CNS Part 2 Flashcards
(24 cards)
What is the dosing schedule recommended for fluoxetine?
Avoid taking in the evening or before bedtime due to sleep impairment
What is the initial dose recommended for fluoxetine?
20 mg/day
Which SSRI has the longest half-life and the least potential for withdrawal?
Fluoxetine
What are the withdraw side effects of SSRIs?
F – flu like
L – lightheadedness
U – uneasiness
S – Sleep/sensory disturbance
H - headache
Which SSRI has more of a risk of causing moderate sedation?
Fluvoxamine
Which SSRI has little potential for drug interactions and is one of the more serotonin specific?
Citalopram
Which SSRI is approved for OCD and social anxiety?
Fluvoxamine
Which SSRI is the active enantiomer of Citalopram?
Escitalopram
Which SSRI is used in general anxiety in adults and major depressive disorder in adolescents and adults?
Escitalopram
What issues does SSRIs cause in neonates in pregnancy?
They can be used but the neonate may go through withdrawal
Which SSRI has less risk of pregnancy effects?
Fluoxetine
Which SSRI has an increased risk for pregnancy effects?
Paroxetine
What issues are associated with the pediatric population in SSRIs?
They can increase the risk of suicide
What are the drugs examples of Tricyclic Antidepressants (TCA)?
- Imipramine (Tofranil)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Amitryptyline (Elavil)
- Doxepin (Sinequan)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
What is the mechanism of action of TCAs?
Block neuronal reuptake of two monoamine transmitters (NE / Serotonin)
What are the therapeutic uses of TCAs?
Major depression, bipolar disorder, neuropathic pain, chronic insomnia, attention-deficit/hyperactivity disorder, and panic disorder
What are the adverse effects of TCAs?
o Orthostatic hypotension
o Anticholinergic effects
o Diaphoresis
o Sedation
o Tachycardia, arrhythmias
o Seizures (rare)
o Hypomania
o Suicide Risk (especially in peds population)
o Weight gain (some)
What are the major toxicity effects of TCAs?
- Blockade NE reuptake at synapse
- Direct α-adrenergic blockade
- Block Na-membrane channels
What is the lethal dose of TCAs?
It is 8 times the average daily dose
What are the contraindications of TCAs?
Acute recovery from MI
Conduction blocks
Severe hepatic and renal impairment
Narrow angle glaucoma
Urinary dysfunction
Thyroid disease
When should TCAs be taken?
At bedtime due to sedating side effects
What should be discussed with patients before taking TCAs?
Discuss sexual dysfunction side effects before starting therapy
Anticholinergic effects can cause urinary retention and worsen BPD symptoms
TCAs act as potent anticholinergics. What common side effects does this produce?
The main adverse effects of TCA’s are related to the antimuscarinic properties which produce dry mouth, blurred vision, constipation, urinary retention, hypotension, and sedation
Would an SSRI or a TCA be indicated in a patient with chronic insomnia and MDD?
TCA
