8196700
Description
Flashcards by Victoria Wright, updated more than 1 year ago
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Created by Victoria Wright
about 7 years ago
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| Question | Answer |
| What is the Amine Hypothesis? | Abnormally low levels of norepinephrine and/or serotonin underlie depression |
| The following is the definition of what? Abnormally low levels of norepinephrine and/or serotonin underlie depression | Amine Hypothesis |
| What 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. |
| What 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 |
| What 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 |
| What is the Neuroendocrine Hypothesis? | Depression is associated with elevated cortisol levels HPA axis is dysregulated Abnormal (low) thyroid function is common in depression |
| Which drugs are Serotonin Selective Reuptake Inhibitors (SSRIs)? | Fluoxetine, paroxetine, sertraline, citalopram, escitalopram |
| What are the antidepressant drug classes? | SSRI, SNRI, TCA, MAO-I, Atypical |
| What is the antidepressant drug class of the following? Amitriptyline | TCA |
| What is the antidepressant drug class of the following? Clomipramine | TCA |
| What is the antidepressant drug class of the following? Imipramine | TCA |
| What is the antidepressant drug class of the following? Phenylzine | MAO-I |
| What is the antidepressant drug class of the following? Tranylcypromine | MAO-I |
| What is the antidepressant drug class of the following? Selegiline | MAO-I Used for Parkinson’s Disease, rarely for depression |
| What is the antidepressant drug class of the following? Fluoxetine | SSRI |
| What is the antidepressant drug class of the following? Paroxetine | SSRI |
| What is the antidepressant drug class of the following? Sertraline | SSRI |
| What is the antidepressant drug class of the following? Citalopram | SSRI |
| What is the antidepressant drug class of the following? Escitalopram | SSRI |
| What is the antidepressant drug class of the following? Venlafaxine | SNRI |
| What is the antidepressant drug class of the following? Duloxetine | SNRI |
| What is the antidepressant drug class of the following? Trazodone | Atypical |
| What is the antidepressant drug class of the following? Mirtazapine | Atypical |
| What is the antidepressant drug class of the following? Bupropion | Atypical |
| What is the antidepressant drug class of the following? Desvenlafaxine | SNRI |
| What 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 |
| What 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 depression | Neurotrophin Hypothesis |
| Why do none of the depression hypotheses provide the full answer? | Patients have different neurochemistry, life history, genetics, etc. |
| Inhibition of serotonin transporter (SERT) is the mechanism of action for which antidepressant drug class? | Serotonin Selective Reuptake Inhibitors (SSRIs) |
| What is the mechanism of action of Serotonin Selective Reuptake Inhibitors (SSRIs)? | Inhibition of serotonin transporter (SERT) |
| Which antidepressant drug class is first line in treating depression? | SSRIs with SNRIs |
| Which SSRI(s) is approved for children? | Fluoxetine |
| Which SSRI(s) is approved in adolescents? | Fluoxetine and Escitalopram |
| Which antidepressant drug class (and which drugs) are used for the following? Depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimia | SSRI (Fluoxetine, paroxetine, sertraline, citalopram, escitalopram) |
| What are the SSRIs used for? | Depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimia |
| Which SSRIs are potent inhibitors of CYP 2D6? - Interactions with tamoxifen and other CYP 2D6 substrates | Fluoxetine and paroxetine |
| Which SSRI does the following apply to? Long half life of active metabolite; risk of serotonin syndrome if switching to MAOI | Fluoxetine |
| Which antidepressant drug class has high selectivity for SERT (serotonin transporter)? | SSRIs |
| Which antidepressant drug class has a high therapeutic index? | SSRIs |
| What 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 |
| Which SSRI is Category D? Risk of heart defects with first trimester exposure | Paroxetine |
| True or False Discontinuation syndrome is an adverse effect of SSRIs and SNRIs | True (anxiety, irritability, confusion, crying) SSRI: Especially paroxetine SNRI: Are common with Venlafaxine and desvenlafaxine |
| True or False Significant weight loss is an adverse effect of SSRIs. | False There is significant weight gain in some patients |
| Which drugs are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)? | Venlafaxine, desvenlafaxine, duloxetine |
| Which antidepressant drug class have high selectivity for SERT and NET (norepinephrine transporter)? | Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) |
| Which 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 |
| Venlafaxine is metabolized to what by CYP 2D6? | Desvenlafaxine Venlafaxine is metabolized to Desvenlafaxine by CYP 2D6 |
| What are the uses of SNRIs? | Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause |
| What 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 |
| Discontinuation syndrome is an adverse effect of which antidepressants? | SSRI: Especially paroxetine SNRI: Are common with Venlafaxine and desvenlafaxine |
| The 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 |
| Which drugs are Tricyclic antidepressants (TCAs)? | Amitriptyline, imipramine, chlomipramine |
| The following applies to which antidepressant drug class? Dominant class of antidepressants until ~ 1990s when SSRIs took over | Tricyclic antidepressants (TCAs) |
| What is used in depression that is unresponsive to SSRIs and SNRIs? | Tricyclic antidepressants (TCAs) |
| What are Tricyclic antidepressants (TCAs) used for? | Used in depression that is unresponsive to SSRIs and SNRIs Used in neuropathic pain, enuresis |
| As 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 |
| The following applies to which antidepressant drug class? Narrow therapeutic index and bothersome side effects explain reduced use | Tricyclic antidepressants (TCAs) Efficacy is similar to SSRIs, SNRIs |
| When are Tricyclic antidepressants (TCAs) taken? | Sedating – taken at bedtime |
| The following applies to which antidepressant drug class? Metabolized by CYP 2D6, serum levels are affected by inhibitors (e.g. fluoxetine) | Tricyclic antidepressants (TCAs) |
| The following applies to which antidepressant drug class? Potentially lethal in overdose | Tricyclic antidepressants (TCAs) and Monoamine oxidase inhibitors |
| What 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 |
| What are the drug interactions of TCAs? | CNS depressants, e.g. antihistamines, alcohol, benzodiazepines |
| The following are drug interactions for which antidepressant drug class? CNS depressants, e.g. antihistamines, alcohol, benzodiazepines | TCAs |
| The following applies to which antidepressant? Antagonist for 5-HT2A receptor | Trazodone |
| The following applies to what antidepressant? Used for depression and anxiety Seldom used as monotherapy Adjunct with SSRI for patients with insomnia | Trazodone |
| What 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 |
| The following applies to which antidepressant? Used as a hypnotic – highly sedating and not associated with tolerance or dependence | Trazodone |
| If Trazodone is used as a hypnotic, how many times a day should it be taken? | One a day |
| The following applies to which antidepressant? Rapid metabolism requires multiple doses per day | Trazodone |
| What are the adverse effects of Trazodone? | Sedation GI α1-antagonism: orthostatic hypotension Has been associated with priapism |
| The following are the adverse effects of which antidepressant? Sedation GI α1-antagonism: orthostatic hypotension Has been associated with priapism | Trazodone |
| The following applies to which antidepressant? Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine | Bupropion |
| What is the mechanism of action of Bupropion? | Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine |
| What is the mechanism of action of Trazodone? | Antagonist for 5-HT2A receptor |
| The following applies to what antidepressant? Not used for anxiety Not sedating Not associated with sexual side effects, bleeding or weight gain | Bupropion |
| The following are the adverse effects of what antidepressant? Agitation, anxiety, headache, insomnia, nausea, anorexia Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders | Bupropion |
| What is the pharmacology of Mirtazapine? | Complex pharmacology; antagonist at adrenergic α2 and 5-HT2 receptor; also H1 antagonist (sedative effects, weight gain) |
| The following applies to what antidepressant? Complex pharmacology; antagonist at adrenergic α2 and 5-HT2 receptor; also H1 antagonist (sedative effects, weight gain) | Mirtazapine |
| The 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 anorexia | Mirtazapine |
| True or False Mirtazapine is useful for depression with insomnias. | True Sedating – useful for depression with insomnias |
| True or False Mirtazapine may be useful for depression plus anorexia. | True Appetite stimulating – may be useful in depression plus anorexia |
| Mirtazapine 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 |
| The following are the adverse effects of what antidepressant? Weight gain, dry mouth, constipation | Mirtazapine |
| What are the adverse effects of Mirtazapine? | Weight gain, dry mouth, constipation |
| What are the drug-drug interactions of Mirtazapine? | Drug interactions with alcohol, benzodiazepines (increased sedative effects) |
| The following are the drug-drug interactions of what antidepressant? Drug interactions with alcohol, benzodiazepines (increased sedative effects) | Mirtazapine |
| What drugs are Monoamine oxidase inhibitors (MAOI)? | Phenylzine, tranylcypromine |
| What 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 dopamine | Monoamine oxidase inhibitors (MAOI) |
| True or False Monoamine oxidase inhibitors (MAOI) lead to irreversible inhibition of MAO-A and MAO-B | True Irreversible inhibition of MAO-A and MAO-B; long duration of effect MAO-A: metabolizes NE, 5-HT and dopamine MAO-B: metabolizes dopamine |
| True or False MAO-A: metabolizes dopamine MAO-B: metabolizes NE, 5-HT and dopamine | False (Reverse) MAO-A: metabolizes NE, 5-HT and dopamine MAO-B: metabolizes dopamine |
| What class of antidepressant drugs are used in treatment resistant depression? | Monoamine oxidase inhibitors (MAOI) |
| What are Monoamine oxidase inhibitors (MAOI) used for? | Used in treatment resistant depression |
| The 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 syndrome | Monoamine oxidase inhibitors (MAOI) |
| What are the adverse effects of Monoamine oxidase inhibitors (MAOI)? | Potentially lethal in overdose (autonomic, cardiac, seizures) Orthostatic hypotension, weight gain Insomnia, restlessness Discontinuation syndrome |
| What 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 |
| What foods should be avoided with Monoamine oxidase inhibitors? | Avoid foods such as aged cheese, cured meats, soy products, beer, pseudoephedrine |
| What classes of antidepressants are approved for PTSD, OCD, social anxiety, GAD and panic disorder? | SSRIs and SNRIs Slower onset of benefit than benzodiazepines |
| Therapeutic use of antidepressants requires how many months for benefit? | 1-2 months |
| How 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 |
| What are the therapeutic uses of antidepressants for pain? | Effects on pain are independent of antidepressant effects TCAs, SNRIs are more effective than others |
| Which antidepressants are approved therapies for Premenstrual Dysphoric Disorder? | Fluoxetine and Sertraline |
| Which antidepressant is as effective as nicotine patches for Smoking Cessation? | Bupropion |
| True or False Antidepressants have more success helping anorexia than bulimia. | False More success with bulimia than anorexia Mirtazapine stimulates appetite and used in anorexia |
| Most antidepressants have sexual side effects. Which do not? | Bupropion, Mirtazapine |
| Which class of antidepressant can help with premature ejaculation? | SSRIs |
| Which class of antidepressant can help with “hot flashes”? | SSRIs and SNRIs show benefit |
| What 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 |
| St. John’s wart can cause serotonin syndrome in the presence of what? | SSRI or MAOI |
| How 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 |
| True or False At the population level, efficacy is similar for all antidepressant drugs. | True |
| Another 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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