antidepressants Flashcards
1
Q
treatment principles for antidepressants
A
- establish diagnosis
- assess for suicide risk
- counseling or psychotherapy
- non-pharmacologic tx: relaxation, exercise, sleep hygiene, nutrition
- pharmacological tx: acute treatment phase, augmentation for partial responders, continuation phase, maintenance phase
- educate about concurrent herbal use: brewers yeast, st. johns wart, gingko
2
Q
SSRI
A
- fluoxetine HCL (Prozac)
- used for anxiety and antidepressant
- good for young adults, and pediatrics, and geriatrics
- Celexa not good for CV-QT prolongation
- blks synaptic cleft from the serotonin transporter returning serotonin to presynaptic cell
- contraindications: no MAOI within 14 days, severe hepatic/renal impairment, 1st and 3rd trimester of pregnancy,
- adrs: seratonin syndrome
- drug interactions: no MAOI or TCA, CNS depression with ETOH, antihistamines, opoids, St. Johns wart may cause seratonin syndrome
3
Q
antidepressant drugs
A
- SSRI- most common
- SNRI (serotonin/norepinephrine reuptake inhibitors): venlafaxine (Effexor) duloxetine (Cymbalta II)
- NDRI (norepi/dopamine reuptake inhibitor): buproprion (Wellbutrin)
- TCA: nortriptyline (Parnate)
- noradrenergic agonist: mirtazapine (Remeron)
- SARI/SSRI: trazadone (Desyrel); nefazodone (Serzone)
- MAOI: phenelzine (Nardil); tranylcpromine (Parnate)
4
Q
SNRI
A
- venlafaxine(Effexor)
- blocks both seratonin and norepi reuptake
- potential for increased suicidal ideation especially early in initial therapy
- may exacerbate glaucoma
- preg. class C
- adrs: abnormal ejaculation, HTN2
- 2nd line for antidepressants; can be used for chronic pn and for pts
5
Q
NDRIs
A
- buproprion (Wellbutrin)
- increases norepi and dopamine
- don’t stop suddenly-must wean
- off MAOIs 14 days prior b/4 startint
6
Q
nonadrenergic antagonists/mixed serotonin blkers
A
- blks histamine leads to weight gain
- mirtazapine (Remeron)
- good for insomnia and aggitation
