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Flashcards in Antidepressants Deck (30):
1

SSRIs:

Fluoxetine, Paroxetine, Sertraline, Citalopram
"Flashbacks Paralyze SEnior CITazens"

2

SSRI mech:

5-HT specific reuptake inhibitors

3

SSRI uses:

Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, PMDD

4

SSRI tox:

Fewer than TCAs. *GI distress, *sexual dysfunction (anorgasmia and decreased libido).
Serotonin syndrome with any drug that increases 5-HT (MAO inhibitors, SNRIs, TCAs) - hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.
Tx: cyproheptadine (5-HT2 receptor antagonist)

5

Tx for Serotonin syndrome

Cyproheptadine (5-HT2 receptor antagonist)

6

"Activation syndrome": what drug

Fluoxetine - makes symptoms worse before making them better

7

"Discontinuation syndrome": what drug

Paroxetine - stop problem, when drug is stopped, symptoms get really bad before they get better

8

SNRIs:

Venlafaxine, duloxetine
VD

9

SNRI mech:

Inhibits 5-HT and NE reuptake

10

SNRI uses:

Depression.
Venlafaxine is also used in generalized anxiety and panic disorders, PTSD;
Duloxetine is also indicated for diabetic peripheral neuropathy

11

SNRIs tox:

*Increases BP most common; also stimulant effects, sedation, nausea

12

Tricyclic Antidepressants:

Amitriptyline, nortriptyline, imipramine, despramine, clomipramine, doxepin, amoxapine
All TCAs end in -iptyline or -ipramine except doxepin and amoxapine

13

TCA mech:

Block reuptake of norepinephrine and 5-HT

14

TCA uses:

Major depression, OCD (clomipramine), fibromyalgia, urinary incontinence (imipramine), neuropathic pain

15

TCA tox:

Sedation, alpha1-blocking efects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth). Tertiary TCAs (amitriptyline) have more anticholinergic effects than Secondary TCAs (nortriptyline) have. Despiramine is less sedating, but has higher seizure incidence.

16

Tri-C's: tox

Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia.
Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline).
Tx: NaHCO3 for cardovascular toxicity

17

Monoamine Oxidase Inhibitors (MAO inhibitors):

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
MAO Takes Pride In Shanghai

18

Selective MAO-B inhibitor:

Selegiline

19

MAO mech:

Nonselective MAO inhibition increases levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine) by decreasing metabolic breakdown of trasmitters

20

MAO uses:

Atypical depression, anxiety

21

MAO tox:

Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese); CNS stimulation. Contraindicated with SSRIs, TCAs, St. John's wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

22

Atypical antidepressants:

Bupropion, Mirtazapine, Trazodone

23

Bupropion: mech

selectively blocks DA reuptake "Psychic Energizer"
Increases NE and DA via unknown mechanism

24

Bupropion: uses

Used for smoking cessation, cocaine, amphetamines

25

Bupropion: tox

Stimulant effects (tachycardia, insomnia), HA, SEIZURE in bulimic patients. NO SEXUAL SIDE EFFECTS!

26

Mirtazapine: mech

alpha2-antagonist (increases release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.

27

Mirtazapine: tox

Sedation (which may be desirable in depressed pts with insomnia), increases appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth.

28

Trazodone: mech

Primarily blocks 5-HT2 and alpha1-adrenergic receptors

29

Trazodone: use

Used primarily for insomnia, as high doses are needed for antidepressant effects.

30

Trazodone: tox

sedation, nausea, priapism, postural hypotension
Called TrazoBONE due to male-specific side effects