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Flashcards in Antidepressants Deck (40):
1

what are the MAOI inhibitors

MAO Take Pride In Shanghai

Tranylcypromine (non hydrazine)
Phenelzine (hydrazine)
Isocarboxazid (hydrazine)
Selegiline (non hydrazine)

2

mechanism of MAO inhibitors (name them)

tranylcypromine, phenelzine, isocarboxazid, selegiline

-prevent the breakdown of serotonin, dopamine, norepinephrine
-PIT bind irreversibly and nonselectively to MAO-A and MAO-B
-Selegiline binds to MAO-B

3

use of MAOI

-depression unresponsive to other antidepressants
-Selegiline for early Parkinson's

4

AE of MAOI

tranylcypromine, phenelzine, isocarboxazid, selegiline

drowsiness, insomnia, orthostatic hypotension, weight gain, muscle pain, sexual dysfunction

5

contraindication of MAOI (name them)

tranylcypromine, phenelzine, isocarbaxozid, selegiline

-serotonin agents: SSRI, SNRIs, or TCAs --> serotonin syndrome due to excess stimulation --> hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vitals (so they must be stopped 2 weeks before administering MAOIs)

-tyramine containing food such as aged wine and cheese: they are broken down by MAO --> large release of catecholamines --> hypertension, tachycardia, arrhythmias, headache, stiff neck

-sympathomimetic drugs: pseudoephedrine and phenylpropanolamine (both in cold meds)

6

what is used to control or manage tyramine induce hypertension

Phentolamine
Prazosin

7

what happens if overdose on MAOI

tranylcypromine, phenelzine, isocarboxazid, selegeline

autonomic instability, hyperadrenergic symptoms, psychotic symptoms, confusion, delirium, fever

8

what happens with discontinuation of MAOI

discontinuation syndrome (seen with all antidepressants) --> worsening of depressive symptoms, confusion, disorientation, psychosis, anxiety

9

what are the TCAs

DANI and CAM

Desipramine
Amitriptyline
Nortriptyline
Imipramine

Clomipramine
Amoxapine
Maprotiline

10

mechanism of action of TCAs (name them)

desipramine, amitripyline, nortriptyline, imipramine, clomipramine, amoxapine, maprotiline


blocks reuptake of serotonin and NE by competitively binding their carrier protein --> increased monoamine in the cleft

block alpha adrenergic, muscarinic, histamine, and cardiac fast Na channels

11

AE of TCAs (name them)

desipramine, amitriptyline, nortriptyline, imipramine, clomipramine, amoxapaine, maprotiline


-block muscarinic receptors --> blurred vision, xerostomia, urinary retention, constipation, narrow angle glaucoma
-increase catecholamine receptors --> increased cardiac stimulation
-inhibit cardiac fast Na channel --> arrhythmias
-block alpha 1 receptor: orthostatic hypotension with rebound tachycardia
-H1 blocker: sedation and weight gain
-sexual effects

12

what metabolizes TCAs and how does it affect the population

CYP2D6 so those (esp whites) with polymorphism are associated with slow metabolism of TCAs

13

what occurs with overdose of TCAs

lethal arrhythmias --> v-tach and v-fib

14

what reverses the cardiac block caused by overdose of TCAs

sodium bicarbonate

15

what are the SSRIs

SEP of FFC

Sertraline
Escitalopram
Paroxetine
Fluoxetine
Fluvoxamine
Citalopram

16

mechanism of SSRIs (name them)

Sertraline, Escitalopram, Paroxetine, Fluoxetine, Fluvoxamine, Citalopram

-inhibit the reuptake of serotonin
-unlike TCAs, they have little blocking activity at muscaranic, histamine H1, and alpha adrenergic receptors

17

SSRIs are first line treatment for what conditions

Depression and Premature Ejaculation

SSRIs because of few sider effects

SEP of FFC
Sertraline
Escitalopram (S enantiomer of Citalopram)
Paroxetine
Fluoxetine
Fluvoxamine
Citalopram

18

what else are SSRIs used for

OCD, panic disorder, generalized anxiety disorder, PTSD, Social anxiety disorder, premenstrual dysphoric disorder, bulimia nervosa

19

AE of SSRIs (name them)

sertraline, escitalopram, paroxetine, fluoxetine, fluvoxamine, citralopram

Increased serotonergic activity in the gut
Diminished sexual interest and function
Weight gain

20

drug interaction of SSRIs

-Fluoxetine and Paroxetine are inhibitors of CYP2D6 needed for metabolism of TCAs
-Fluvoxamine is inhibitor of CYP1A2, CYP2C19, and CYP3A4
-Serotonin Syndrome

21

what occurs with overdose of SSRIs

seizures

22

what are the SNRIs

Venlafaxine
Duloxetine

23

mechanism of SNRIs (name them)

Venlafaxine and Duloxetine

inhibit the reuptake of serotonin and NE but differ from TCAs in that they do not block the muscarinic, H1, and alpha adrenergic 1 receptors

24

which of the SNRIs behaves like an SSRI and why

Venlafaxine at low doses only inhibits uptake of serotonin but at high doses also inhibits uptake of NE

25

adverse of SNRIs

dry mouth, constipation, decreased appetite, fatigue, somnolence, sweating, asthenia, dizziness, sexual dysfunction

26

name and mechanism of NDRI

Bupropion

norepinephrine and dopamine reuptake inhibitor

27

use of NDRI

bupropion

decrease the craving and attenuating the withdrawal symptoms of nicotine in tobacco users

28

overdose and contraindication of bupropion

seizures

29

name and mechanism of SARIs

5HT2 (serotonin) antagonist and 5-HT reuptake inhibitor

Nefazodone
Trazodone

30

use of SARIs

nefazodone and trazodone

-since 5-HT2 is inhibited --> no agitation, anxiety, or sexual dysfunction
-actions of 5-HT with blockade of 5-HT2 --> antidepressive, antianxiety, antipsychotic

31

AE of nefazodone

hepatotoxicity

32

AE of trazodone

block alpha 1 and H1 --> extreme sedation and hypnotic hence why it is used as an off label hypnotic

33

example and mechanism of NASSAs

noradrenergic and specific serotonergic antidepressant --> alpha 2, 5-HT2, and 5-HT3 antagonist

also H1 antagonist

Mirtazapine

34

AE of NASSA

Mirtazapine

sedation
weight gain

35

first choice for depression in adults and children not taking any drug that can antagonize it

Fluoxetine

36

first choice for depression in adults taking medication that can antagonize fluoxetine

Citaprolam or Sertraline

37

since SSRI are first choice for depression, what are TCAs used for

neuropathic and other pain conditions

38

antidepressants that is approved for pain associated with diabetic neuropathy and fibromyalgia

SNRI Duloxetine

39

antidepressant approved for treatment of bulimia

Fluoxetine

40

antidepressant approved for premenstrual dysphoric disorder

Fluoxetine and Sertraline

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