ANTIDEPRESSANTS Flashcards
Primary desired effect of Antidepressants
Reduction of depression
Secondary desired effect of antidepressants
Control of anxiety or obsession
what are the 3 anti depressants drugs?
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Cyclic Antidepressants
- Monoamine Oxidase Inhibitors (MAOI)
Mechanism of action of SSRI
Inhibits reuptake of serotonin
Mechanism of action of Cyclic Antidepressants
Inhibits reuptake of serotonin and norepineprine in the synaptic cleft
Mechanism of Action of MAOI
Increases monoamine (NE, serotonin, dopamine) by inhibiting monoamine oxidase
What are the drugs of SSRI?
-Escitalopram
- Fluoxetine, Fluvoxamine
- Sertraline
- Paroxetine
- Citalopram
Side effects of SSRI
-Sexual dysfunction
- Insomnia
- GI upset
- Akathisia
-Weight Gain
Lag period of SSRI
2 to 3 days
Drugs of Cyclic Antidepressants
“CANDID”
-Clomipramine
-Amitriptyline
-Nortriptyline
-Desipramine
-Imipramine
-Doxepine
Side effects of Cyclic Antidepressants
“SHAWT”
-Sexual dysfunction
- Hypotension
- Anticholinergic Effects
- Weight Gain
- Tachycardia
Lag period of cyclic antidepressants
1 to 4 weeks
Monoamine Oxidase Inhibitor (MAOI) Drugs
“TIPS”
-Tranylcypromine
- Isocarboxazid
- Phenelzine
- Selegiline (Emsam)- transdermal
Side Effects of MAOI
-Sleep disturbances
- Weight Gain
- Dry mouth
- Orthostatic Hypotension
- Sexual dysnfunction
Lag period of MAOI
2 to 4 weeks
A potentially life-threatening condition associated with increased serotonergic activity in the central nervous system
Serotonin Syndrome
Causes of Serotonin Syndrome
-Simultaneous intake of MAOI and SSRI
- Inadequate washout period
Clinical Manifestations of Serotonin Syndrome
A- Altered Mental Status (agitation, restlessness, or anxiety
N- Neuromuscular hyperactivity
(ocular clonus, hyperreflexia, tremors, or rigidity)
A- Autonomic hyperactivity
(Tachycardia, Hyperthermia, Hypertension, Diaphoresis, Mydriasis)
Twitching activity
Ocular Clonus
Autonomic hyperactivity stimulates what?
SNS stimulation
Management of Serotonin Syndrome
-Discontinue medication
- Supportive care (oxygen, IV fluids, antipyretics)
- Benzodiazepine for sedation
- Intubation and ventilatory support if necessary
- Cyproheptadine- serotonin agonist if all else fail
It must be resolve for 24 hours
Cyproheptadine
A rapid BP elevation with readings of 180/110 mmHg or greater
Hypertensive Crisis
Causes of Hypertensive Crisis
Ingestion of tyramine- containing foods while taking MAOI
Hypertensive Crisis Clinical Manifestations
-Severe HPN
- Hyperpyrexia
- Tachycardia
- Diaphoresis
- Tremors
- Cardiac dysrhythmias
BP >180mmHG systolic
Severe HPN
T >41C
Hyperpyrexia
Management of Hypertensive Crisis
-Discontinue medication
- DOC: Phentolamine-alpha-adrenergic blocker
- Low-tyramine diet
-No Canned foods
- No processed foods
- No aged foods/drinks
- No MSG
A reaction that BP will increase
Cheese Reaction
