Flashcards in Somatic Therapies Deck (78):
Why do antidepressants take a long time to work?
Need to increase receptors, and gene transcription
What is the MOA of imipramine? Use?
What is the MOA of bupropion?
NE and dopamine reuptake inhibitor
What is the MOA of venlafaxine?
What is the MOA of desvenlafaxine?
What is the MOA of duloxetine?
What is the MOA of levomilnacipran?
What are the two TCAs that are used to treat pain?
What is the only SSRI that is not approved for use in MDD? What is it used for?
Which SSRI is used for bulimia?
Which SSRIs are used to treat GAD?
True or false: structurally, the SSRIs are structurally similar
What is the major side effect of bupropion?
Lowers seizure threshold
SSRIs are metabolized through what organ?
Which of the SSRIs have long lasting, active metabolites? (2)
What are the side effects of SSRIs?
-Weight gain or loss
-mild GI symptoms
What is the treatment for serotonin syndrome?
What is the effect of SSRIs and the p450 system?
Metabolized by it--cause drug interactions
What is the age range that SSRIs can cause increased suicidality?
up to 24
True or false: there is no evidence that there is an increased in actual suicide with antidepressants, just thoughts
What are the s/sx of serotonin syndrome?
True or false: SNRIs inhibit both NE and 5HT in equal amounts
What is the SNRI that has been approved for MDD, GAD, panic DO, SAD, pain syndrome?
What is the effect of venlafaxine at higher and lower doses?
Lower = 5HT reuptake inhibition
Higher = NE and dopamine
What is the effect of venlafaxine an p450 enzymes?
Does not use the p450 system
What is the major downside of venlafaxine withdrawal?
What is the MOA of levomilnacipran?
What is the role of bupropion in the treatment for anxiety disorders?
Why is it that bupropion may test positive for amphetamine use?
What is the effect of bupropion on sexual function?
What is the factor that determines the risk of bupropion on seizure threshold?
Plasma levels--even transiently
What is the MOA of vilazodone?
SSRI and 5HT1A partial agonist, to enhance serotonergic activity
What is the MOA of vortioxetine?
Lots of 5HT modulation and reuptake inhibition
What is the MOA of trazodone? Use?
Weak inhibitor of serotonin, but also blocks 5HT2 receptors
What is the risk for addiction of trazodone?
Low to none
What is the MOA and use of nefazodone? Major side effect
-Weak inhibition of neuronal 5HT
What is the MOA of mirtazapine? Use?
Potent antagonist at post synaptic 5HT2 and 5HT3 receptors
used as a sleep aid
What are the side effects of mirtazapine?
-minimal p450 interaction
Which of the TCAs can treat OCD?
What is the major side effect of clozapine?
What is the general MOA of TCAs?
Blocks reuptake of NE, and 5HT
What are the adverse effects of TCAs?
What organ metabolizes TCAs?
What is the interaction between p450 enzymes and TCAs?
TCAs metabolized by them, so anything that inhibits them will increase blood TCA levels
What is the use of obtaining blood levels of TCAs? (2)
-Ensure no cardiac issues
What are the major side effects of TCA?
-sedation and weight gain (antihistamine effect)
What are the alpha adrenergic effects of TCAs?
Are TCAs safe in prego?
What are the cardiovascular effects of TCAs?
What is the dose range for amitriptyline for pain control, as compared to antidepressant effects?
Much smaller for pain control
What is the general MOA of MAOIs?
blocks enzyme that degrades neurotransmitters.
Increased 5HT, NE, dopamine
Draw out the dopamine pathway
True or false: MAOIs do not have active metabolites
What are the three major MAOIs?
What are the side effects of MAOIs?
What are the high tyramine foods? (6)
What is the major issue with MAOIs and tyramine?
Hypertensive crises and strokes
What is the major use of selegiline?
MAO-A inhibitor for PD
What is the major benefit of transdermal selegiline?
No tyramine dietary restrictions
What is the usual timeframe in which antidepressants work?
within 6 weeks
True or false: bipolar depression does not respond well to antidepressants
What endocrine lab must be monitored with Li?
True or false: In general, the less severe the depression, the less response to antidepressants
True or false: secondary MDD respond better than primary with antidepressants
What is the difference between remission and response?
Response = 50% better
Remission = 100% better
What is the only SSRI that is not given daily?
At what point should you switch drugs if not working?
What is the only SSRI that does not need to taper off of?
Who needs to start at lower doses of SSRIs?
Old or hepatically disabled
For unresponsiveness with SSRIs, what should always be done?
Reassess for other diseases
What are the pharmacological augmentation strategies?
Add second antidepressant with a different MOA:
What are the non-pharmacological augmentation strategies?
What is the MOA of buspirone? Use?
-serotonin 5-HT1A receptor partial agonist
What is the treatment duration for antidepressants?
stable for 6 months or 12 month for a complicated case
What happens to treatment time with increasing age?
Shorter treatment time needed
What are the major fetal effects on SSRIs?
What is the focus of SSRIs in pregnancy?
Maintaining health of the mother