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44 Cards in this Set
- Front
- Back
What are the risk factors for depression?
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- gender : more women
- age - 25-40 - Family history - postpartum - psychosocial stressors |
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What is the etiology of depression?
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- genetic factors
- personality and enviromental factors - biochemical abnormalities |
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Reasons for choosing an antidepressant...
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- anticipate adverse effects
- presence of comorbid medical or psychiatric conditions - history of prior response - patient preference - cost |
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How many weeks do antidepressants take to reach maximal therapuetic benefits?
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4-6 weeks
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What is the MOA of Tricyclic Antidepressants?
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TCAs block the reuptake pumps for serotonin and norepinephrine.
TCAs bind @ other sites which are not therapietic > extensive side effects. TCAs can cause conduction disturbances and ECG changes > QT prolonged and can lower seizure threshold profile overdose is fatal 2nd amines are more tolerable than tertiary amines |
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What is the MOA of Trazodone (Desyrel)?
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- weakens serotonin reuptake inhibitors and a 5HT2 receptor antagonist
- very safe in overdose - no anticholinergic and cardiovascular side effects |
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What are the SE of Trazodone?
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sedation
orthostatic hypotension priapism (rare) GI |
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What is the most common use of Trazodone?
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sedative/ hypnotic--- rarely used for antidepressant anymore
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What is the MOA of Monoamine Oxidase Inhibitors?
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inhibits the enzyme of monoamine oxidase
inhibits MAO A and B nonspecific and irreversible tyramine restricted diet |
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What are the Adverse Reactions to MAOIs?
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sedation
insomnia weight gain decreased or increased blood pressure |
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What is the presentation of MAOIs during a hypertensive crisis?
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nausea, vomiting, sweating, headache, stiff neck, chest pain, hpertension, palpitations
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When does an MAIO hypertensive crisis occur...
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usually develops 20 minutes - 1 hour after ingestion of the interacting food or drug > could lead to CVA or death
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What is the treatment of a MAIO hypertensive crisis?
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IV nicardipine
veraapamil fenoidopam phentolamine |
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Foods to avoid with MAIOs
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acocados, aged cheese, dried meats, soybean products, red wine, tap beers, sauerkraut, raw yeast, pods of broad beans, pickled herring, chicken livers
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What foods should be limited with MAIOs?
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caffiene, chocolate, figs, meat tenderizers, raisins
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MAIOs interact with what drugs?
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amphetamines, antidepressants, appetite suppressants, asthma inhalers, buspirone, carbamazepine, decongestants, dextromethorphan, dopamine, ephedrine, epinephrine, levodopa, methylphenidate, stimulants, sympathomimetics, triptans
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What is the MOA of Serotonin Reuptake Inhibitors?
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block serotonin reuptake pump
less SE than TCAs and safer w/overdose used for depression and anxiety |
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What are the AE of SSRIs
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GI
headache sexual dysfunction insomnia activation discontinuation syndrome |
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What is the presentaion of discontinuation syndrome?
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dizziness, nausea, vomiting, flulike symptoms, anxiety, irritabilty
solution - taper/ don't abruptly stop taking |
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What is serotonin syndrome?
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overactivation of central serotonin receptors
rare- SSRI and MAIO combo |
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What is the presentation of Serotonin syndrome?
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abdominal pain, diarrhea, sweating, fever, tachycardia, delirium, myocionus, irriability
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What is the TX of serotonin syndrome?
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discontinue suspected causative agents
provide support therapy for symptoms |
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How can you prevent serotonin syndrome?
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SSRIs > MAOIs 2 week washout
Fluoxetine > 5 week washout MAOI > SSRI 2 week washout |
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What is the MOA of Buproprion (Wellbutrin)?
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Norepinephrine and dopamine reuptake blockade
treatment of ADHD and smoking ( not labeled uses) increased seizures activity does not cause sexual dysfunction |
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What is the AE of Buproprion ?
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nausea
incomnia agitation. anxiety tremors not as safe with overdose as trazodone or SSRIs Cont > people with eating disorders |
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What is the MOA of Venlafaxine (Effexor)?
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inhibits the reuptake of serotonin and norepinephrine > similar to the TCAs
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What are the AE of Venlafaxine?
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risky in overdose > seizure risk
n/h insomnia, hypertension, nervousness, sexual dysfunction |
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What is the MOA of duloxetine (Cymbalta)?
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inhibits the reuptake of serotonin and norepinephrine
indicated for MDD and Diabetic perpheral neuropathic pain |
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What are the adverse effects of duloxetine ?
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n/ dry mouth
c/ sweating tachy hypertension |
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What is the MOA of nefazodone (serazone)?
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aan antagonist of the 5HT2 receptor and it also blocks reuptake of serotonin
well tolerated in overdose less side effects than SSRIs little sedation due to teh removal of antihistamine avtivity present in trazadone |
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What are the AE of Nefazodone?
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somnolence
dry mouth nausea dizziness |
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What is the BLACK BOX warning on Nefazodone?
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life threatening cases of hepatic failure have been reported
no pts with liver disease or elevated serum transaminases No pts w/ GI comp drugs should be discontinued with ALT or AST > 3 ULN Monitor for signs of anorexia or jaundice |
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What is the MOA of Mirtazapine (Remeron)?
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potent alpha 2 adrenergic auto and heteroreceptor antagonist
5HT2 and 5HT3 postsynaptic receptor antagonist SE are minimized decrease SE potent histamine blocking effect SO wt gain, increased appetite, and sedation |
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What are the future targets for drug development?
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NMDA receptors antagonist
GABA CRF1 antagonist NK1 antagonist Neurotrophic factors |
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Drug Interactions
Substrate |
drug metabolized by a particular enzyme
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Drug Interaction
Inhibitor |
drug that prevents a particular enzyme from metabolizing a substrate
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Drug Interaction
Inducer |
drug that speeds up the metabolism of a sustrate of a particular enzyme
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How do antidepressant drugs interact with CYP450 drugs?
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hepatocytes in the liver
involved in metabolism # of drug classes |
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Suicide risk
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SSRi
Avoid: TCAs and MAOIs |
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Weight Gain
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SSRIs and bupropion
Avoid: TCAs, mirtzapine, MAIOs |
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With antidepressants, what are special things to watch for with elderly?
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r/o dementia, delirium, and medication
SSRIs are 1st line (esp. citalopram & sertraline) AVOID TCAs due to anticholernergic rxn Start low and go slow |
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What drug do you use for Peds antidepressants?
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fluoxetine MDD
OCD- fluisetine, sertaline,& fluvooxamine |
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What drugs do use in pregnant women?
What is the possible side effect? |
SSRIs, desipramine, and nortriphyline
Paroxetine heart problems and pulmonary HTN |
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What about women and antidepressants with lactation?
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setraline- seems to produce lowest serum concentration
mothers should pump milk before talking the drug |