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Flashcards in Antidepressants Deck (30)
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1
Q

SSRIs:

A

Fluoxetine, Paroxetine, Sertraline, Citalopram

“Flashbacks Paralyze SEnior CITazens”

2
Q

SSRI mech:

A

5-HT specific reuptake inhibitors

3
Q

SSRI uses:

A

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

4
Q

SSRI tox:

A

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
Q

Tx for Serotonin syndrome

A

Cyproheptadine (5-HT2 receptor antagonist)

6
Q

“Activation syndrome”: what drug

A

Fluoxetine - makes symptoms worse before making them better

7
Q

“Discontinuation syndrome”: what drug

A

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

8
Q

SNRIs:

A

Venlafaxine, duloxetine

VD

9
Q

SNRI mech:

A

Inhibits 5-HT and NE reuptake

10
Q

SNRI uses:

A

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

11
Q

SNRIs tox:

A

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

12
Q

Tricyclic Antidepressants:

A

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

13
Q

TCA mech:

A

Block reuptake of norepinephrine and 5-HT

14
Q

TCA uses:

A

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

15
Q

TCA tox:

A

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
Q

Tri-C’s: tox

A

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
Q

Monoamine Oxidase Inhibitors (MAO inhibitors):

A

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

18
Q

Selective MAO-B inhibitor:

A

Selegiline

19
Q

MAO mech:

A

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

20
Q

MAO uses:

A

Atypical depression, anxiety

21
Q

MAO tox:

A

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
Q

Atypical antidepressants:

A

Bupropion, Mirtazapine, Trazodone

23
Q

Bupropion: mech

A

selectively blocks DA reuptake “Psychic Energizer”

Increases NE and DA via unknown mechanism

24
Q

Bupropion: uses

A

Used for smoking cessation, cocaine, amphetamines

25
Q

Bupropion: tox

A

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

26
Q

Mirtazapine: mech

A

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

27
Q

Mirtazapine: tox

A

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
Q

Trazodone: mech

A

Primarily blocks 5-HT2 and alpha1-adrenergic receptors

29
Q

Trazodone: use

A

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

30
Q

Trazodone: tox

A

sedation, nausea, priapism, postural hypotension

Called TrazoBONE due to male-specific side effects