Antidepressants Flashcards
1
Q
SSRIs=serotonin reuptake inhibitors
A
- Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram
- Antidepressant actions are similar in efficacy and time-course to TCAs
- Less acute toxicity than TCAs–decreased overdose risk
- Side effects: nausea, insomnia, sexual dysfunction
- If given with MAOIs–>serotonin reaction (hyperthermia, muscle rigidity, CV collapse)
- also may be associated with neuroleptic malignant syndrome.
- Use: MDD, OCD, Panic disorder, Social anxiety disorder, PTSD, GAD, PMS, Hot flashes associate with menopause.
2
Q
Imipramine
Amitriptyline
Clomipramine
A
- TCAs
- Block norepinephrine and serotonin reuptake; now used secondarily to SSRIs and other new compounds
- Elevate mood in depressed patients after 2-3 weeks
- Uses: MDD, Enuresis in childhood (imipramine), chronic pain (amitriptyline), OCD (clomipramine, SSRIs)
- Decrease REM and increase stage 4 sleep
- Anticholinergic effects: dry mouth, blurred vision, urinary retention
- Also cause sedation, orthostatic hypotension, cardiac abnormalities (anticholinergic effects and increased NE–>palpitations, tachycardia, arrhythmias).
- EKG: lengthened QRS, flat/inverted T wave
- Overdose: hyperpyrexia, BP change, seizure, coma, cardiac conduction defects
- Interacts with guanethidine, sympathomimetics
3
Q
SSRI Withdrawal
A
- Dizziness and light-headedness, vertigo, feeling faint
- Shock-like sensations
- Paresthesia
- Anxiety
- Diarrhea
- Fatigue
- Gait instability
- Headache
- Insomnia
- Irritability
- Nausea and vomiting
- Tremor
- Visual disturbances
(1-7 days after stopping SSRI)
4
Q
Fluoxetine
A
- First SSRI
- Long half-life active metabolite
- SR product available for PMS
5
Q
Sertraline
A
- similar to fluoxetine but with fewer effects on drug metabolism
- Used for OCD, PTSD, Panic attacks
6
Q
Paroxetine
A
- SSRI
- Also used for hot flashes associated with menopause
7
Q
Fluvoxamine
A
- SSRI
- Approved for OCD
8
Q
Citalopram
Escitalopram
A
SSRIs
9
Q
SNRI (Serotonin Norepinephrine Reuptake Inhibitor)
A
- Block reuptake of serotonin and NE
- side effect profile more similar to SSRI than TCA
10
Q
Duloxetine
A
- SNRI
- Used for MDD and anxiety
- Also used for neuropathic pain syndromes, fibromyalgia, back pain, osteoarthritis
- Caution in patients with liver disease
11
Q
Venlafaxine
A
- SNRI
- severe depression and anxiety
12
Q
Bupropion
A
- Atypical antidepressant
- Weakly blocks NE and dopamine uptake
- Also approved for nicotine withdrawal and SAD
- No associated weight gain or sexual dysfunction
13
Q
Mirtazapine
A
- Atypical antidepressant
- Blocks presynaptic alpha-2 receptors in the brain
- Increases appetite
- Used in AIDS patients
14
Q
Trazodone
A
- Atypical antidepressant
- Weak SSRI-like effect; sedating, so used also for insomnia
- Low incidence of CV side effects; can cause priapism
15
Q
Phenelzine
Tranylcypromine
A
- MAO inhibitors
- Uses: Major depression (not first choice) and narcolepsy
- Selegiline patch also used to treat depression; relatively nonselective (A and B) at dose used.
- Antidepressant action takes about 2 weeks–>mood elevation in depressed pts. May progress to hypomania, esp. in bipolar.
- Corrects sleep disorders in depression.
- May produce stimulation in normal people.
- Lowers BP and may produce orthostatic hypotension.
- Acute toxicity: agitation, hallucination, hyperpyrexia, convulsions, change in BP.
- Tyramine in diet can increase NE effect in presence of MAOI
