Antidepressants Flashcards Preview

Conditions: Psychiatry > Antidepressants > Flashcards

Flashcards in Antidepressants Deck (39):
1

What are the 3 big classes of side effects of TCAs?

Antihistaminic
Anticholinergic
Antiadrenergic

2

What antihistaminic side effects are there of TCAs?

Sedation
Weight gain

3

What anticholinergic SEs are there?

Dry mouth
Dry eyes
Constipation

4

What antiadrenergic SE are there?

Orthostatic hypotension
Sexual dysfunction

5

How do TCAs work?

Side chains that bind to serotonin receptors

6

What are examples of TCAs?

Amitrytiline
Clomipramine
Imipramine
Doxepin

7

Heart SE of TCAs?

QT prolongation

8

What are secondary TCAs?

Metabolites of TCAs

Primarily block noradrenaline

9

How do monoamine oxidase inhibtors work?

Bind irreversibly to monoamine oxidase

Prevent inactivation of amines

10

What amines are stopped from being deactivated by MAOIs?

Dopamine
Serotonin
Norepinephrine

11

What happens with these non-inactivated amines?

They don't get broken down in the gut and get absorbed to increase levels

12

Side effects of MAOIs?

Orthostatic hypotension
Sexual dysfunction
Sleep disturbance
Sedation

HYPERTENSIVE CRISIS
SEROTONIN SYNDROME

13

What causes a hypertensive crisis with MAOIs?

When consumed with tyrosine rich foods

14

Why does tyrosine cause a hypertensive crisis with MAOIs?

Is also an amine that is sympathomimetic

15

What must be done when switching an SSRI to a MAOI because of serotonin syndrome?

Must wait 2 - 3 weeks depending on SSRI halflife

16

Example of a MAOI?

Phenelzine

17

Name 6 SSRIs?

Sertraline
Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine

18

Pros of sertraline?

Weak P450 interactions
Short half life
Less sedating

19

Cons sertraline?

GI adverse SE

20

Pros paroxetine?

Short half life
No build up if mania occurs

21

Cons paroxetine?

CYP2D6 inhibition
Sedation
Weight gain

22

Pros fluoxetine?

Long half life
Increases energy
Good to use to wean off SSRIs and prevent discontinuation syndrome

23

What is good about a longer half life in SSRIs?

Less chance of discontinuation syndrome

24

Cons fluoxetine?

Increased chance of metabolite build up

P450 interactions

MORE LIKELY TO CAUSE MANIA!

25

Pro citalopram?

Low P450 interaction
Longer half life than fluoxetine

26

Cons citalopram?

LONG QT

Sedation

GI effects

27

Pros fluvoxamine?

Analgesic properties

28

Cons fluvoxamine?

Short half life
Headache
Strong inhibitor of CYPs

29

4 SNRIs?

Venlafaxine

Duloxetine

Mirtazipine

Bupropion

30

How do SNRIs work?

Inhibit reuptake of serotonin and noradrenaline

31

Pros venlafaxine?

No P450 activity
Good renal clearance
- Better for geriatrics

32

Cons venlafaxine?

Increased BP
Bad discontinuation syndrome
QT prolongation

33

Pros duloxetine?

Good for physical symptoms of depression
Smaller BP increase than venlafaxine

34

Cons duloxetine?

CYP inhibitor
Study indicated high drop out rate

35

Pros mirtazipine?

Good augmentation with SSRI
Hypnotic
Less sexual SE

36

Cons mirtazipine?

Hella weight gain
Increased cholesterol and TAGs
Very sedating at low doses

37

Pros bupropion?

Good augmentation
No weight gain
Low mania chance
Good in ADHD

38

Cons bupropion?

LOWERS SEIZURE THRESHOLD
Does not treat anxiety

39

Pharma regimen for treatent resistant depression?

SSRI + SNRI
+ Lithium
+ antipsychotic

ECT