Meds Flashcards
(53 cards)
BOXED WARNING: antidepressants increase the risk compared to placebo in suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders
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Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Escitalopram
Selective Serotonin Reuptake Inhibitors (SSRI’s)
Onset of action takes 3-8 weeks (or even longer in some cases)
Selective Serotonin Reuptake Inhibitors (SSRI’s)
Most activating SSRIs?
: fluoxetine and sertraline
does in morning, avoid in patients with troubl sleepign
Most sedating SSRIs?
: paroxetine and fluvoxamine
does in evening
SSRIs can cause weight gain. Which is the worst?
paroxetine
Sexual dysfxn
CNS events (agitation, anxiety, panic esp. in early phase)
Weight gain
Seratonin syndrome (rare but severe)
SSRI adverse events
Serotonin syndrome… triad of cognitive effects, NM and autonomic dysfxn
-Cognitive Confusion Agitation Coma Anxiety
-NM myoclonus hyperreflexia muscle rigidity tremors
-Autonomic hyperthermia diaphoresis sinus tachy HTN
Avoid abrupt d/c of SSRIs (exception is fluoxetine)
What SSRI may cuase QT prolongation at doses higher than 40 mg?
citalopram
SNRIs?
duloxetine
venlafaxine
TCAs CIed in?
pts w/ SI, CV condtions, closed angle glaucoma, urinary retention, severe prostate hypertrophy
NDRI?
Buproprion
Associated with less sexual dysfunction than other anti-depressants
Contraindication: patients at risk for seizures including patients with seizure disorders, history of anorexia or bulimia, or using or withdrawing from medications such as alcohol or benzodiazepines
Buproprion
Serotonin Receptor Antagonists
Trazodone
Mirtazapine
Nefazodone
Used for depression, typically with an SSRI, profound sedative effect
Mirtazapine
Used for anxious depression, or when SSRI causes too much sexual dysfunction
Black box warning for liver failure
Nefazodone
Clinical Use: Atypical depression (hypersomnia, hyperphagia, and mood reactivity)
Patients refractory to other anti-depressant agents
Monoamine Oxidase Inhibitors (MAOI’s)
Hypertensive crisis induced by MAOIs is considered a medical emergency
Interactions: the infamous food-drug interactions caused by these medications occur because they inhibit MAO in the GI track that normally breakdown tyramine
Hypertensive Crises: increased levels of catecholamines, which can be the result of ingestion of tyramine containing foods
Serotonin Syndrome: when levels of 5HT become too high usually as the result of multiple serotonergic agents
Weight gain
Sexual dysfunction
Monoamine Oxidase Inhibitors (MAOI’s)
Adequate trial of any agent includes full therapeutic doses for 2-8 weeks and in some cases for up to 12 weeks
If no response at that point, the drug can be considered a failure
Antidepressants:
Response and Remission: usually defined as a 50% reduction in symptoms
Short Term (acute): goal is to resolve symptoms (usually takes 4-6 weeks)
Continuation: keep symptoms in remission by using full-dose therapy (continues 4-9 additional months)
Maintenance: long-term therapy at full doses that are required in high-risk patients to prevent relapse
Antidepressants:
effective for treatment resistant depression
Lithium:
One study linked ___ in the third trimester to low birth weight; generally considered safe
fluoxetine (antiDs)
___ is associated with heart defects
Paroxetine (antiDs)
Response to medications is NOT immediate, maximal treatment response may take 6 months or longer to be observed
After treatment response observed; maintain current therapy for a minimum of 6 months
Antipsychotics
atypical first, unless pt has strong histroy w/ typical
