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Pharm II
Antidepressants
111
Pharmacology
Graduate
09/06/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
occurs in response to grief, illness, loss
Definition

reactive (secondary) depression

60%

Term
treatment for reactive (secondary) depression
Definition
psychotherapy or acute therapeutics
Term
Genetic - inability to experience ordinary pleasure, cope with daily life
Definition

major (endogenous) depression

25%

Term
treatment for major (endogenous) depression
Definition
antidepressants or ECT
Term
characterized by cyclic periods of mania
Definition

bipolar disorders (manic-depressive)

10-15%

Term
bipolar disorders are treated with
Definition
lithium in combo w/ antidepressants and/or antipsychotic agents
Term
Feelings of sadness, hopelessness, despair, and inability to experience pleasure in daily activities
Definition
depression
Term
depression is due to a deficiency of NE and serotonin in key sites in the brain (monamines)
Definition
biogenic amine theory for depression
Term
ethusiasm, rapid though and speech, extreme self-confidence and impaired judgement
Definition
mania symptoms
Term
mania is caused by an overproduction of NE, dopamine, and serotonin
Definition
biogenic amine theory for mania
Term
Most common psychiatric disorder in adults
Definition
major depression
Term
13-20% of the population have symptoms
Definition

major depression

males - 5-12% lifetime prevalence

females - 9-26% lifetime prevalence

Term
onset for major depression is most common in..
Definition
late 20s but this varies widely
Term
comparable incidence between older adults and the general population
Definition
major depression
Term
symptoms of depression
Definition

lost interest (anhedonia)

sleep disturbance

appetite changes

depressed mood (dysthymia)

concentration problems

activity diminished

guilt

energy diminished

suicidal ideation

Term
Manic symptoms are thought to be due to..
Definition
neurotransmitter overactivity
Term
Manic symptoms
Definition

inflated self esteem/grandiosity

irritability

pressured speech

distractibility

impaired judgement

psychomotor agitation

Term
mild to moderate depression psychotherapy is comparable to...
Definition
pharmacologic intervention
Term
Recommended for treatment resistant depression, vegetative depression, and psychotic depression
Definition
electroconvulsive therapy
Term
unlike drugs this shows a therapeutic response within 1-2 weeks
Definition
electroconvulsive therapy
Term
classes of drugs for treatment of depression
Definition

TCA's

SSRI

SNRI

Atypical antidepressants

MAOI

antimanics

Term
all potentiate, either directly or indirectly, NE, 5HT
Definition
classes of drugs for treatment of depression
Term
Drugs used to treat depression are all...
Definition
equally effective with about a 50-70% response rate
Term
first generation TCA's
Definition

ADDIN

amitriptyline

desipramine

doxepin

imipramine

nortriptyline

Term
second generation TCA's
Definition

amoxapine

maprotiline 

Term
Could be considered third generation TCA's
Definition
SSRI
Term

block the reuptake of NE and serotonin in the presynpatic neurons

block alpha adrenergic, histamine & muscarinic receptors

Definition
TCA's
Term
actions of TCA's
Definition

elevate mood

improve mental alertness

increase physical activity

reduce morbid preoccupation

Term
therapeutic uses for TCA's
Definition

moderate to severe depression

some panic disorders

Term
What is used to treat bed wetting (enuresis)
Definition

not until the child is older than 6

imipramine (its a TCA)

Term
onset of TCA's
Definition
2-4 weeks
Term
Pharmacokinetics of TCA's
Definition

oral but inconsistent bioavailability- dosage adjustment required

lipophilic -MEOS & glucuronidated in liver

Term
Weight gain, antihistaminic, anticholinergic, block alpha receptors, cardiovascular
Definition
side effects of TCA's
Term
Antihistaminic effect of TCAs
Definition
sedation
Term
dry mouth (xerostomia), urinary retention, constipation, blurred vision, glaucoma
Definition
anticholinergic side effects of TCA
Term
orthostatic hypotension, reflex tachycardia
Definition

block alpha receptors

side effects of TCA

Term
fatal arrhythmias
Definition
cardiovascular effects of TCA's
Term
Cautions/warnings of TCA's
Definition

narrow therapeutic index

manic-depressive patients

suicidal patients

Term

drug interactions of TCA's

 

Definition
ethanol and other CNS depressants - toxic depression
Term
SSRI's
Definition

celexa

lexapro

prozac, sarafem

luvox

paxil

zoloft

Term
selective inhibition of serotonin reuptake
Definition
MOA of SSRI's
Term

fewer anticholinergic (muscarinic) effects

less cardiotoxicty

less weight gain

no orthostatic hypotension

Definition
SSRI's
Term
SSRI clinical use
Definition

major depression

OCD 

bulimia/anorexia nervosa

panic disorder

premenstrual dysphoric disorder (PMS)

postmenopausal syndrome

generalized anxiety???

Term
which SSRI is used to treat OCD
Definition
luvox
Term
what is the point of slide 18??
Definition
Term
pharmacokinetics of SSRI's
Definition

takes 2-4 weeks to see effect

slowly cleared from body

steady state achieved after several weeks

Term
t 1/2 of SSRI's
Definition
16-32 hours
Term
fluoxetine has an extra half life
Definition

50 hours

because of norfluoxetine active metabolite (t1/2 =10 days)

Term
drug interactions of SSRI's
Definition

potent inhibitors of P 450 (CYP2D6) 

7% caucasian population lack this isoenzyme

Term

nausea

sleep disturbances

sexual dysfunction

GI, anorexia

weight loss

children/teenagers --> suicidal ideation

hallucinations

Definition
adverse reactions of SSRI's
Term
Sexual dysfunction associated with SSRI's
Definition

loss of libido

delayed ejaculation

anorgasmia

incidence is 30-50% more common males

Term
If a depressed person cannot sleep you should give them..
Definition
prozac
Term
if a depressed person has insomnia you should give them
Definition
fluoxetine
Term
Read slide 21
Definition
Term
SNRI's
Definition

Pristiq

Effexor

Cymbalta

Term

Safer than TCA's in overdoses

unique mechanism of action, used when SSRI's have failed

not as activating as fluoxetine

Definition
SNRI's
Term

Depression associated w/ neuropathic pain

(backache & muscle ache)

Definition
SNRI's
Term

Unlike TCA's 

no adrenergic, muscarinic, histaminergic receptor blockade

fewer adverse effects

Definition
SNRI
Term
Nausea, headache, dry mouth, somnolence, sexual dysfunction
Definition
SNRI adverse effects
Term
Atypical antidepressants
Definition

buproprion (wellbutrin)

mirtazapine (Remeron)

trazodone

nefazodone

Term

Weak NE/DA reuptake inhibitor

no anticholinergic/antihistamine/alpha blockade

Definition
wellbutrin
Term
______ has a low incidence of sexual dysfunction therfore alternative for SSRI's
Definition
wellbutrin
Term
has been used in "SR" form for smoking cessation
Definition
wellbutrin
Term
xerostomia, sweating, nervousness, tremor, lowers seizure threshold
Definition
wellbutrin
Term

alpha 2 antagonist

serotonin receptor antagonist

increases 5HT and NE neurotransmission

Definition
Remeron
Term
antihistamine (H1) =
Definition
sedation
Term

increased appetite, weight gain

no anticholinergic

little sexual dysfunction

minimal drug-drug interactions

Definition
remeron
Term

5HT2A antagonists

weak 5HT reuptake inhibitors

Definition
trazadone and nefazodone
Term
desensitizes 5HT1A presynaptic receptors =
Definition
increase 5HT release
Term
low incidence of sexual dysfunction but with trazadone may see..
Definition
priapism
Term
fewer anticholinergic side effects than TCA's
Definition
trazadone and nefazodone
Term

hepatotoxicity

pulled in Canada and USA 

only generics remain available

Definition
serzone
Term
MAOI
Definition

nardil

parnate

marplan

 

Term
only inhibits MAO- B so only for dopamine
Definition
selegiline
Term

inhibit monoamine oxidase

increase stores of intraneuronal NE, dopamine, & serotonin

Definition
MOAI
Term
food-drug interactions are seen with?
Definition

MAOI

inhibition of MAO in the GI tract = increased tyramine

Term
Tyramine will release stored EPI/NE causing...
Definition

hypertension

tachycardia

nausea

arrhythmias

stroke

hypertensive crisis induced by MAOI's med emergency

Term

only used today in patients refractory or hypersensitive to other antidepressants

strong anxiety, phobic states

Definition
MAOI
Term

labile mood

rejection sensitivity

appetite disorders

Definition
atypical depression
Term
drowsiness, orthostatic hypotension, blurred vision, xerostomia, constipation/urinary retention
Definition
adverse effecs of MAOI
Term
adverse effects of tyramine
Definition
headache, hypertension, stroke
Term
dietary restriction of MAOI
Definition

avoid use w/ aged cheeses, wine, beer, organ meats, sausage, seafood, avocados

this limits therapy

Term
the full effects of these drugs is delayed several weeks
Definition
MAOI
Term

the effects are also continued several weeks after discontued

need to wait @ least 2 weeks after d/c to start new drug

Definition
MAOI
Term

Do not use with SSRI's (wait 6 weeks)

could cause serotonin syndrome

Definition
MAOI
Term
potentially fatal interaction cause by the combination of 2 or more drugs that enhance serotonin transmission
Definition
serotonin syndrome
Term

anxiety, shivering, tremor, diaphoresis

death has been attributed to malignant hyperthermia

Definition
serotonin syndrome symptoms
Term
If someone has a mild case of serotonin syndrome then you should......
Definition
discontinue serotonergic antagonists and symptoms should resolve in 1-2 days
Term
If someone is having a severe serotonin syndrome reaction then....
Definition
serotonergic antagonists such as methysergide and propranolol have been used
Term
most cases of serotonin syndrome are due to..
Definition
MAOI and SSRI's
Term
other problem combinations that cause serotonin syndrome include
Definition
meperidine, TCA, dextromethorphan, lithium, triptans, and St. John's wort
Term
chart on slide 33 and 34
Definition
Term
drug selection in depression is based on
Definition

patient history

safety in overdose

adverse effects

patients age

ease of admin

possible interactions

Term
drug specific  adverse effects to consider when selecting a drug for depression
Definition

TCA's are more sedating than SSRI

TCA's cause more anti-cholinergic side effects

Term
patient specific things to consider when considering drug selection in depression
Definition

TCA's can cause weight gain so avoid in obese pt's

wellbutrin will lower seizure threshold so avoid in epilepsy

best not to use antidepressants during pregnancy

Term

considered the most deadly psychiatric illness due to the suicide rate in patients

10-15% suicide rate if left untreated

Definition
bipolar disorder
Term
Both characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood
Definition
manic and hypomanic epidodes
Term
ethusiasm, rapid thought and speech, extreme self confidence
Definition
manic and hypomanic episodes
Term
the difference between manic and hypomanic is that manic episodes are...
Definition

severe enough to impair functioning

(self-care, work, or social functioning)

Term

used in the treatment of manic-depressive illnesses

standard of therapy for decades (60-80% effective)

Definition
lithium salts
Term

preventitive for manic/depressive symptoms

not used for acute mania as delayed drug effect

Definition
lithium salts
Term

MOA : unknown, may work by altering the cellular concentration of inositol triphosphate 

(2nd messenger)

Definition
lithium salts
Term
onset of lithium salts
Definition
1-2 weeks
Term
may be necessary to use benzodiazepines (clonazepam) or antipsychotics until onset
Definition
lithium salts
Term
Lithium salts are a toxic drug with..
Definition

a narrow therapeutic index

requires monitoring

Term
This drug is a potential teratogen
Definition
lithium salt
Term
Adverse effects - tremors, weight gain, confusion, convulsions
Definition
lithium salts
Term
Many _______ will increase lithium due to an enhanced reabsorption of sodium and lithium secondary to inhibition of prostaglandin therapy
Definition
NSAIDS
Term
New treatment for bipolar disorder
Definition

pyrexia + prozac

atypical antipsychotic + SSRI antidepressant

combo of pyrexia + prozac = symbyax

Anticonvulsants : mood stabilizers

Term
anticonvulsants
Definition

carbamazepine (tegretol)

valproic acid (Depakote)

Lamictal

Term
5HT receptor antagonist
Definition
pyrexia
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