Antidepressants Flashcards
What are the two monoamine oxidase inhibitors?
Tranylcypromine and Phenelzine
What is the mechanism of action of Tranylcypromine? Phenelzine?
They BOTH irreversibly inhibit MAOa and MAOb
What conditions are MAO inhibitors used to treat?
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, and alcoholism
What are two potentially life-threatening side effects of MAOI use?
Hypertensive crisis and serotonin syndrome (w/ssri)
Betty is using a MAOI to treat her depression. She decides to go to a wine, cheese, pepperoni and pickled herring party. Besides the ridiculous gas she will have, why is attending this party a bad idea?
Use of a MAOI with concurrent ingestion of tyramine can precipitate a hypertensive crisis
George is using a MAOI to treat his depression. When he goes to take his medication, he accidentally ingests the wrong pills. He begins to experience hyperthermia, muscle rigidity, myoclonus and rapid changes in his mental status. What type of pills did he accidentally take and what condition does he have?
Likely SSRI; Serotonin Syndrome
What are other, less potentially fatal side effects of MAOI use?
Delerium, seizures, anticholinergic effects, orthostatic hypotension, sexual dysfunction, weight gain, sedation
What are the 4 tricyclic antidepressants?
Desipramine, Imipramine, Amitriptyline, Nortriptyline
What is the general mechanism of action of the tricyclic antidepressants?
They block reuptake of NE or 5HT at varying potencies and selectivity. Some tricyclics also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
What are all of the COMMON therapeutic uses of tricyclics
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, and alcoholism
Bjorn has depression. Even worse, he has tension headaches and migraines too! Bummer! He as the option to prescribe himself either a tricyclic or an MAOI. He doesn’t want to go back and study unit 2 to figure out what type of medication he should use to treat his migraines. What medication (out of the MAOIs and tricyclics) can he use to treat his depression AND his migraines?
Amitriptyline
What are important side effects of tricyclics?
They are sympathomimetic and can cause cardiac arrhythmias, and conduction defects (especially when OD)
What are other less potentially fatal side effects of tricyclics?
Antimuscarinic effects, orthostatic hypotension, sedation (additive w/ alcohol), seizures
Suzy Q, a budding medical student, is diagnosed with depression and she tells her doctor that she thinks she should be put on tricyclics. The doctor thinks this is a bad idea and instead prescribes her an SSRI instead. Why?
Tricyclics are rarely used anymore because they are unsafe (cardiac side effects)
Which two tricyclics form active metabolites? What are the respective metabolites?
Imipramine and Amitriptyline form Desipramine and Nortriptyline, respectively.
What are the 5 SSRIs?
Fluoxetine, Paroxetine, Sertraline, Escitalopram, and Citalopram
What is the mechanism of action for the SSRIs?
They inhibit reuptake of 5-HT (and NE to a lesser extent)
What are the common therapeutic uses for SSRIs?
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
A woman is diagnosed with premenstrual dysphoric disorder. What does the doctor prescribe her?
Fluoxetine
What is an important side effect to be aware of when prescribing a patient an SSRI? What medication should you make sure that they’re not on?
Serotonin syndrome. Make sure they’re not taking an MAOI!
What are the less life-threatening effects of SSRIs? Do they have more or less side effects than tricyclics?
Nausea, decreased sexual function; Less side effects than tricyclics!
Which SSRI forms an active metabolite? What is the metabolite?
Fluoxetine forms norfluoxetine
Jonny Twobyfour is diagnosed with depression and you want to prescribe him an SSRI. His history is significant for P450 insufficiency. What two SSRIs are contraindicated?
Fluoxetine and Paroxetine because of their potent ability to inhibit any residual P450
What are the two SNRIs?
Duloxetine and Venlafaxine
What is the mechanism of action of the SNRIs?
Inhibit reuptake of 5-HT and NE
What are the therapeutic uses of SNRIs?
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
What class are Bupropion and Mirtazapine in?
Atypical antidepressants
What is the mechanism of action of Bupropion?
Blocks DA and NE reuptake
What is the mechanism of action of Mirtazapine?
5HT2a antagonist and inhibits 5HT reuptake
What are the common therapeutic uses of atypical antidepressants?
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Joe Camel has been smoking for some time and wants to stop. What atypical antidepressant does Joe’s doctor recommend? What serious side effect does Joe’s doctor warn him about?
Bupropion; Bupropion lowers the seizure threshold
What is the mechanism of Lithium Salts?
Magic! (The mechanism is mostly unknown. Li does however deplete IP3 and DAG which are important for a-adrenergic and muscarinic-cholinergic transmission)
What are the therapeutic uses of lithium?
Anti-manic/mood-stabilizing (bipolar) and long-term cluster headache prevention
John Texas overdoses on his lithium medication. What adverse side effects might he potentially experience?
Neurotoxicity, cardiac toxicity, and renal dysfunction; Nausea and vomiting acutely
What general side effects will a person using lithium salt medication experience?
Drowsiness, weight gain, tremor, polydipsia, polyuria
