week3 anti depressants Flashcards

(18 cards)

1
Q

Fluoxetine

moa, clinical use, side effects, must knows

A

MOA: SSRI – blocks serotonin reuptake

Use: Depression, bulimia, OCD, panic disorder, PTSD

Side Effects: Insomnia, sexual dysfunction, GI upset, anxiety

Must-Knows:
approved for teens
Longest half-life (weeks); ideal for poor compliance

expreSS tRIps: selective serotonin reuptake inhibitors (SSRIs) 2. Fly out: fluoxetine (SSRI) 3. Parrot: paroxetine (SSRI) 4. Desert Airline: sertraline (SSRI) 5. City: citalopram (SSRI) 6. Smiley face: serotonin (5-HT) 7. Keeping post-it out of the drawer: SSRIs inhibit the presynaptic reuptake of serotonin (5-HT)
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2
Q

sertraline

A

MOA: SSRI

Use: Depression, anxiety, PTSD, OCD, panic disorder

Side Effects: GI distress (very common), sexual dysfunction

Must-Knows:

Most GI side effects among SSRIs

Often used postpartum; low drug transfer in breast milk

expreSS tRIps: selective serotonin reuptake inhibitors (SSRIs) 2. Fly out: fluoxetine (SSRI) 3. Parrot: paroxetine (SSRI) cropped symbol image 3 4. Desert Airline: sertraline (SSRI) 5. City: citalopram (SSRI) 6. Smiley face: serotonin (5-HT) 7. Keeping post-it out of the drawer: SSRIs inhibit the presynaptic reuptake of serotonin (5-HT)
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3
Q

citalopram

A

MOA: SSRI

Use: Depression, anxiety

Side Effects: QT prolongation, sexual dysfunction, dry mouth

Must-Knows:

Dose-dependent QT prolongation

Avoid in patients with cardiac risk or on QT-prolonging drugs

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4
Q

escitalopram

A

MOA: SSRI (S-enantiomer of citalopram)

Use: Depression, GAD

Side Effects: Generally well tolerated; mild QT prolongation

Must-Knows:

Fewer drug interactions than citalopram

Cleanest SSRI for side effects; often first choice- approved for teens

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5
Q

paroxetine

A

MOA: SSRI

Use: Depression, GAD, panic, PTSD, PMDD

Side Effects: Sedation, weight gain, anticholinergic effects

Must-Knows:

Worst withdrawal syndrome (short half-life)

Avoid in pregnancy (Category D – teratogenic)

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6
Q

fluvoxamine

A

MOA: SSRI

Use: OCD (primary), social anxiety

Side Effects: GI upset, sedation, sexual dysfunction

Must-Knows:

CYP1A2 and CYP3A4 inhibitor → many drug interactions

Less used for depression

expreSS tRIps: selective serotonin reuptake inhibitors (SSRIs) 2. Fly out: fluoxetine (SSRI) 3. Parrot: paroxetine (SSRI) 4. Desert Airline: sertraline (SSRI) 5. City: citalopram (SSRI) 6. Smiley face: serotonin (5-HT) 7. Keeping post-it out of the drawer: SSRIs inhibit the presynaptic reuptake of serotonin (5-HT)
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7
Q

vortioxetine

A

MOA: SSRI + 5-HT1A partial agonist, 5-HT3 antagonist

Use: Major depressive disorder

Side Effects: Nausea, constipation, sexual dysfunction

Must-Knows:

Cognitive-enhancing effects (may help with “brain fog”)

Less weight gain than older SSRIs

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8
Q

vilazodone

A

MOA: SSRI + 5-HT1A partial agonist

Use: Depression

Side Effects: GI upset, sexual dysfunction, insomnia

Must-Knows:

Take with food for proper absorption

Risk of serotonin syndrome when combined with other serotonergic drugs

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9
Q

List common SSRI’s

A

Fancy Fluoxetine
Cool Citalopram
People Paroxetine
Find Fluvoxamine
Super Sertraline
“Calm”
Escitalopram Emotions
very Vortioxetine
vibrant Vilazodone

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10
Q

venlafaxine

A

MOA: SNRI – Inhibits 5-HT and NE reuptake (NE effect stronger at higher doses)

Clinical Use:
Major depressive disorder
Generalized anxiety disorder
Panic disorder
Social anxiety
PTSD

Side Effects:
Increased BP (dose-dependent)
Insomnia, anxiety, GI upset
Sexual dysfunction
Discontinuation syndrome if stopped abruptly

Must-Knows:
Avoid in hypertensive patients

**Short half-life **→ taper slowly to avoid withdrawal symptoms

Fax machine: venlafaxine (SNRI) 9. Dual copier/scanner: duloxetine (SNRI) 10. North and South: SNRIs (e.g. venlafaxine, duloxetine) inhibit the presynaptic reuptake of norepinephrine and serotonin 11. Happy and sad masks: SSRIs and SNRIs are first line agents for the treatment of depression
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11
Q

duloxetine

A

MOA: SNRI – Balanced inhibition of 5-HT and NE reuptake

Clinical Use:
Depression +** chronic pain**
Diabetic peripheral neuropathy
Fibromyalgia
Chronic musculoskeletal pain

Side Effects:
Nausea, dry mouth
Fatigue, dizziness
Hepatotoxicity (rare)
Mild ↑ in BP

Must-Knows:
Great for patients with depression + pain
Avoid in patients with liver disease
Fewer sexual side effects than SSRIs

Fax machine: venlafaxine (SNRI) 9. Dual copier/scanner: duloxetine (SNRI) 10. North and South: SNRIs (e.g. venlafaxine, duloxetine) inhibit the presynaptic reuptake of norepinephrine and serotonin 11. Happy and sad masks: SSRIs and SNRIs are first line agents for the treatment of depression
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12
Q

desvenlafaxine

A

MOA: SNRI – Active metabolite of venlafaxine

Clinical Use:
Major depressive disorder

Side Effects:
Similar to venlafaxine: ↑ BP, GI upset, insomnia

Must-Knows:
No advantage over venlafaxine, but has more predictable pharmacokinetics
Useful when patients can’t tolerate venlafaxine’s metabolism

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13
Q

levomilnacipran

A

MOA: SNRI – Inhibits NE > 5-HT reuptake (unlike others)

Clinical Use:
Major depressive disorder

Side Effects:
Nausea, constipation
Increased HR and BP
Sexual dysfunction

Must-Knows:
Stronger norepinephrine activity → may cause sympathetic side effects
Less commonly used SNRI
Avoid in uncontrolled hypertension

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14
Q

Bupropion

A

norepinephrine dopamine reuptake inhibitor
short half life
side effects- jitteriness
less sexual SE.
also used for smoking cessation.

"NET DAT ball": bupropion inhibits the norepinephrine transporter (NET) and the dopamine transporter (DAT) 2. Pro ball player: bupropion (atypical antidepressant) 3. Aroused from sleep: bupropion exerts CNS activating effects 4. "Pros don't smoke": bupropion can be used to treat tobacco dependence 5. Shaking: bupropion can induce seizures 6. Shaking binge snacker: bupropion is contraindicated in bulimia (may induce seizures) 7. Shaking skinny player: bupropion is contraindicated in anorexia nervosa (may induce seizures) 8. Kissing couple: bupropion does not cause sexual dysfunction 9. "Lose weight": bupropion is less likely to cause weight gain
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15
Q

Trazodone

A

moa- 5-HT and NE reuptake inhibition, alpha-1 and alpha-2, muscurinix and histamine antagonism

side effects- rare priapism

uses- insonmia becuase of its powerful sedation effects

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16
Q

Mirtazepine

A

tetracyclic antidepressant, alpha 2 and 5-HT antagonist

side effects- appetite stimulation, fewer sexual SE, low dose, more sedation.

17
Q

Amitriptyline, Desipramine, Doxepin, Imipramine, Nortiptyline-
MOA
Clinical Use
Side Effects

A

MOA- 5-HT and NE reuptake inhibition, Alpha-1&2, muscurinic, His antagonism

USE- antidepressant, neuropathic pain

AE- anticholinergic, antihistamine (sedation), alpha 1 anatgomsin(orthostatic hypotension, 3 C’s= cv arythmia, convulsions, coma

1. Tricycle: tricyclic antidepressants (TCAs) 2. Imprint: imipramine (and derivatives desipramine, clomipramine - TCAs) 3. Tripping: amitriptyline, nortriptyline 4. Prevented from picking up smiley face and compass balls: TCAs inhibit presynaptic uptake of serotonin and norepinephrine 5. Happy and sad masks: TCAs can be useful in treatment resistant depression 6. Resistant door: TCAs can be useful in treatment resistant depression 7. Pain from Diasweeties machine: TCAs treat diabetic neuropathy 8. Chronically frayed wire: TCAs treat chronic pain (e.g. neuropathic pain) 9. Pounding head bell: TCAs can be used for migraine prophylaxis 10. Obsessively neat: clomipramine (TCA) treats OCD (SSRIs first line) 11. Rejected advances: TCAs can cause sexual dysfunction 12. Anti-muscarinic tea party: TCAs inhibit muscarinic acetylcholine receptors → dry mouth, constipation, blurred vision, urinary retention 13. Northside Prep: nortriptyline and desipramine (secondary amines) 14. Protected by secondary sign: secondary amines (e.g. nortriptyline and desipramine) are associated with less cholinergic effects 15. Confused elderly: TCAs are relatively contraindicated in elderly patients due to severe anticholinergic and antihistamine effects 16. Bee swatter: TCAs block H1 histamine receptors 17. Hefty kid: TCAs can cause increased appetite and weight gain 18. Sleeping kid: TCAs can cause sedation 19. Extinguished alpha flame: TCAs block alpha-1 receptors 20. Passed out: TCAs can cause orthostatic hypotension 21. Broken hearts: TCAs induced cardiotoxicity (e.g. fatal cardiac
18
Q

isocarboxazid, phenelzine, selegiline, tranycycpromine-
MOA
clinical Use
Side EFFECTS

A

MOA- inhibit NT degrdation in synaptic cleft by MAO-A/b

antidepressive for resistant depression, pain

serotenergic, noradrenergic, alpha 1 blockage, antihistaminergic, HYPERTENSIVE CRISIS, tyramine containing foods

Albino mouse: monoamine oxidase A (MAO-A) cropped symbol image 1 2. Albino mouse eating smiley face: MAO-A breaks down serotonin cropped symbol image 2 3. Albino mouse eating north compass: MAO-A breaks down norepinephrine cropped symbol image 3 4. Albino mouse eating rope: MAO-A breaks down dopamine cropped symbol image 4 5. Black mouse: MAO-B cropped symbol image 5 6. Black mouse eating rope: MAO-B breaks down dopamine cropped symbol image 6 7. Mouse trap: MAO inhibitors cropped symbol image 7 8. Irreversible trap: MAO inhibitors are irreversible cropped symbol image 8 9. "Try a sip of wine": tranylcypromine (MAO inhibitor) cropped symbol image 9 10. Funnel: phenelzine (MAO inhibitor) cropped symbol image 10 11. Boxed wine: isocarboxazid (MAO inhibitor) cropped symbol image 11 12. Happy and sad masks: MAO inhibitors can treat depression (not first line) cropped symbol image 12 13. "Not typical": MAO inhibitors may be useful in atypical depression cropped symbol image 13 14. Resistant wine bottle: MAO inhibitors can be useful in treatment resistant depression cropped symbol image 14 15. Sledge hammer: selegiline (selective MAO-B inhibitor) cropped symbol image 15 16. Brain tied with rope: selegiline (selective MAO-B inhibitor) increases dopamine levels in the CNS cropped symbol image 16 17. Cog wheels: selegiline is useful in the management of Parkinson's disease (increases dopamine levels in the CNS) cropped symbol image 17 18. Aged meats, wine, cheese: MAO inhibitors should be avoided with these tyramine containing foods cropped symbol image 18 19. Albino mouse eating GI meat: tyramine is normally broken down by MAO-A in the GI tract cropped symbol image 19 20. Trap releasing north compass cheeses: in the presence of MAO inhibitors, tyramine enters the circulation and acts as a sympathomimetic agent cropped symbol image 20 21. Hypertensive and sweaty: tyramine toxicity can precipitate a hypertensive cri