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Flashcards in 519-520: Psych Drugs 2 Deck (33):
1

Name 4 SSRI's

Fluoxetine
Paroxetine
Sertaline
Citalopram

"Flashbacks paralyze senior citiznes"

2

What are the clinical uses for SSRIs?

Depression
GAD
Panic disorder
OCD
Bulimia
Social Phobias
PTSD

3

How long does it take for antidepressants to take effect?

4-8 weeks

4

Are SSRIs or TCAs more toxic?

TCAs

5

What are the toxicities of SSRIs?

GI distress
Sexual dysfunction (anorgasmia, ↓ libido)
Serotonin syndrome

6

What drugs can cause serotonin syndrome?

Any drug that ↑ SSRIs (e.g. MAO inhibitors, SNRIs, TCAs)

7

What are the symptoms of serotonin syndrome?

seizures
myoclonus
confusion

hyperthermia
flushing
cardiovascular collapse

diarrhea

8

What do you treat serotonin syndrome?

Cyproheptadine (5-HT2 receptor antagonist)

9

List 2 SNRIs

Venlafaxine, duloxetine

10

Mechanism of SNRIs:

Inhibit 5-HT and NE reuptake

11

Clinical use of SNRIs:

Depression
GAD and panic disorder - venlafaxine
Diabetic peripheral neuropathy - duloxetine

12

Toxicity of SNRIs:

Stimulant effects
Nausea
Relaxxation (sedation)
Increased BP - most common

13

List as many TCAs as you can:

-triptyline: amitriptyline, nortriptyline
-imprame: imipramine, desipramine, clomipramine
doxepin, amoxapine

14

Mechanism of TCAs:

Block reuptake of NE and 5-HT

15

Clinical use of TCAs:

Major depression
OCD (clomipramine)
Fibromyalgia

16

Toxicities of TCAs:

Anticholinergic: tachycardia, urinary retention, dry mouth; confusion and hallucinations in elderly
α1-blocking effects (e.g. postural HTN)
Respiratory depression
Hyperprexia
Sedation

Tri-C's: convulsions, coma, cardiotoxicity (arrhythmias)

17

Name the MAO inhibitors

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)

(MAO Takes Pride In Shanghai)

18

MAO inhibitor effects on levels of amine transmitters:

↑ levels of NE, 5-HT, dopamine

19

Clinical use of MAO inhibitors:

Atypical depression
Anxiety
Hypochondriasis

20

Toxicities of MAO inhibitors:

Hypertensive crisis (esp. w/ tyramine ingestion)
CNS stimulation
Contraindicated with SSRIs, TCAs, St. John's wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

21

What is the difference in side effect profiles between second and third generation TCAs?

third generation TCAs (amitriptyline) have more anticholinergic effects than second (nortriptyline)

22

List three atypical antidepressants

Bupropion, mirtazapine, trazodone

23

What are the clinical uses for bupropion?

Depression, smoking cessation

24

What neurotransmitters are involved in the actions of bupropion?

↑ NE and dopamine (unknown mechanism)

25

What are the toxicities of bupropion?

stimulant effects (tachycardia, insomnia)
headache
seizure in bulimic paitents

26

Regarding its side effect profile, what is an advantage to the use of bupropion for treating depression?

no sexual side effects

27

What receptor does mirtazapine act on, and what neurotransmitters are involved?

α2-antagonist (↑ release of NE and 5-HT)

28

Toxicity of mirtazapine

Sedation
↑ appetite
Weight gain
Dry mouth

29

Which antidepressant might you consider using for a depressed patient with insomnia?

mirtazapine

30

Which antidepressant might you consider using for a depressed patient with anorexia, or an elderly patient who is in danger of wasting away?

mirtazapine - it causes weight gain

31

What is the mechanism of trazodone?

Primarily blocks 5-HT and α1-adrenergic receptors

32

What are the clinical applications for trazodone?

Insomnia is the primary use b/c high doses are needed for antidepressant effects

33

What are the toxicities of trazodone?

sedation
nausea
priapism ("trazobone")
postural hypotension