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Flashcards in PHARMA antidepressants Deck (90):
1

Main classes of antidepressants

A Selective Serotonin Reuptake Inhibitor (SSRIs); B Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs); C Tricyclics (TCAs) (pramines & -tryptylines); D 5-HT2 Antagonists (-zodones); E Tetracyclics/Unicyclics; F Monoamine Inhibitors (MAOIs)

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1 Citalopram

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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2 Escitalopram

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

4

3 Fluoxentine*

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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4 Fluvoxamine

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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5 Paroxentine

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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6 Sertraline

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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7 Vilazodone

A SELECTIVE Serotonin Reuptake inhibitors (SSRIs)

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MOA of SSRIs

Selective blockage of SERT, little effect in NET and beta adrenergic receptors

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SSRI with longest half life

Fluoxentine

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SSRI with highest bioavailability

FluVoxamine (bioaVailability)

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SSRI with highest volume of distribution

Paroxentine

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SSRI na potent inhibitor of CYP206, with higest drug interactions

FluvoXamine & ParoXentine (with X = enzyme inhibitor)

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SSRI that causes weight GAIN and cardial septal defect

Paroxentine

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SSRI that causes dizziness and paresthesias

Sertraline and Paroxentine

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SSRI adverse effect related to reproduction

sexual dysfunction

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SSRI that significantly improves anxiety symptoms

Citalopram

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Most potent SSRI

Escitalopram

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SSRI that causes weight LOSS

Fluoxentine

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Clinical use of Fluvoxamine (SSRI)

used in OCD and panic disoders

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Clinical use of Paroxentine (SSRI)

anticholinergic function; sedating

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SSRI na taken with food to increase absorption, causes nausea

Sertraline

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1 Duloxetine* class

B Serotonin-Norepinephrine Reuptake inhibitors (SnRIs)

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2 Milnacipran class

B Serotonin-Norepinephrine Reuptake inhibitors (SnRIs)

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3 Venlafaxine class

B Serotonin-Norepinephrine Reuptake inhibitors (SnRIs)

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4 Desvenlafaxine class

B Serotonin-Norepinephrine Reuptake inhibitors (SnRIs)

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MOA of SNRIs

moderate selective blockade of SERT and NET

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Half life of Venlaxagine and Desvenlaxagine (SNRIs)

11-12 hours, short half life but dosing is still OD

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SNRI shortest t1/2 & highest bioavailability

Milnacipran

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SNRI na highest volume of distribution & most protein-bound; once daily dosing

Duloxetine

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SNRI na lowest protein binding

Venlafaxine and Desvenlafaxine

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SNRI na conugated

Desvenlafaxine

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Most common adverse effects of SNRI

Anticholinergic like dry mouth, constipation, urinary retention, blurred vision, confusion

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SNRI that causes cardiac toxicity

Venlafaxine

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SNRI that causes hepato toxicity

Duloxentine

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Contraindication of SNRI

MAOIs

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SNRI that elevates TCA levels

Duloxentine

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Clinical use of Duloxentine (SNRI)

Urinary stress incontinence

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Clinical use of Venlafaxine and Desvenlafaxine

Vasomotor symptoms of menopause

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1 Imipramine*

C Tricyclic

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2 Clomipramine*

C Tricyclic

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3 Desipramine

C Tricyclic

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4 Trimipramine

C Tricyclic

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5 Amitryptyline

C Tricyclic

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6 Nortriptyline

C Tricyclic

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7 Protryptyline

C Tricyclic

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8 Doxepin

C Tricyclic

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MOA of tricyclics

same with SNRI but less adverse effects

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Tricyclics have long half lives Pero sino yung shortest half life sakanila?

Imipramine (imi mini miney moe Shortie hahaha)

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TCA with shortest t1/2 but highest volume of distribution

Imipramine

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TCA with no active metabolites but with wide therapeutic window

Desipramine and Nortryptyline

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alpha blocking effect of anti depressants causes what

Orthostatic hypotension

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h1 antagonism effect of anti depressants causes what

Weight gain and sedation

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TCA with sexual effects

Clomipramine

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TCA that causes weight gain and sedation

Doxepine

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1 Nefazodone

D 5 HT 2 Antagonists

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2 Trazodone

D 5 HT 2 Antagonists

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Nefazodone and Trazodone MOA

Inhibition of 5-HT2A receptor

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5HT2 antagonist that causes sedation

Trazodone

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5HT2 antagonist that causes hepatotoxicity

Nefazodone

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5HT2 antagonist that causes PRIAPISM

Trazodone

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1 Bupropion

E Tetracyclics / Unicyclics

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2 Amoxapine

E Tetracyclics / Unicyclics

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3 Maprotiline

E Tetracyclics / Unicyclics

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4 Mirtazapine

E Tetracyclics / Unicyclics

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Tetracyclic with biphasic elimination

Bupropion

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Tetracyclic with shortest half life

Amoxapine

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Amoxapine adverse effect (tetracyclic)

Parkinsonian syndrome

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Mirtazapine adverse effect (tetracyclic)

Sedation

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TCA-like tetracyclics

Maprotiline and Amoxapine

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1 Isocarboxazid

F MAO inhibitor

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2 Phenelzine

F MAO inhibitor

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3 Tranylcypromine

F MAO inhibitor

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4 Selegiline

F MAO inhibitor

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5 Moclobemide

F MAO inhibitor

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MAOIs most common adverse effect

hypotension & weight gain

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MAOIs drug interaction

Serotonergic agents - causing SEROTONIN SYNDROME

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Indication for use of Antidepresants

Major depression

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What to use for post traumatic stress disorder

SSRIs

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What to use for OC DISORDER

SSRIs

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What to use for SOCIAL ANXIETY DISORDER

SSRIs, Venlafaxine

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What to use for PAIN DISORDER

TCAs, Duloxetine, Milnacipran

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What to use for PRE MENSTRUAL DYSPHORIC DISORDER

Fluoxetine, Sertraline

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What to use for SMOKING CESSATION

Bupropion

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What to use for BULIMIA

Fluoxetine, Bupropion (weight loss)

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What to use for URINARY STRESS INCONTINENCE

Duloxetine

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What to use for PERIMENOPAUSAL EFFECTS

Desvenlafaxine, Venlafaxine, Nefazodone

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What to use for PREMATURE EJACULATION

SSRIs

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Order of choice of antidepressants

SSRIs then SNRIs then Bupropion then Mirtazapine

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Order of choice of antidepressants with least association with side effects

Bupropion then Mirtazapine then Nefazodone