Antidepressants Flashcards
What are the symptoms of major depressive disorder
This disorder causes a persistent feeling of sadness and loss of interest in everyday activities.
How do selective serotonin reuptake inhibitor work?
They work by increasing the levels of serotonin to alleviate the symptoms of depression.
List 6 mild selective serotonin reuptake inhibitors
escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine, and citalopram.
Upon taking SSRIs, how long can it take before improvements are seen and why?
It can take 4-6 weeks because they are slow acting as it takes time for serotonin to accumulate within the synaptic cleft
What are the side effects of SSRIs?
Anxiety Sexual dysfunction Insomnia GI stress syndrome of inappropriate antidiuretic hormones Suicidal ideations Serotonin syndrome
What is serotonin syndrome and what are its symptoms?
a life threatening condition caused serotonin accumulation which causes over stimulation of the nervous system. Symptoms are skin flushing, hyperthermia, agitation, muscle rigidity, seizure, and coma.
What is the treatment of Serotonin syndrome?
administration of cyproheptadine, which is a serotonin antagonist that blocks 5HT2 receptors.
What are the risks of taking fluoxetine, fluvoxamine, and paroxetine?
They are inhibitors of cytochrome P450 enzymes.
These are liver enzymes responsible for the metabolism of a variety of drugs and toxins in our body.
So, when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, SSRIs will reduce their rate of elimination and cause them to build up in the body..
List common Serotonin norepinephrin reuptake inhibitors
duloxetine, venlafaxine, desvenlafaxine, which is actually an active metabolite of venlafaxine, milnacipran, and levomilnacipran.
What are other uses of duloxetine?
can be used to treat urinary incontinence, and fibromyalgia, a condition characterized by chronic muscle pain, fatigue, and sleep problems.
What are some other uses of venlafaxine?
Can be used for social anxiety,
panic disorders,
PTSD and obsessive-compulsive disorder or OCD.
venlafaxine can also treat postmenopausal hot flashes, sudden feelings of heat, usually most intense over the face, neck, and chest.
What are side effects of SNRIs?
Nausea sexual dysfunction Insomnia Due to high levels of epinephrine they can also cause high blood pressure, sweating and Headaches
What are medicine specifis side effects of venlefaxine?
It is an inhibitor of cytochrome P450 enzymes, liver enzymes responsible for the metabolism of a variety of drugs and toxins in our body.
when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, SSRIs will reduce their rate of elimination and cause them to build up in the body.
What are medicine specific side effects of duloxetine?
It can cause liver damage because its hepatotoxic
How many groups of Tricyclic antidepressants are there? Name them
There are 2 main groups, Tertiary TCAs (non specific TCAs and inhibit both SERTs and NETs) and Secondary (specific TCAs that inhibit only NETs) TCAs
List some tertiary TCAs
amitriptyline,
imipramine,
and clomipramine;
List some secondary TCAs
Nortriptyline
Desipramine
Upon using TCAs, how long can it take to see improvements and why?
2-4 weeks because they are slow acting
What are other medical uses of clomipramine?
Can be used for OCD
What are other uses of Imipramine?
Can be used to treat nocturnal enuresis
What else can TCAs block?
They can also block histamine H1 receptors, causing sedation;
alpha 1 receptors, causing orthostatic hypotension;
and muscarinic receptors, causing atropine-like side effects.
Atropine-like side effects occur more commonly with tertiary TCAs and they include dry mouth, tachycardia, urinary retention, confusion, and hallucinations.
What is a toxic side effect of TCAs?
They are cardiotoxic and can lead to arrhythmias and prolong the QT interval.
How is cardiotoxicity treated?
By administration of sodium bicarbonate in order to prevent arrhythmias.
What are the most common causes of death when using TCAs?
the most common causes of death when using TCAs are
convulsion, coma, and cardiotoxicity.
How do TCAs affect liver enzymes?
are inhibitors of cytochrome P450 enzymes.
These liver enzymes are responsible for the metabolism of a variety of drugs and toxins in our body.
So, when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, TCAs will reduce their rate of elimination and cause them to build up in the body.
What happens if you take TCAs with ethanol or sedative hypnotics?
If taken with ethanol or sedative hypnotics, TCAs can cause severe respiratory depression and death.
How do individuals with atypical depression act?
They are able to improve their mood in response to positive events and circumstances.
They also experience increased appetite, weight gain, sleepiness, and fatigue.
How many groups of Monoamine oxidase inhibitors are there? name them
There are 2 groups, Non-selective and selective
List down non selective MAOIs, and what they do
isocarboxazid,
phenelzine,
and tranylcypromine
They inhibit monoamine oxidase A and monoamine oxidase B, so serotonin, norepinephrine, and dopamine levels will increase.
Why are non selective MAOIs also called irreversible MAOs?
These medications are also called irreversible MAOIs because they bind irreversibly to the enzymes, permanently blocking their function.
What happens when non selective MAOIs bind to the enzymes?
Once these enzymes are inhibited, the monoamines neurotransmitters get packed into pre-existing vesicles.
So, the next time an action potential reaches the presynaptic membrane, more neurotransmitters are released into the synaptic cleft and thus alleviating the symptoms of depression.
List selective MAOIs and what they do
selegiline
and rasagiline
They only inhibit MAO B, so they only increase the level of dopamine and more more commonly used to treat parkinsons
Before starting another antidepressant, how long should you stop taking MAOIs beforehand and why?
For 2 weeks because this is the time it takes to replenish the MAO enzymes
How can MAOIs lead to hypertensive crisis?
hypertensive crisis is a condition characterized by hyperthermia, increased blood pressure, increased heart rate (tachycardia), arrhythmias, and agitation.
It’s commonly seen in individuals that combine MAOIs with tyramine-rich food and drinks, such as cheese, wine, and beer.
within the cells of the gut wall, both monoamine oxidase A and monoamine oxidase B break down tyramine.
But when they’re inhibited, more tyramine is absorbed.
High concentration of tyramine increases norepinephrine release, which leads to hypertensive crisis.
How is hypertensive crisis treated?
Treatment of this condition consists of administration of phentolamine, which is an adrenergic antagonist that blocks norepinephrine receptors.
