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Psychiatry pro +1700 > Somatic Therapies > Flashcards

Somatic Therapies Flashcards

1
Q

Why do antidepressants take a long time to work?

A

Need to increase receptors, and gene transcription

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2
Q

What is the MOA of imipramine? Use?

A

TCA

Enuresis

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3
Q

What is the MOA of bupropion?

A

NE and dopamine reuptake inhibitor

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4
Q

What is the MOA of venlafaxine?

A

SNRI

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5
Q

What is the MOA of desvenlafaxine?

A

SNRI

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6
Q

What is the MOA of duloxetine?

A

SNRI

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7
Q

What is the MOA of levomilnacipran?

A

SNRI

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8
Q

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

A

Amitriptyline

Nortriptyline

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9
Q

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

A
  • Fluvoxamine

- OCD

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10
Q

Which SSRI is used for bulimia?

A

Fluoxetine

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11
Q

Which SSRIs are used to treat GAD?

A

Escitalopram

Paroxetine

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12
Q

True or false: structurally, the SSRIs are structurally similar

A

False

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13
Q

What is the major side effect of bupropion?

A

Lowers seizure threshold

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14
Q

SSRIs are metabolized through what organ?

A

Liver

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15
Q

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

A
  • Fluoxetine

- Sertraline

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16
Q

What are the side effects of SSRIs?

A
  • Weight gain or loss
  • Vivid dreams
  • mild GI symptoms
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17
Q

What is the treatment for serotonin syndrome?

A

Cyproheptadine

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18
Q

What is the effect of SSRIs and the p450 system?

A

Metabolized by it–cause drug interactions

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19
Q

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

A

up to 24

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20
Q

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

A

True

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21
Q

What are the s/sx of serotonin syndrome?

A
  • Diaphoresis
  • Mental confusion
  • Flushing
  • Hyperthermia
  • Hypertonicity
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22
Q

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

A

True

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23
Q

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

A

Venlafaxine

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24
Q

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

A

Lower = 5HT reuptake inhibition

Higher = NE and dopamine

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25
Q

What is the effect of venlafaxine an p450 enzymes?

A

Does not use the p450 system

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26
Q

What is the major downside of venlafaxine withdrawal?

A

fast onset

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27
Q

What is the MOA of levomilnacipran?

A

SNRI

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28
Q

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

A

Not effective

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29
Q

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

A

Similar structure

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30
Q

What is the effect of bupropion on sexual function?

A

No effect

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31
Q

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

A

Plasma levels–even transiently

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32
Q

What is the MOA of vilazodone?

A

SSRI and 5HT1A partial agonist, to enhance serotonergic activity

33
Q

What is the MOA of vortioxetine?

A

Lots of 5HT modulation and reuptake inhibition

34
Q

What is the MOA of trazodone? Use?

A

Weak inhibitor of serotonin, but also blocks 5HT2 receptors

Sleep agent

35
Q

What is the risk for addiction of trazodone?

A

Low to none

36
Q

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

A
  • Weak inhibition of neuronal 5HT
  • MDD
  • Hepatotoxic
37
Q

What is the MOA of mirtazapine? Use?

A

Potent antagonist at post synaptic 5HT2 and 5HT3 receptors

used as a sleep aid

38
Q

What are the side effects of mirtazapine?

A

-Sedation
Weight gain
-minimal p450 interaction

39
Q

Which of the TCAs can treat OCD?

A

Clomipramine

40
Q

What is the major side effect of clozapine?

A

Agranulocytosis

41
Q

What is the general MOA of TCAs?

A

Blocks reuptake of NE, and 5HT

42
Q

What are the adverse effects of TCAs?

A
  • Anticholinergic
  • Antihistamine
  • Anti-alpha adrenergic
43
Q

What organ metabolizes TCAs?

A

LIver

44
Q

What is the interaction between p450 enzymes and TCAs?

A

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

45
Q

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

A
  • Ensure no cardiac issues

- treatment adherence

46
Q

What are the major side effects of TCA?

A
  • anticholinergic effects

- sedation and weight gain (antihistamine effect)

47
Q

What are the alpha adrenergic effects of TCAs?

A
  • Orthostatic hypotension

- reflex tachycardia

48
Q

Are TCAs safe in prego?

A

No

49
Q

What are the cardiovascular effects of TCAs?

A
  • QT prolongation

- Arrhythmias

50
Q

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

A

Much smaller for pain control

51
Q

What is the general MOA of MAOIs?

A

blocks enzyme that degrades neurotransmitters.

Increased 5HT, NE, dopamine

52
Q

Draw out the dopamine pathway

A

Draw

53
Q

True or false: MAOIs do not have active metabolites

A

True

54
Q

What are the three major MAOIs?

A
  • Tranylcypromine
  • Phenelzine
  • Selegiline
55
Q

What are the side effects of MAOIs?

A
  • Sedation
  • Orthostatic hypotension
  • anticholinergic
56
Q

What are the high tyramine foods? (6)

A
  • Chicken liver
  • Beer
  • Wine
  • Soft cheeses
  • fava beans
  • chocolate
57
Q

What is the major issue with MAOIs and tyramine?

A

Hypertensive crises and strokes

58
Q

What is the major use of selegiline?

A

MAO-A inhibitor for PD

59
Q

What is the major benefit of transdermal selegiline?

A

No tyramine dietary restrictions

60
Q

What is the usual timeframe in which antidepressants work?

A

within 6 weeks

61
Q

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

A

True

62
Q

What endocrine lab must be monitored with Li?

A

Hypothyroidism

63
Q

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

A

True

64
Q

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

A

False–worse

65
Q

What is the difference between remission and response?

A 
Response = 50% better
Remission = 100% better
66
Q

What is the only SSRI that is not given daily?

A

fluvoxamine

67
Q

At what point should you switch drugs if not working?

A

2-3 months

68
Q

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

A

Fluoxetine

69
Q

Who needs to start at lower doses of SSRIs?

A

Old or hepatically disabled

70
Q

For unresponsiveness with SSRIs, what should always be done?

A

Reassess for other diseases

71
Q

What are the pharmacological augmentation strategies?

A

Add second antidepressant with a different MOA:

  • stimulant
  • buspirone
72
Q

What are the non-pharmacological augmentation strategies?

A
  • Sleep promoters
  • Lifestyle changes
  • Psychotherapy
73
Q

What is the MOA of buspirone? Use?

A
  • serotonin 5-HT1A receptor partial agonist

- Non-sedating anxiolytic

74
Q

What is the treatment duration for antidepressants?

A

stable for 6 months or 12 month for a complicated case

75
Q

What happens to treatment time with increasing age?

A

Shorter treatment time needed

76
Q

What are the major fetal effects on SSRIs?

A
  • Paroxetine

- persistent pHTN

77
Q

What is the focus of SSRIs in pregnancy?

A

Maintaining health of the mother

78
Q

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

A

A = brain, liver, gut

B - Brain, liver, platelets

Psychiatry pro +1700 (28 decks)

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