Antidepressants Flashcards
At low doses SNRIs act as…
SSRIs only causing the inhibition of serotonin reuptake
At high doses SNRIs action is…
potent inhibition of reuptake of serotonin
inhibition of NE at higher doses
inhibition of dopamine at very high doses
What category of antidepressants does SNRI’s fit in?
heterocyclic antidepressants (also include bupriopion NDRI, trazadone, mirtazpine)
when is venlafaxine indicated?
SNRI
general anxiety disorder
depression
What is the newer formulation of venlafaxine?
desvenlafaxine (prtistiq)
What is the brand name for venlafaxine?
Effexor IR or Effexor XR
what are the side effects of SNRI’s?
venlafaxine and duloxetine similar to SSRIS 1) more initial anxiety 2) more insomnia/sedation 3) nauseas, constipation 54increased BP-monitor serially when on and when discontinue 5)fewer sex and weight gain issue than SSRI 6) modulate ANS effect 7) withdrawl similar to paroxitine
How can SNRI’s side effects be useful?
use increased BP to treat orthostatic intolerance
When are SNRI’s indicated?
- depression
- general anxiety disorder
- chronic pain like TCAs
- fibromyalgia -diabetic neuropathy
why is duloxetine contraindicated in glaucoma?
SNRI’s increase BP so too much pressure
If a patient wants to go off vanlafaxine or duloxetine what is the best way?
slower taper of many months to avoid withdrawal (same as paroxetine)
What are some side effects of duloxetine?
- fatal hepatotoxicity reported
- contraindicate in glaucoma
- like SSRIs- more initial anxiety, more insomnia
- sedation possible
- increased BP
- less weight and sex issues
- nausea, constipation
- withdrawl symptoms
What type of metabolism is a concern when prescribing multiple drugs to a duloxetine pt?
drugs that also use CYP2D6 metabolism
