare. In patients who develop goiter, discontinuation of Li+ or treatment with thyroid hormone results in shrinkage of the gland |
|
|
Term
| Describe the neutrophilia associated with lithium treatment= |
|
Definition
| a benign, sustained increase in circulating polymorphonuclear leukocytes occurs during chronic treatment and is reversed within a week of terminating treatment |
|
|
Term
| What are the symptoms of acute lithium intoxication? |
|
Definition
| vomiting, profuse diarrhea, coarse tremor ataxia, coma, convulsions (in non-epileptic patients at therapeutic doses) |
|
|
Term
| What is lamotrigine used for? |
|
Definition
| first drug given FDA approval for long-term prophylactic treatment of bipolar disorder without an indication of acute mania; it is particularly effective against bipolar depression with minimal risk of inducing mania |
|
|
Term
| What are the drug interactions associated with lithium? |
|
Definition
|
|
Term
| How does tyramine interact with MAOIs? |
|
Definition
| tyramine releases stored pools of neurotransmitters leading to a hypertensive crisis |
|
|
Term
| How does lithium interact with diuretics? |
|
Definition
| diuretics seem to be the most problematic interaction because most diuretics will increase sodium excretion and indirectly decrease lithium excretion. This, in turn, leads to increased or toxic levels of lithium. Increased excretion with osmotic diuretics and acetazolamide, decreased excretion with the thiazides and other diuretics that deplete sodium |
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|
Term
| How do NSAIDS interact with lithium? |
|
Definition
| indomethacin, naproxen and ibuprofen may diminish clearance and increase reabsorption of lithium leading to toxicity |
|
|
Term
| Besides lithium, what other drugs can be perscribed for bipolar d/o? |
|
Definition
| lamotrigine, valproic acid (long term prophylaxis of bipolar patients), and carbamazepine (sometimes used for treatment resistant bipolar disorder and remains under investigation) |
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