Lec 74 Antidepressants Flashcards Preview

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Flashcards in Lec 74 Antidepressants Deck (60)
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31

What is the phrase for anticholinergic toxicity?

red as a beet
dry as a bone
blind as a bat
mad as a hatter
hot as a hare
full as a flask

32

How are TCAs metabolized?

by cyp450
tertiary --> secondary
1/2 life 10-70 hrs

33

What drug-drug interactions with TCAs?

- block effect of antihypertensives
- additive tox with anti-arrhythmics/QTc prolonging agents, anticholinergics, CNS depressants, sympathomimetics

- drugs that increase TCA level: cimetidine, fluoxetine, ritonavir
- drugs that decrease TCA: carbamazepine, rifampin, phenytoin, nictonie, barbituates

MAOIs: wait 14 days between MAOI and TCA

34

What is dosing/monitoring of TCA?

- narrow therapeutic index
- similar dose range and plasma levels for most
- lower doses for pain
- unclear value in monitoring drug levels

35

What are uses for SSRIs?

- depression
- generalized anxiety
- panic disorder
- PTSD
- OCD
- premenstrual dysphoric disorder
- social phobias
- bulimia

36

What is mech of action SSRIs?

bind to serotonin transporter and inhibit reuptake of 5HT into presynaptic nerve terminals

37

What is first aid mnemonic for SSRI names?

Flashbacks paralyze senior citizens
- Fluoxetine
- paroxetine
- setraline
- citalopraom

38

Which SSRI has highest potency for DA?

setraline

39

Which SSRIs have highest potency for NE?

fluvoxamine
paroxetine

40

Which SSRIs are most selective for 5HT reuptake?

citalopram
fluoxetine

41

What are common side effects of SSRIs?

GI distress
sexual dysfunction (anorgasmia and decrease libido)
weight gain
tremor
sweating


serotonin syndrome with any drug that increases 5HT [MAOI, SNRI, TCA] --> hyperthermia, confusion, myoclonus, flushing, diarrhea, seizures

42

What is treatment for serotonin syndrome?

cyproheptadine = 5HT2 receptor antagonist

43

What is metabolism of SSRI?

significant 1st pass
metabolized in liver by CYP enzymes

44

Which SSRIs have less drug-drug interactions?

citalopram and escitalopram

45

Which SSRIs have more drug drug interactions?

fluxoamine

46

Which SSRI has longest half life and least withdrawal?

fluoxetine

47

What are properties of fluoxetine?

- activating, may cause insomnia
- long half life
- least withdrawal symptoms
- more drug-drug interactions than others

48

What are properties of sertraline?

- activating
- mild DA reuptake inhibitor

49

What are properties of paroxetine?

- short half life
- withdrawal symptoms
- control release form available

- blocks NE reuptake, some anti-ACh activity, more sedation, dry mouth, weight gain

50

What happens in SSRI withdrawal? treat?

- if abrupt discontinuation after >6 wks of treatment
- dizziness, weakness, nausea, headache, anxiety, insomnia, paresthesias, flu-like symptoms, muscles aches

usually resolves within 3 wks

can treat with fluoxetine

51

What are advantages of SSRIs over older agents?

standard dosing = easy to titrate
often get clinical response at starting dose
usually not lethal in overdose
no arrhythmias/disturbance in BP/seizure/coma/resp depression
fewer drug-drug interactions
no special diet

52

What is use of SNRIs?

- depression
venlafaxine = also generalzie anxiety + panic disorders
duloxetine = also diabetic peripheral neuropathy

fibromyalgia, painful physical symptoms of depression, stress urinary incontinence, vasomotor symptoms

53

What is mech of SNRIs?

at low dose < 150mg/day act as SSRI
at higher doses --> SNRI = inhibit 5HT and NE reuptake

54

What are side effects of SNRIs?

increase BP [more in venlafaxine than duloxetine], stimulant effects, sedation, nausea

55

What is unique about bupropion's side effects?

no sexual dysfunction or weight gain

stimulant effects: tachycardia, insomnia; headache, seizure in bulimic pts

56

What are side effects of mirtazapine?

Sedation [may be desirable in depressed pts with insomnia]

increased appetite, weight gain [may be desirable in elderly or anorexic]

dry mouth

57

What is use of mirtazapine?

- depression
- insomnia
- appetite stimulation

58

Which anti-depressant is known for its priapism effects?

trazodone

59

What causes the therapeutic delay in onset of antidepressant action?

downregulation of serotonergic receptors

may enhance neruonal regeneration process + restore cortical dendrites

60

Which type of antidepressants best for co-morbid pain disorders?

SNRI