Antidepressants Flashcards
MAOI (Monoamine oxidase inhibitor) SE
Tremor Weakness Dizziness HA HTN
For these reasons, MAOIs are not commonly used.
When using MAO inhibitors what foods must you avoid?
Potential SE
Those with tyramine (aged cheese, soy products, red wine, meats, raisins)
GI MAO is essential for the breakdown of tyramine. Using an MAO inhibitor will not allow for breakdown.
Potential SE: HTN emergency and fatal accelerated HTN
What are the typical anti-cholinergic SE?
What class of anti-depressants are these common in?
Dry mouth Constipation Urinary hesitancy Orthostatic hypotension Sedation
Tricyclic antidepressants (Amitriptyline/Elavil)
What is a serious SE of tricyclic antidepressants?
Low therapeutic index.
Fatal in doses as little as 10x the daily dose.
Amitriptyline/Elavil Class Ind MOA Char
Amitriptyline/Elavil
Class: Tricyclic antidepressant (TCA)
Ind: Depression, insomnia, migraine HA, chronic pain
MOA: CNS modulation of serotonin and norepinephrine
Char: PO and IM. Taken at bedtime to minimize SE
Amitriptyline/Elavil
SE
Dizziness/drowsiness
Anticholinergic effects: dry mouth, constipation, urinary hesitancy, blurred vision
What can happen with abrupt withdrawal of Amitriptyline/Elavil?
Discontinuation syndrome
Nausea HA Dizziness Lethargy Flu-like symptoms
Trazodone/Desyrel
Class:
Ind:
MOA:
Trazodone/Desyrel
Class: Tetracyclic antidepressant SARI: serotonin antagonist and reuptake inhibitor
Ind: Depression, anxiety (anxiolytic), insomnia (hypnotic), panic disorder
MOA: Serotonin reuptake inhibitor and partial antagonist
Trazodone/Desyrel SE
Sedation, orthostatic hypotension, fatigue, cardiac dysrhythmias, mania (in bipolar disorder), increased risk of suicide
SSRI’s common SE
Dizziness Nausea HA Fatigue Diarrhea Anxiety Insomnia Weight gain Impotence Suicide (after abrupt discontinuation, especially in adolescents)
Fluoxetine/Prozac
Class:
Ind:
MOA:
Fluoxetine/Prozac
Class: SSRI
Ind: Major depressive disorder, OCD, bulimia, panic disorder
MOA: decreased serotonin reuptake at presynaptic cleft
Fluoxetine/Prozac
Char:
Additional SE:
Fluoxetine/Prozac
Char: PO, once daily. 1/2 life of 48-72 hours. Takes weeks to achieve desired effect.
Additional SE: potential for serotonin syndrome - fever, agitation, diarrhea, elevated BP, sexual dysfunction
What may interfere with the use of SSRIs like Prozac?
NSAIDs : may compound the risk of GI bleeds caused by SSRI use.
Duloxetine/Cymbalta
Class:
Ind:
MOA:
Duloxetine/Cymbalta
Class: SNRIs (Serotonin and norepinephrine reuptake inhibitors)
Ind: Major depressive disorder, GAD, painful peripheral neuropathy and fibromyalgia
MOA: Blocks reuptake of serotonin and norephinephrine
Duloxetine/Cymbalta SE
HA Somnolence Fatigue Nausea Xerostomia (dry mouth) Insomnia Erectile dysfunction
What antidepressant is known to treat neuropathic pain?
Duloxetine/Cymbalta
Bupropion/Wellbutrin
Class:
Ind:
MOA:
Bupropion/Wellbutrin
Class: Norepinephrine and dopamine reuptake inhibitors (NDRI) and nicotine receptor antagonist
Ind: Major depression, bipolar disorder, ADD, smoking cessation
MOA: Blockade of norepinephrine and dopamine reuptake
Bupropion/Wellbutrin
SE
HA Insomnia Dry mouth Tremors Restlessness Agitation Anxiety Sweating Dizziness
Bupropion/Zyban (name for smoking cessation)
Char
Zyban
Char: Start one week before smoker’s target quit date.
150 mg/day for 3 days then 150 mg BID; tx for 7-12 weeks
Depression may be associated with what deficiency?
Folate deficiency Levomefolic acid (5-MTHF: active form of folic acid)
What is Methyltetrahydrofolate’s role in depression?
Methyltetradydrofolate (5-MTHF) acts a co-enzme modulator in the synthesis of three monoamines: dopamine, serotonin and norepinephrine.
Supplementing folic acid, MTHF or folinic acid with SSRI tx may be beneficial.
How is MTHF marketed in the US?
Medicinal food
Brand name: Deplin (7.5 or 15 mg)
