Somatic Therapies Flashcards Preview

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Flashcards in Somatic Therapies Deck (78):
1

Why do antidepressants take a long time to work?

Need to increase receptors, and gene transcription

2

What is the MOA of imipramine? Use?

TCA
Enuresis

3

What is the MOA of bupropion?

NE and dopamine reuptake inhibitor

4

What is the MOA of venlafaxine?

SNRI

5

What is the MOA of desvenlafaxine?

SNRI

6

What is the MOA of duloxetine?

SNRI

7

What is the MOA of levomilnacipran?

SNRI

8

What are the two TCAs that are used to treat pain?

Amitriptyline
Nortriptyline

9

What is the only SSRI that is not approved for use in MDD? What is it used for?

-Fluvoxamine
-OCD

10

Which SSRI is used for bulimia?

Fluoxetine

11

Which SSRIs are used to treat GAD?

Escitalopram
Paroxetine

12

True or false: structurally, the SSRIs are structurally similar

False

13

What is the major side effect of bupropion?

Lowers seizure threshold

14

SSRIs are metabolized through what organ?

Liver

15

Which of the SSRIs have long lasting, active metabolites? (2)

-Fluoxetine
-Sertraline

16

What are the side effects of SSRIs?

-Weight gain or loss
-Vivid dreams
-mild GI symptoms

17

What is the treatment for serotonin syndrome?

Cyproheptadine

18

What is the effect of SSRIs and the p450 system?

Metabolized by it--cause drug interactions

19

What is the age range that SSRIs can cause increased suicidality?

up to 24

20

True or false: there is no evidence that there is an increased in actual suicide with antidepressants, just thoughts

True

21

What are the s/sx of serotonin syndrome?

-Diaphoresis
-Mental confusion
-Flushing
-Hyperthermia
-Hypertonicity

22

True or false: SNRIs inhibit both NE and 5HT in equal amounts

True

23

What is the SNRI that has been approved for MDD, GAD, panic DO, SAD, pain syndrome?

Venlafaxine

24

What is the effect of venlafaxine at higher and lower doses?

Lower = 5HT reuptake inhibition

Higher = NE and dopamine

25

What is the effect of venlafaxine an p450 enzymes?

Does not use the p450 system

26

What is the major downside of venlafaxine withdrawal?

fast onset

27

What is the MOA of levomilnacipran?

SNRI

28

What is the role of bupropion in the treatment for anxiety disorders?

Not effective

29

Why is it that bupropion may test positive for amphetamine use?

Similar structure

30

What is the effect of bupropion on sexual function?

No effect

31

What is the factor that determines the risk of bupropion on seizure threshold?

Plasma levels--even transiently

32

What is the MOA of vilazodone?

SSRI and 5HT1A partial agonist, to enhance serotonergic activity

33

What is the MOA of vortioxetine?

Lots of 5HT modulation and reuptake inhibition

34

What is the MOA of trazodone? Use?

Weak inhibitor of serotonin, but also blocks 5HT2 receptors

Sleep agent

35

What is the risk for addiction of trazodone?

Low to none

36

What is the MOA and use of nefazodone? Major side effect

-Weak inhibition of neuronal 5HT
-MDD
-Hepatotoxic

37

What is the MOA of mirtazapine? Use?

Potent antagonist at post synaptic 5HT2 and 5HT3 receptors

used as a sleep aid

38

What are the side effects of mirtazapine?

-Sedation
Weight gain
-minimal p450 interaction

39

Which of the TCAs can treat OCD?

Clomipramine

40

What is the major side effect of clozapine?

Agranulocytosis

41

What is the general MOA of TCAs?

Blocks reuptake of NE, and 5HT

42

What are the adverse effects of TCAs?

-Anticholinergic
-Antihistamine
-Anti-alpha adrenergic

43

What organ metabolizes TCAs?

LIver

44

What is the interaction between p450 enzymes and TCAs?

TCAs metabolized by them, so anything that inhibits them will increase blood TCA levels

45

What is the use of obtaining blood levels of TCAs? (2)

-Ensure no cardiac issues
-treatment adherence

46

What are the major side effects of TCA?

-anticholinergic effects
-sedation and weight gain (antihistamine effect)

47

What are the alpha adrenergic effects of TCAs?

-Orthostatic hypotension
-reflex tachycardia

48

Are TCAs safe in prego?

No

49

What are the cardiovascular effects of TCAs?

-QT prolongation
-Arrhythmias

50

What is the dose range for amitriptyline for pain control, as compared to antidepressant effects?

Much smaller for pain control

51

What is the general MOA of MAOIs?

blocks enzyme that degrades neurotransmitters.

Increased 5HT, NE, dopamine

52

Draw out the dopamine pathway

Draw

53

True or false: MAOIs do not have active metabolites

True

54

What are the three major MAOIs?

-Tranylcypromine
-Phenelzine
-Selegiline

55

What are the side effects of MAOIs?

-Sedation
-Orthostatic hypotension
-anticholinergic

56

What are the high tyramine foods? (6)

-Chicken liver
-Beer
-Wine
-Soft cheeses
-fava beans
-chocolate

57

What is the major issue with MAOIs and tyramine?

Hypertensive crises and strokes

58

What is the major use of selegiline?

MAO-A inhibitor for PD

59

What is the major benefit of transdermal selegiline?

No tyramine dietary restrictions

60

What is the usual timeframe in which antidepressants work?

within 6 weeks

61

True or false: bipolar depression does not respond well to antidepressants

True

62

What endocrine lab must be monitored with Li?

Hypothyroidism

63

True or false: In general, the less severe the depression, the less response to antidepressants

True

64

True or false: secondary MDD respond better than primary with antidepressants

False--worse

65

What is the difference between remission and response?

Response = 50% better
Remission = 100% better

66

What is the only SSRI that is not given daily?

fluvoxamine

67

At what point should you switch drugs if not working?

2-3 months

68

What is the only SSRI that does not need to taper off of?

Fluoxetine

69

Who needs to start at lower doses of SSRIs?

Old or hepatically disabled

70

For unresponsiveness with SSRIs, what should always be done?

Reassess for other diseases

71

What are the pharmacological augmentation strategies?

Add second antidepressant with a different MOA:
-stimulant
-buspirone

72

What are the non-pharmacological augmentation strategies?

-Sleep promoters
-Lifestyle changes
-Psychotherapy

73

What is the MOA of buspirone? Use?

-serotonin 5-HT1A receptor partial agonist
-Non-sedating anxiolytic

74

What is the treatment duration for antidepressants?

stable for 6 months or 12 month for a complicated case

75

What happens to treatment time with increasing age?

Shorter treatment time needed

76

What are the major fetal effects on SSRIs?

-Paroxetine
-persistent pHTN

77

What is the focus of SSRIs in pregnancy?

Maintaining health of the mother

78

Where are MAO-A enzymes found? MAO-B?

A = brain, liver, gut
B - Brain, liver, platelets