Flashcards in Antidepressants Deck (30):
Fluoxetine, Paroxetine, Sertraline, Citalopram
"Flashbacks Paralyze SEnior CITazens"
5-HT specific reuptake inhibitors
Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, PMDD
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)
Tx for Serotonin syndrome
Cyproheptadine (5-HT2 receptor antagonist)
"Activation syndrome": what drug
Fluoxetine - makes symptoms worse before making them better
"Discontinuation syndrome": what drug
Paroxetine - stop problem, when drug is stopped, symptoms get really bad before they get better
Inhibits 5-HT and NE reuptake
Venlafaxine is also used in generalized anxiety and panic disorders, PTSD;
Duloxetine is also indicated for diabetic peripheral neuropathy
*Increases BP most common; also stimulant effects, sedation, nausea
Amitriptyline, nortriptyline, imipramine, despramine, clomipramine, doxepin, amoxapine
All TCAs end in -iptyline or -ipramine except doxepin and amoxapine
Block reuptake of norepinephrine and 5-HT
Major depression, OCD (clomipramine), fibromyalgia, urinary incontinence (imipramine), neuropathic pain
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.
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
Monoamine Oxidase Inhibitors (MAO inhibitors):
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
MAO Takes Pride In Shanghai
Selective MAO-B inhibitor:
Nonselective MAO inhibition increases levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine) by decreasing metabolic breakdown of trasmitters
Atypical depression, anxiety
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)
Bupropion, Mirtazapine, Trazodone
selectively blocks DA reuptake "Psychic Energizer"
Increases NE and DA via unknown mechanism
Used for smoking cessation, cocaine, amphetamines
Stimulant effects (tachycardia, insomnia), HA, SEIZURE in bulimic patients. NO SEXUAL SIDE EFFECTS!
alpha2-antagonist (increases release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.
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.
Primarily blocks 5-HT2 and alpha1-adrenergic receptors
Used primarily for insomnia, as high doses are needed for antidepressant effects.