psychopharm3 Flashcards
(50 cards)
amitryptaline
Elavil; TCA (tertiary amine); useful in chronic pain, migraines, and insomnia
imipramine
tofranil; TCA (tertiary amine); has IM form; useful in enuresis and panic disorder
clomipramine
anafranil; TCA (tertiary amine); most seratonin specific, useful in treatment of OCD
doxepin
sinequin; TCA (tertiary amine); useful in treatment of chronic pain; emerging use as a sleep aid in low doses
examples of secondary amine type of TCA
metabolites of tertiary amines (less anticholinergic, less sedating); nortryptline, desipramine
nortryptaline
pemlor, aventyl; secondary amine TCA; least likely to cause orthostatic hypotension; useful in treating chronic pain
desipramine
norpramin; TCA secondary amine; more activating, least sedating; least anticholinergic
what are the tetracyclic antidepressants
amoxapine, maprotiline
amoxapine
tetracyclic antidepressant; Ascendin; metabolite of antipsych loxapin; may case EPS and has similar side effect profile to typical antipsychotics
maprotiline
tetracyclic antidepressant; ludiomil; higher rates of seizure, arrhythmia, and fatality in overdose;
why do TCAs have so many side effects?
they are highly protein bound and lipid soluble, and therefore can interact with other meds that have high protein binding ability
what are the TCA side effects?
antihistamine (sedation); antiagrenergic (cardiovascular, incl ECG changes); antimuscarinic (aka anticholinergic); weight gain; seizures; seratonergive effects
TCAs should be avoided in what patients
those with cardiac abnormalities or recent MI
what happens when you OD on TCAs
agitation, tremors, ataxia, delirium, hypoventalation from CNS depression, myoclonus, hyperreflexia, seizures, and coma
seizures and TCAs
more common with clomipramine and tetracyclics
what are the seratonergic side effects of TCAs
erectile/ejaculatory dysfunction; anorgasmia in females
how do MAOIs work?
prevent th einactivation of norepi, serotonin, dopamine, and tyramine
what is tyramine
intermediate in the conversion of tyrosine to norepi
difference between MAOI-A and B
A preferentially deactivates seratonin, and MAO-B preferentially deactivates norepi and epi; both types also act on dopamine and tyramine
examples of MAOIs
phenelzine (nardil); tranylcypromine (parnate); isocarboxazid (marplan)
side effects of MAOIs
seratonin syndrome when SSRIs and MAOIs are taken together; hypertensive crisis when MAOIs are taken with tyramine-rich foods or sympathomimetics
seratonin syndrome
initially lethargy, restlessness, confsion, flushing, sweating, tremor, and myoclonic jerks; may progress to hyperthermia, hypertonicity, rhabdo, renal failure, convuslions, coma, death
how to avoid seratonin syndrome
wait at least 2 weejs before switching from SSRI to MAOI and at least 5-6 weeks with fluoxeitne
foods with tyramine
red wine, cheese, chicken liver, fava beans, cured meats
