Antidepressants Flashcards
(26 cards)
SSRI medications
Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro), Sertraline (Zoloft)
Fluoxetine (Prozac)
SSRI, 5HT reuptake inhibitor
SFx: sex dysfunction, GI, insomnia, anorexia/weight loss, cause weight gain (long term), discontinuation syndrome, 5HT syndrome w MAOIs
inhibits cytP450
Uses: anxiety, depression, migraine prophylaxis, bulimia
Paroxetine (Paxil)
SSRI, 5HT reuptake inhibitor,
SFx: sex dysfunction, GI, insomnia, anorexia/weight loss weight gain, discontinuation syndrome, 5HT syndrome w MAOIs
Pregnancy: contraindicated, CV malformation
Inhibits cytP450
Uses: depression, SAD, PMS/PMDD/hot flashes
Citalopram (Celexa)
SSRI, 5HT reuptake inhibitor
SFx: sex dysfunction, GI, insomnia, anorexia/weight loss/ weight gain. QT prolongation, discontinuation syndrome, 5HT syndrome with MAOIs
low potential for cytP450 inhibition
Uses: depression
Sertraline (Zoloft)
SQUIRTraline
SSRI, 5HT reuptake inhibitor
SFx: sex dysfunction, GI, insomnia, anorexia/weight loss/ weight gain. QT prolongation, discontinuation syndrome, 5HT syndrome with MAOIs, diarrhea
low potential for cytP450 inhibition
Uses: depression
SNRI medications
Venlafaxine (Effexor), Duloxetine (Cymbalta)
V(EN)lafaxine (Effexor)
SNRI, 5HT and NE reuptake inhibitor (some DM)
SFx: Sex dysfunction, insomnia, GI, discontinuation syndrome, dose related inc. in BP
Uses: depression, anxiety, neuropathic pain
Duloxetine (Cymbalta)
DULL-oxetine
SNRI, 5HT and NE reuptake inhibitor (some DM)
SFx: Sex dysfunction, insomnia, GI, discontinuation syndrome, dose related inc. in BP
Uses: depression, fibromyalgia, diabetic peripheral neuropathy, GAD
Contradiction: chronic liver disease/hepatic insufficiency
TCA medications
Nortriptyline (Aventyl), Amitriptyline (Elavil)
Nortriptyline (Aventyl)
SNRI+TCA, 5ht and Ne reuptae inhibitor, (mACh, alpha1, H1 elevated in Elavil)
SFx: fatal in overdose (hyperpyrexia, HTN, tachy,anticholinergic effects, convulsions), cardiotoxic (QT prolong, ventricular block, arrhythmias), lower seizure threshold, antagonist activity on other receptors- not specific
weight gain
Uses: depression- last resort in refractory depression
Amitriptyline (Elavil)
SNRI+TCA, 5ht and Ne reuptae inhibitor, (mACh, alpha1, H1 elevated in Elavil)
SFx: fatal in overdose (hyperpyrexia, HTN, tachy,anticholinergic effects, convulsions), cardiotoxic (QT prolong, ventricular block, arrhythmias), lower seizure threshold, antagonist activity on other receptors- not specific
weight gain
Uses: depression- last resort in refractory depression, migraine prophylactic
Buproprion (Wellbutrin)
Dopamine reuptake inhibitor, some NE block
SFx: restlessness, insomnia, agitation, weight loss, anorexia, inc. seizure risk, may cause psychotic episodes NO SEX SIDE EFFECTS
Uses: depression, Zyban for smoking cessation
Contra: ppl with seizure disorders and eating disorders
Agonist/Antagonist activity at specific 5HT and NE receptors
Mirtazepine (Remeron), Trazodone (Desyrel), Vilazodone (Vibryd)
Mirtazapine (Remeron)
antag. Of central presyn alph2 adrenergic autoreceptors (neg feedback NE/5-HT), block 5-HT2 and 5-HT3
SFx: sedation, solomnence, dizziness, weight gain, stim appetite, few sex side fx
Trazodone (Desyrel)
trazoBONE
ant. 5HT2 partial agonist 5-HT1a blocks 5HT reuptake SFx: drowsiness, dizziness,GI (nausea, vomiting) orthostatic hypotension, protracted erection Uses: depression
Vilazodone (Vibryd)
partial agonist 5-HT1a receptor
blocks 5-HT reuptake
SFx: NO WEIGHT GAIN, NO SEX DYSFUNCTION, insomnia, GI disturbances
Uses: depression
MAOIs
Selegiline (Eldepryl)- reversible inhibitor, Phenelzine (Nardil)- irreversible inhibitor
Selegiline (Eldepryl)
(select-iline)
reversible inhibitor
blocks MAO (enz that converts NE, 5-HT and DM to inactive products) MOA-A-> NE
MOA-B-> DM
MOA-B for selegiline
SFx: anorgasmia, sexual impotence, CNS stim (restlessness, insomnia). Sleep disturbances, weight gain, orthostatic hypoTN
drug interactions with indirect sympathomimetics and tyramine-containing food, SSRIs and 5-HT receptor agonists
Uses: depression (refractory), last choice med due to HTN crisis, treat parkinsons
Phenelzine (Nardil)
irreversible inhibitor
blocks MAO (enz that converts NE, 5-HT and DM to inactive products) MOA-A-> NE
MOA-B-> DM
SFx: anorgasmia, sexual impotence, CNS stim (restlessness, insomnia). Sleep disturbances, weight gain, orthostatic hypoTN
drug interactions with indirect sympathomimetics and tyramine-containing food, SSRIs and 5-HT receptor agonists
Uses: depression (refractory), last choice med due to HTN crisis, treat parkinsons
Lithium
Eskalith-CR and Cibalith-S
MOA unknown, mood stabilizer
takes several weeks, neuroplastic changes, inhibits recycling of inositol substrates
SFx: small therapeutic range, drowsiness, slowed mentation, forgetfulness, GI (nausea, vomiting, diarrhea), polyuria, thirst, weight gain, mild tremor, degenerative kidney changes, depression of thyroid (goiter) due to iodine use, avoid in first timester of pregnancy and breast feeding
above 2.5 mEq/L: ataxia, gross tremor, arrhythmias, coma, convulsions–> death
elim by kidney- affect clearance= inc or dec of lithium stored in body
Uses:first line drug for acute mania, long term therapy to avert M&D episodes
not effective for rapid cyclers
Anti-epileptic medications
mixed mania states
Valproic Acid (Depakote)- good for rapid cyclers Carbamazepine (Tegretol, Equetro)
Valproic Acid (Depakote)
prolongs inactivated state of Na channels, reduces Ca entry via volt-dep T type Ca channels, inc GABA synth and dec GABA breakdown, inhibit GABA reuptake by GAT1
Uses: Good for rapid cyclers, more sedating than lithum
Carbamazepine (Tegretol)
prolongs inactivated state of Na channels
see picmonic
Atypical antipsychotics for bipolar for bipolar disorder
Quetiapine (Seroquel), Olanzapine (Zyprexa), Risperidone (Risperdal), Aripiprazole (Abilify), Lurasidone (Latuda), Asenapine (Saphris)- bipolar depression only
