(6) Neuro & Psych: Antidepressents (3.1-3.4) Flashcards
Name 4 SSRIs
(1) Fluoxetine
(2) Paroxetine
(3) Sertraline
(4) Citalopram
Name 2 SNRIs
(1) Duloxetine
(2) Venlafaxine
* (Also the “-nacipran” drugs)*
Indications (4) : SSRIs/SNRIs
(1) Depression
(2) Generalized anxiety disorder
(3) Panic disorder
(4) PTSD
Indications (3) : SSRIs (not SNRIs)
(1) OCD
(2) Bulimia
(3) Social anxiety disorder
Indications (3) : SNRIs (not SSRIs)
(1) Diabetic neuropathy
(2) Chronic pain
(3) Fibromyalgia
How long does it take for SSRIs/SNRIs to achieve maximum effect?
1-2 months
Adverse Effects (4) : SSRIs
(1) SIADH
(2) Sexual dysfunction
(3) Weight gain
(4) Drowsiness
What are the symptoms of serotonin syndrome?
(1) Hypertension
(2) Hyperthermia
(3) Hyperreflexia
What are two drug classes which could cause serotonin syndrome when combined with SSRIs/SNRIs?
(1) TCAs
(2) MAO inhibitors
Treatment: Serotonin syndrome
Cyproheptadine
(Considered an H1 antagonist with secondary anti-serotonergic effects)
What is the main side effect of SNRIs?
Hypertension
Rapid withdrawal of SSRIs/SNRIs can cause what?
Flu-like symptoms
Suffix: TCAs
(1) “-pramine”
(2) “-triptyline”
MOA: TCAs
(1) Inhibit NET/SERT
(2) Inhibit muscarinic receptors
(3) Inhibits H1 receptor
(4) Inhibits α1 receptors
Indications (5) : TCAs
(1) Resistant depression
(2) Diabetic neuropathy
(3) Chronic pain
(4) Migraines
(5) OCD
Adverse Effects (8) : TCAs
(1) Sexual dysfunction
(2) Anti-muscarinic effects
(3) Sedation
(4) Weight gain
(5) Orthostatic hypotension
(6) Seizures
(7) Serotonin syndrome
(8) Torsades
Which TCAs have reduced anti-cholinergic effects?
(1) Nortriptyline
(2) Desipramine
Why are TCAs relatively contraindicated in the elderly?
Severe anticholinergic and antihistamine effects
(⇒ Excess sedation)
What is the most common cause of death in TCA overdose?
Fatal arrhythmia
Describe the mechanism of arrhythmia in a TCA overdose
Inhibition of cardiac fast Na+ channels
(∝ Class IC antiarrhythmic)
What would the EKG show in a TCA overdose?
Widened QRS complex
Which antidepressant class is associated with Torsades de Pointes?
TCAs
What is the treatment for widened QRS and arrhythmia in TCA overdose?
Sodium bicarbonate
What does MAOA degrade?
(1) Dopamine
(2) Norepinephrine
(3) Serotonin
What does MAO<strong>B</strong> degrade?
Dopamine
Are MAO inhibitors reversible or irreversible?
Irreversible
Name 3 non-selective MAO inhibitors
(1) Tranylcypromine
(2) Phenelzine
(3) Isocarboxazid
Indications (2) : Non-selective MAOIs
(1) Atypical depression
(2) Treatment-resistant depression
Name a MAOB selective inhibitor
Selegiline
Indication: Selegiline
Parkinsons disease
When taking MAO inhibitors, what type of food should be avoided?
(1) Aged meats
(2) Cheeses
(3) Wine
How is Tyramine usually metabolized?
MAOA in GI tract
Adverse Effects (2) : MAOIs
(1) Hypertensive crisis with Tyramine ingestion
(2) Serotonin syndrome
What drug can be used to manage hypertensive symptoms of tyramine toxicity?
Phentolamine
MOA: Bupropion
Inhibits NET and DAT
What is Bupropion used to treat?
(1) Atypical depression
(2) Tobacco dependence
(3) Somnolence
Adverse Effect: Bupropion
Seizures
Contraindications (2) : Bupropion
(1) Bulimics
(2) Anorexics
Name 2 benefits of Bupropion over other antidepressants
(1) No sexual side effects
(2) No weight gain
* (Also reduces desire to smoke ∴ indicated with comorbid tobacco addiction)*
MOA (4) : Mirtazapine
(1) Inhibits α2 receptors
(2) ↑ Release of 5-HT and NE
(3) Inhibits 5-HT2 and 5-HT3 receptors
(4) Inhibits H1 receptor
Adverse Effects (2) : Mirtazapine
(1) Sedation
(2) Weight gain
What is the benefit of Mirtazapine over other antidepressants?
No sexual dysfunction
(Also causes weight gain ∴ indicated in anorexia)
MOA (4) : Trazodone
Inhibition of:
(1) 5-HT reuptake
(2) 5-HT2 receptors
(3) α1 receptors
(4) H1 receptors
What is the distinctive side effect of Trazodone?
Priapism
Adverse Effects (4) : Trazodone
(1) Orthostatic hypotension
(2) Sedation
(3) Sexual dysfunction
(4) Serotonin syndrome
