depression 2 Flashcards
(18 cards)
It a patient has depression and anxiety, what first line MDD me should not be used
anxiety
bupropion inhibits what enzyme, interacting with what drugs
CYP 2D6 inhibitor; tamoxifen ritonavir
what is the MOA of trazodon
5-HT reuptake antagonist; 5HT2A antagonist; enhances 5HT1A neurotransmission
what are some side effects of trazodone
congestion
priapism
orthostatic hypotension
weight gain
what are the therapeutic uses of trazodone? how long are their onsets?
major depression = up to 6 week onset
hypnotic = 1-3 hours for onset
what drug works well with trazodone, increasing its concentration
fluoxetine
trazodone lacks blocking properties of what?
cholinergic receptors and norepinephrine reuptake
why is nefazodone rarely used
hepatotoxicity
If a patient can’t tolerate an SSRI because of nausea, what is another good option?
mirtazapine
what component of mirtazapines MOA leads to weight gain
5HT2C antagonism
mirtazapines antagonism of what site decreases nausea
5HT3
what is the unlabeled use for mirtazipine
PTSD
True/ False:
the higher the dose of mirtazapine the more sedating
false; less sedating at high doses, more sedating at low doses
what are the adverse effects of tricyclic antidepressants
- dry mouth
- blurred vision
- constipation
- urinary retention
- confusion
what is antagonized by tricyclics and what adverse effects do these cause
- H1 histamine antagonism - sedation and weight gain
2. a1-adrenergic antagonism - orthostatic HTN and diaphoresis
Why should suicidal ideation patients not get a 30 day supply of TCA’s
low therapeutic index; can be lethal in overdoses
what are the 4 contraindications with TCAs
- QTc greater than 450
- concomitant use of MAOI in the past 14 days
- patients who are pregnant or lactating
- patients with narrow angle glaucoma
what are the advantages of TCAs for depression
therapeutic levels can be drawn for adherence or toxicity
