Antidepressants and Mood Stabilizers (Segars) Flashcards
(32 cards)
What can occur with sudden discontinuation of antidepressant medication?
withdrawal syndrome, including symptoms: F - flu-like symptoms I - insomnia N - nausea I - imbalance S - sensory disturbances H - hyperarousal
How should you discontinue antidepressant medications?
“deprescribing,” a slow titration downward
Indication for bupropion besides depression
nicotine withdrawal
indication for imipramine besides depression
enuresis
indications for duloxetine besides depression (4)
1) diabetic peripheral neuropathy
2) fibromyalgia
3) chronic musculoskeletal pain
4) stress incontinence
SSRI that is also a partial agonist of 5-HT1A
Vilazodone
SSRI that is also a partial agonist of 5-HT1B and full agonist of 5-HT1A/5-HT1D,3,7
Vortioxetine
Concerns with SSRI and sudden termination of medication
acute withdrawal reactions (concern with all categories)
serious side effects SSRI (2)
1) serotonin syndrome
2) suicidality (highest risk in children/adolescents/young adults)
When taking an SSRI, when are you at the greatest risk for serotonin syndrome?
when given concurrently with other “serotonin-affecting” agents (MAOIs, TCAs)
Describe serotonin syndrome symptoms (4)
1) sweating
2) hyperreflexia
3) akathisia/myoclonus
4) shivering/tremors
SSRI with highest risk of CYP450 drug-drug interactions
Fluoxetine
SSRIs (2) with lowest risk of CYP450 drug-drug interactions
1) Vortioxetine
2) escitalopram
TCA affects which receptors
1) inhibit serotonin and norepinephrine reuptake via SERT/NET
2) block H1 receptors
3) block muscarinic receptors
4) block alpha 1 adrenergic receptors
TCA side effects due to alpha 1 adrenergic blockade
cardiovascular:
- tachycardia
- orthostatic hypotension
- dysrhythmias
TCA side effects due to muscarinic blockade
anticholinergic
- dry mouth
- urinary retention/constipation
- blurred vision/increased IOP
TCA side effects due to histamine (H1) blockade
CNS
- sedation/fatigue
- dizziness/seizures
Symptoms of toxic ingestion of TCAs (3)
1) coma
2) cardiotoxicity
3) convulsions
“quinidine-like” effect due to sodium channel blockade
important side effect of Bupropion
seizures
Major side effect of MAOIs
hypertensive crisis (especially with excessive tyramine consumption)
MAOIs drug interactions and how to prevent them
5-HT/NE affecting drugs
- need 2 week wash-out period of other drugs before starting MAOIs (fluoxetine; 5 weeks)
signs/symptoms of hypertensive crisis
- severe HA
- n/v
- sweating/severe anxiety
- nosebleeds
- tachycardia
- chest pain/SOB
Foods containing tyramine
- aged cheeses
- wine
- fermented meats
Lithium drug class
mood stabilizer
