Antidepressants Flashcards
The symptoms of ____
- Apathy, depressed mood
-Weight changes, sleep disturbances, psychomotor agitation or retardation, fatigue, guilt/worthlessness, executive dysfunction, suicidal ideation
Depression
What 2 neurotransmitters are thought to be deficient causing depression?
Norepinephrine
Serotonin
HOw long do the antidepressants take to begin to cause noticeable change due to downregulation of receptors?
2-4 weeks
What are the 2 most common oral side effects with antidepressants?
Xerostomia and Dysgeusia
- phenelzine (Nardil)
- tranylcypromine
(Parnate) - drug-drug and
drug-food interactions
– hypertensive crisis
– serotonin syndrome
Monoamine Oxidase Inhibitors
(MAO-I)
- Defined by diastolic blood pressure > 120 mmHg
- Potentially fatal reaction characterized by:
– Occipital headache – may radiate frontally
– Palpitation
– Neck stiffness or soreness
– Nausea and/or vomiting
– Sweating
– Dilated pupils, photophobia
– Tachycardia or bradycardia
– Chest pain
MAO-I
Hypertensive crisis
Foods that contain _____ can cause interactions MAO-I
Tyramine
- Addition or increase of
known serotonergic agent to
an established medication
regimen - Other etiologies (infectious,
metabolic, substance abuse
or withdrawal) have ruled
out. - Antipsychotic has not been
started or increased prior to
the onset of sign/symptoms - Three of more of the
following symptoms:
– Agitation
– Diaphoresis
– Diarrhea
– Fever
– Hyperreflexia
– Incoordination
– Mental status changes
(confusion, hypomania)
– Myoclonus
– Shivering
– Tremor
Serotonin syndrome
WHat are TCAs used in now more than for depression?
Neuropathic pain
What are the 2 TCAs that we talked about?
Amitriptyline
Nortriptyline
What type of antidepressant has an additive effect with CNS depressants?
TCAs
– minimal to no effect on
H1, M1 or alpha1
receptors
– side effect profile - GI
upset, headache,
insomnia, restlessness,
anxiety, weight gain,
sexual dysfunction
SSRIs
What is the one class of antidepressant that cause bruxism?
SSRIs
The following are what type of drugs?
* fluoxetine (Prozac)
* paroxetine (Paxil, Paxil CR,
Pexeva)
* sertraline (Zoloft)
* citalopram (Celexa)
* escitalopram (Lexapro)
SSRIs
What drug interaction is important for SSRI?
NSAIDs
What 2 SSRIs have a pharmacokinetic interaction with opioids via P450 inhibition to decrease pain control of the opioids?
Paroxetine
Fluoxetine
Venlafaxine (Effexor) and Duloxetine
(Cymbalta) are what class of drug?
SNRI
Side effect profile
– no effect on H1, M1 or
alpha1 receptors
– side effect profile -
nausea, elevated BP,
weight gain, sexual
dysfunction
SNRI
Bupropion (Wellbutrin) is what type of drug?
NDRI, norepinephrine dopamine reuptake inhibitor
What are NDRI contraindicated in?
Seizure
What NRDI inhibits P450 decreasing effects of opioids?
Buproprion
What drug is a Presynaptic Alpha2 Antagonist
Mirtazapine (Remeron)
What % of symptoms are needed to reduce to consider depression in remission?
75% +
