Antidepressant Deck 2 Flashcards
TCA are
very sedating and are lethally in overdose.
SSRIs
most common
SSRIs work at what bases
1st, 2nd, and 3rd
SSRI LEA…P effects
L: Decrease libido and sleep
E: Neutral effect on energy*
A: Neutral effect on addiction and craving
Which SSRI can you stop abruptly and why
fluoxetine due to it’s long half life.
SSRI P in LEAP
y P: Differences within class
y Some may “poop out (just stops working)” (Celexa)
y Sedating and activating properties
y Weak anticholinergic and dopaminergic
y Fluoxetine activating, Paroxetine sedating
Fluoxetine is
activating
paraoxetine is
sedating
NSRI act on what bases
Act at 1st, 2nd, 3rd, home plate and pitcher’s mound
NSRI exampels
Venlafaxine (Effexor) and Duloxetine (Cymbalta)
NSRI effects
y Libido reduced
y Energy increased
y Addiction/craving neutral to helpful
NSRI “P”
May increase GI upset, may increase BP
y Titrate slowly
SNDRIs
Triple reuptake inhibitor results in increase in serotonergic, adrenergic and dopaminergic neurotransmission
SNDRI LEAP
L:More neutral effect on libido (blocks 5HT2a)
E:Decreases energy
A:Neutral effect on addiction/craving
P: Enzyme system 2D6: slow metabolizers may build up stimulate 5HT2 and stimulate 5HT2a and cause increased sleep
y Alpha 1 blocker: postural hypotension risk
SNDRI examples
Mazindol (Sanorex) anorectic
Nefazodone (Serzone) antidepressant*
Nefopam ( Nefadol, Silentan) analgesic
Sibutamine (Meridia) anorectic
TCA bases
Act primarily at 1st base, some 2nd and home plate
TCA LEAP
y L: decrease libido y E: increase energy* y A: Neutral effect y P: May stimulate HT3 y Anticholinergic effects (Elderly especially) y High risk of OD
at a high dose TCA is
sedating
TCA should not be used in
elderly population due to anticholinergic effects
Which has greater side effects amytriptaline or nortriptaline
amytriptaline
Mirtazepine (Remeron) LEAP
L:Neutral effect on libido
E:Decreases energy
A: Neutral on addiction/craving
P: Alpha 1 blocker: postural hypotension risk
Mirtazepine (Remerone) acts at what bases
Acts at 1st, 2nd, 3rd base, and homeplate
Remerone is a
alpha 1 blocker : postual hypotension risk
Bupropion (wellbutrin acts to
to inhibit reuptake of NE, DA, and serotonin
Bupropion (Wellbutrin) uses
Depression, seasonal affective disorder, treats sexual dysfunction
relative to SSRI therapy, smoking cessation
Bupropion (Wellbutrin) has a
long half life
Bupropion (Wellbutrin) lowers
seizure threshold
SSRI population
Post-MI
DM
General
SNRI populations
General
SSRI not
tolerated
Important to do what with SNRI
Monitor blood pressure
Wellbutrin population
SSRI not tolerated
Smokers
Wellbutrin does not effect libido. So people with this consideration
TCA population
young addults
Depression with anxiety drugs
SSRI
SNRI
Depression with decreased libido
Welbutrin
Depression with Insomina
SSRI
TCA
MAOI are used when
all else falis; atypical depression
MAOI have
multiple drug intreacions
make sure what before starting maoi
fully weaned off SSRI
allow time between stopping ___ and starting ___
antidpressant and MAOI
Mood stabilizers example
Bipolar: Lithium, lamotrigine, depakote, oxcarbazepine, gabapentin
Psychotropics
aripiprazole, risperidone, olanzapine, ziprasidone,
clozapine
gabapentin can be used for
chronic pain
Young
SSRIs and TCA
Old
TCA have anticholingeric effects
Young precautions
SSRI (black box warning for SI) TCA overdose
Pregnancy
All are mostly contraindicated. If you need to use, use an SSRI
