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.
