519-520: Psych Drugs 2 Flashcards
Name 4 SSRI’s
Fluoxetine
Paroxetine
Sertaline
Citalopram
“Flashbacks paralyze senior citiznes”
What are the clinical uses for SSRIs?
Depression GAD Panic disorder OCD Bulimia Social Phobias PTSD
How long does it take for antidepressants to take effect?
4-8 weeks
Are SSRIs or TCAs more toxic?
TCAs
What are the toxicities of SSRIs?
GI distress
Sexual dysfunction (anorgasmia, ↓ libido)
Serotonin syndrome
What drugs can cause serotonin syndrome?
Any drug that ↑ SSRIs (e.g. MAO inhibitors, SNRIs, TCAs)
What are the symptoms of serotonin syndrome?
seizures
myoclonus
confusion
hyperthermia
flushing
cardiovascular collapse
diarrhea
What do you treat serotonin syndrome?
Cyproheptadine (5-HT2 receptor antagonist)
List 2 SNRIs
Venlafaxine, duloxetine
Mechanism of SNRIs:
Inhibit 5-HT and NE reuptake
Clinical use of SNRIs:
Depression
GAD and panic disorder - venlafaxine
Diabetic peripheral neuropathy - duloxetine
Toxicity of SNRIs:
Stimulant effects
Nausea
Relaxxation (sedation)
Increased BP - most common
List as many TCAs as you can:
-triptyline: amitriptyline, nortriptyline
-imprame: imipramine, desipramine, clomipramine
doxepin, amoxapine
Mechanism of TCAs:
Block reuptake of NE and 5-HT
Clinical use of TCAs:
Major depression
OCD (clomipramine)
Fibromyalgia
Toxicities of TCAs:
Anticholinergic: tachycardia, urinary retention, dry mouth; confusion and hallucinations in elderly α1-blocking effects (e.g. postural HTN) Respiratory depression Hyperprexia Sedation
Tri-C’s: convulsions, coma, cardiotoxicity (arrhythmias)
Name the MAO inhibitors
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)
(MAO Takes Pride In Shanghai)
MAO inhibitor effects on levels of amine transmitters:
↑ levels of NE, 5-HT, dopamine
Clinical use of MAO inhibitors:
Atypical depression
Anxiety
Hypochondriasis
Toxicities of MAO inhibitors:
Hypertensive crisis (esp. w/ tyramine ingestion)
CNS stimulation
Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)
What is the difference in side effect profiles between second and third generation TCAs?
third generation TCAs (amitriptyline) have more anticholinergic effects than second (nortriptyline)
List three atypical antidepressants
Bupropion, mirtazapine, trazodone
What are the clinical uses for bupropion?
Depression, smoking cessation
What neurotransmitters are involved in the actions of bupropion?
↑ NE and dopamine (unknown mechanism)
What are the toxicities of bupropion?
stimulant effects (tachycardia, insomnia)
headache
seizure in bulimic paitents
Regarding its side effect profile, what is an advantage to the use of bupropion for treating depression?
no sexual side effects
What receptor does mirtazapine act on, and what neurotransmitters are involved?
α2-antagonist (↑ release of NE and 5-HT)
Toxicity of mirtazapine
Sedation
↑ appetite
Weight gain
Dry mouth
Which antidepressant might you consider using for a depressed patient with insomnia?
mirtazapine
Which antidepressant might you consider using for a depressed patient with anorexia, or an elderly patient who is in danger of wasting away?
mirtazapine - it causes weight gain
What is the mechanism of trazodone?
Primarily blocks 5-HT and α1-adrenergic receptors
What are the clinical applications for trazodone?
Insomnia is the primary use b/c high doses are needed for antidepressant effects
What are the toxicities of trazodone?
sedation
nausea
priapism (“trazobone”)
postural hypotension
