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antidepressants Flashcards

1
Q

symptom dimensions of Major depressive episodes

A
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2
Q

DSM-5 Diagnostic Criteria – Major Depressive Episode (MDD)

A
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3
Q

Diagnostic Criteria – MDD
* symptoms cause?
* not attributable to?
* not better explained by?
* has never been?

A
  • symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • not attributable to the physiological effects of a substance or another medical
    condition
  • not better explained by another psychiatric illness
  • has never been a manic episode or a hypomanic episode
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4
Q

Monoamine Hypothesis of Depression

A
  • Depression due to deficiency of monoamine neurotransmitters (NT)
    – norepinephrine
    – serotonin
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5
Q
  • Evidence of monoamine hypothesis
A

– Depletion of NT induces depression
– Antidepressants increase levels of NT
– Onset of antidepressant activity (decrease in depressive symptoms) is correlated with down-regulation of receptors

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6
Q

Heterocyclic Tertiary Amines (TCA)

A

Amitriptyline (Elavil)
Imipramine (Tofranil)
Doxepin (Sinequan)

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7
Q

Heterocyclic Tertiary Amines (TCA) moa

A

Mixed NE and 5HT reuptake inhibition

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8
Q

Amitriptyline (Elavil)

moa and dosage

A

Mixed NE and 5HT reuptake inhibition

50-300 mg

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9
Q

Imipramine (Tofranil)

moa

A

Mixed NE and 5HT reuptake inhibition

tertiary TCA

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10
Q

Doxepin (Sinequan)

moa and dosage

A

Mixed NE and 5HT reuptake inhibition

50-300 mg

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11
Q

Heterocyclic Secondary Amines (TCA)

A

Nortriptyline (Pamelor)
Desipramine (Norpramin)

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12
Q

Heterocyclic Secondary Amines (TCA) moa

A

NE>5HT reuptake inhibition

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13
Q

Nortriptyline (Pamelor) moa

A

NE>5HT reuptake inhibition

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14
Q

Desipramine (Norpramin) moa

A

NE>5HT reuptake inhibition

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15
Q

Selective Serotonin Reuptake Inhibitors (SSRI)

A

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil, Paxil CR, Pexeva)
Fluvoxamine (Luvox, Luvox CR)
Citalopram (Celexa)
Escitalopram (Lexapro)

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16
Q

SSRI moa

A

5HT»>NE reuptake inhibition

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17
Q

Fluoxetine (Prozac)

moa and dosage

A

5HT»>NE reuptake inhibition

10-80 mg

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18
Q

Sertraline (Zoloft)

moa and dosage

A

5HT»>NE reuptake inhibition

50-200 mg

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19
Q

Paroxetine (Paxil, Paxil CR, Pexeva)

moa and dosage

A

5HT»>NE reuptake inhibition

10-40 mg

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20
Q

Fluvoxamine (Luvox, Luvox CR)

moa and dosage

A

5HT»>NE reuptake inhibition

50-300 mg

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21
Q

Citalopram (Celexa)

moa and dosage

A

5HT»>NE reuptake inhibition

20-40 mg

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22
Q

Escitalopram (Lexapro)

moa and dosage

A

5HT»>NE reuptake inhibition

10-20 mg

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23
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq, Khedezla)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)

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24
Q

SNRI moa

A

mixed based on the agents

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25
Q

Venlafaxine (Effexor)

moa

A

5HT >NE»DA reuptake inhibition

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26
Q

Desvenlafaxine

moa

A

5HT=NE reuptake inhibition

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27
Q

Duloxetine (Cymbalta)

moa

A

5HT=NE reuptake inhibition

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28
Q

Levomilnacipran (Fetzima)

moa

A

NE>5HT reuptake inhibition

SNRI

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29
Q

Monoamine Oxidase Inhibitors (MAOI)

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline Transdermal patch (EMSAM)

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30
Q

MAOI moa

A

Nonselective MAO A and B inhibition

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31
Q

Phenelzine (Nardil)

moa and dose

A

Nonselective MAO A and B inhibition

15-90 mg
10-60 mg

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32
Q

Tranylcypromine moa

A

Nonselective MAO A and B inhibition

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33
Q

Selegiline Transdermal patch
(EMSAM) moa and dose

A

Selective MAO B inhibition
Nonselective MAO A and B inhibition
6 mg/24hrs
9 mg/24hrs
12 mg/24hrs

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34
Q

Atypical Antidepressants

A

Bupropion (Wellbutrin, Forfivo)
Mirtazapine (Remeron)
Trazodone
Nefazodone (Serzone)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)

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35
Q

Bupropion (Wellbutrin, Forfivo) moa

A

NE and DA reuptake inhibition

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36
Q

Mirtazapine (Remeron) moa

A

Alpha2-NE
5HT2 presynaptic antagonist
5HT2/3 postsynaptic antagonist

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37
Q

Trazodone moa

A

5HT2 antagonist / Selective 5HT reuptake
inhibitor

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38
Q

Nefazodone (Serzone) moa

A

5HT2 antagonist / Selective 5HT reuptake
inhibitor

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39
Q

Vilazodone (Viibryd) moa

A

Selective 5HT reuptake inhibitor/partial 5HT1A agonist

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40
Q

Vortioxetine (Trintellix) moa

A

5HT3/1D/7 antagonist
5HT1B partial agonist
5HT1A agonist

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41
Q

Novel Antidepressants

A

Esketamine (Spravato)
Brexanolone (Zulresso

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42
Q

Esketamine (Spravato) moa

A

Non-selective, noncompetitive
antagonist of the N-methyl-D-aspartate (NMDA)
receptor

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43
Q

Brexanolone (Zulresso) moa

A

Positive allosteric modulation of GABAA
receptors

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44
Q

Common oral side effects of antidepressants

A

– Xerostomia (96%)
– Dysguesia (65%

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45
Q

less common oral side effects of antidepressants

A
  • Hypersalivation,
  • stomatitis,
  • dysphagia,
  • bruxism,
  • glossiitis,
  • tardive dyskinesia,
  • hairy tongue,
  • salivary gland enlargement,
  • tongue edema,
  • gingivitis,
  • halitosis,
  • ulcers,
  • jaw stiffness,
  • candidiasis,
  • sinusitis,
  • erythema multiforme,
  • Steven-Johnson syndrome,
  • gumline erosion,
  • periodontal disease, tooth disease
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46
Q

Monoamine Oxidase Inhibitors
(MAO-I) drug and food interactions

A

– hypertensive crisis
– serotonin syndrome
NE increaed with MAOI and can be further increaed thru tyramine in diet

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47
Q

Common Side Effects of MAO-I:
* oral?
* GI
* head?
* other side effects
* od?

A
  • Dry mouth
  • Nausea, diarrhea or constipation
  • Headache
  • Drowsiness or Insomnia
  • Dizziness or lightheadedness
  • Weight gain
  • Sexual dysfunction
  • Significant morbidity and mortality associated with overdose
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48
Q

Hypertensive Crisis

A
  • 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
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49
Q

Suggested Tyramine Dietary
Modifications for MAO-I
* Foods to AVOID

A

– Dried, aged, smoked, fermented, spoiled, or improperly stored meat, poultry and fish
– Broad bean pods
– Aged cheeses
– Tap and nonpasteurized beers
– Marmite, sauerkraut
– Soy products/tofu

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50
Q

Suggested Tyramine Dietary Modifications for MAO-I
* Foods ALLOWED

A

– Fresh or processed meat, poultry and fish
– All other vegetables
– Processed and cottage cheese, ricotta cheese, yogurt
– Canned or bottled beers and alcohol
– Brewer’s and baker’s yeast

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51
Q

what common rx should be avoided with MAOI? what is the protocol?

A
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52
Q

Hypertensive Crisis – Drug Interactions to AVOID with MAOI

A

cold meds are big cause

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53
Q

decongestants causing HTN crisis with MAOi

A

– phenylephrine
– ephedrine
– pseudoephedrine
– oxymetazoline

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54
Q

stims causing HTN crisis with MAOi

A

– amphetamines
– methylphenidate

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55
Q

AD’s causing HTN crisis with MAOis

A
  • Antidepressants with NRI activity
    – TCA
    – SNRI (venlafaxine, desvenlafaxine, duloxetine)
    – bupropion, mirtazapine
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56
Q

appetite Rx causing HTN crisis with MOAi

A
  • Appetite suppressants with NRI activity
    – phentermine
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57
Q

Serotonin Syndrome

A
  • 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
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58
Q

SS signs and symptoms

A

Three of more of the following symptoms:
– Agitation
– Diaphoresis
– Diarrhea
– Fever
– Hyperreflexia
– Incoordination
– Mental status changes (confusion, hypomania)
– Myoclonus
– Shivering
– Tremor

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59
Q

Serotonin Syndrome – Drug Interactions to AVOID with MAOI

A

tramadol and dextromethorphan increase 5HT

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60
Q

AD’s associated with SS and MAOi’s

A

– SSRI
– TCA (clomipramine)
– SNRI
– Mirtazapine

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61
Q

other TCA structure rx associated with SS and MAOi

A

– Cyclobenzaprine
– Carbamazepine

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62
Q

pain meds that can cause SS when used with maoi

A

– Meperidine
– Tramadol ✔
– Methadone
– Propoxyphene
– Fentanyl

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63
Q

cough suppressant associated with SS and MAOi

A

Dextromethorphan

64
Q

MAO-I: Summary
Advantages

A
  • May be useful in treatment refractory depression
65
Q

MAO-I: Summary
* tolerable
* OD
* oral?
* diet
* ddi?

A
66
Q

TCA forms

and action sites

A
67
Q

Mechanism of Action of TCA

A

Mixed NE and 5HT reuptake inhibition

mainly used for refactory depression and neuropathic pain

68
Q

Side Effect Profile of TCA

based on?

A

based on effected receptors
h1: weight gain, xerostomia, drowsy
m1: constipation, xero, blurred vision, drowsy
a: dizzy, hypotension

69
Q

TCAs and cardiac function

A

cardiac conduction disturbances - QTc prolongation

70
Q

other TCA side effects

A
  • seizures
  • sexual dysfunction
  • significant risk of morbidity and mortality associated with overdose
71
Q

Drug Interactions with TCA

A
  • TCA + CNS Depressants (ex. opioid pain medication) = additive CNS depressant effects
72
Q

TCA advantages
* May be useful in?
* More commonly used for ?

A
  • May be useful in treatment refractory depression
  • More commonly used for chronic pain (diabetic peripheral neuropathic pain, fibromyalgia, chronic musculoskeletal pain) and insomnia
73
Q

TCA disadvantages
* Tolerability
* Significant risk of?
* Oral?
* side effects?
* ddis?

A
  • Tolerability
  • Significant risk of morbidity and mortality associated with overdose
  • Oral side effect – dry mouth
  • Overall high side effect burden – including weight gain, sedation and sexual dysfunction
  • Significant risk for drug interactions (additive CNS depressant effects)
74
Q

Mechanism of Action and
Side Effect Profile of SSRI

A

only 5HT reuptake inhibited= increased tolerability

weight gain is less than TCAs, 65% sex dysfunc, these tend to remain

75
Q

Side Effects Important in Dentistry for SSRIs

A
  • Increased risk for bleeding and bruising, 5HT reduces this
  • Bruxism related to 5HT
76
Q

what rx can SSRI interact with to increase bleeding

A

Drug Interactions with NSAID
* Pharmacodynamic interactions
– SSRI – decrease platelet aggregation
* INCREASED RISK FOR BLEEDING

77
Q

SSRI and opioids

A
  • Pharmacokinetic interaction
  • Drugs that INHIBIT CYP450 2D6 PREVENT the metabolism of codeine, hydrocodone and
    oxycodone to an active medication.
    – Paroxetine (Paxil)
    – Fluoxetine (Prozac)
  • OUTCOME: pain relieving effects are REDUCED due to decreaed opioid activation

also buprion

78
Q

SSRI

  • overdose?
  • Recommended?
  • safety in patients with medical illnesses?
  • tolerable?
A
  • (+) safety associated with overdose
  • Recommended 1st line in all depression treatment algorithms
  • (+) safety profile in patients with medical illnesses
  • Relatively well tolerated
79
Q

SSRI disadvantages

  • Tolerable?
  • Oral side effect?
  • Long term side effects?
  • Significant risk for?
A
  • Tolerability
  • Oral side effect – bruxism, increased risk for bleeding
  • Long term side effects – weight gain and sexual dysfunction
  • Significant risk for drug interactions
80
Q

Venlafaxine (Effexor) and Duloxetine
(Cymbalta) structure

A

SNRIs (DPI with venlafaxin)

good for neuropathic pain

81
Q

Mechanism of Action of SNRI:

A

both NTs affected

82
Q

Side Effect Profile -
Venlafaxine and Duloxetine

A

NO ORAL SIDE EFFECTS

83
Q

SNRI:
*OD
* Recommended?
* Used to treat?
* tolerated?

A
  • (+) Safety profile in overdose
  • Recommended 1st line in all depression treatment algorithms
  • Used to treat depression and pain (diabetic peripheral neuropathic pain, fibromyalgia, chronic musculoskeletal pain)
  • Relatively well tolerated
84
Q

SNRI
Tolerabler?
* oral side effects?
* Long term side effects?
* ddi?

A

Tolerability
* No specific oral side effects
* Long term side effects – weight gain and sexual dysfunction
* Low risk for drug interactions

85
Q

Bupropion (Wellbutrin) moa

A

NDRI

86
Q

Side Effect Profile of
Bupropion

A
  • no effect on H1, M1 or alpha1 receptors
  • side effect profile -insomnia, seizures (less common)
    – low risk of sexual dysfunction
    – low risk of weight gain
87
Q

Bupropion contraindications
– hx of what dx’s/events
* caution use in ?

A

– seizure history
– history of significant head trauma
– anorexia or bulimia (electrolyte imbalances)
* caution use in psychosis

88
Q

bupropion and opiates

A
  • Pharmacokinetic interaction
  • Drugs that INHIBIT CYP450 2D6 PREVENT the metabolism of codeine, hydrocodone and
    oxycodone to an active medication.
  • OUTCOME: pain relieving effects are REDUCED
89
Q

Bupropion
* Recommended?
* Low risks for?
* Also used for?
* tolerated?

A
  • Recommended 1st line in depression treatment algorithms
  • Low risk of sexual dysfunction
  • Low risk risk for weight gain
  • Used for smoking cessation
  • Relatively well tolerated
90
Q

Bupropion
* Tolerable?
* oral?
* Potential for?
* ddi?

A
  • Tolerability
  • No specific oral side effects
  • Potential for seizures associated with overdose
  • Significant risk for drug interactions
91
Q

Mirtazapine moa

A

A2 antagonsit that increases 5HT and NE, however reuptake pumps work normally.
A2 responsible for signaling when there are adequate amts of NT in synapse= antagonizes this cause no signal and increased NTs

92
Q

Side Effect Profile of Mirtazapine
* no effect on?
* (+) effect on?
* side effect profile?

A
  • no effect on M1 or alpha1 receptors
  • (+) effect on H1 receptors
  • side effect profile
    – Sedation
    – dry mouth
    – weight gain
    – low risk of sexual dysfunction
93
Q

which Ad classes cause xerostomia

A

mirtazapine
TCAs
MAO-i

94
Q

Mirtazapine
* od?
* Recommended?
* Low risk for?

A
  • (+) Safety profile in overdose
  • Recommended 1st line in depression treatment algorithms
  • Low risk for sexual dysfunction
95
Q

Mirtazapine
* Tolerability?
* Oral side effects?
* Long term side effects?
* risk of ddi?

A
  • Tolerability
  • Oral side effect – dry mouth
  • Long term side effects - weight gain, sedation
  • Low risk for drug interactions
96
Q

Goals of Antidepressant Therapy
* REMISSION?
* Improve ?
* Reduce risk of ?
* Increase ?
* Decrease ?
* healthcare costs

A
  • REMISSION = resolution of depression symptoms
  • Improve functioning
  • Reduce risk of relapse
  • Increase quality of life
  • Decrease depression morbidity and mortality
  • Decrease healthcare costs
97
Q

Definitions of Response and Remission

A
98
Q

Selection of Antidepressant Therapy
Empiric selection of antidepressant therapy:

A
  • past history of AD response
  • family history of AD response
  • concurrent disease states/drug therapy
  • adverse effect profile
  • cost
99
Q

Selection of Antidepressant Therapy: Treatment Guidelines (APA 2019)
* Psychotherapy can be used alone for?
* Pharmacotherapy can use used alone for?
* Pharmacotherapy +/- psychotherapy for?
* 1st line therapies?
* Only complimentary therapy recommended 1st line is?

A
  • Psychotherapy can be used alone for mild-moderate depression
  • Pharmacotherapy can use used alone for mild- moderate depression
  • Pharmacotherapy +/- psychotherapy for moderate- severe depression
  • SSRI, SNRI, bupropion and mirtazapine are recommended as 1st line therapy
  • Only complimentary therapy recommended 1st line is St. John’s wort (CANMAT 2016, VA/DoD 2016
100
Q

Efficacy of AD
* % efficacy?
* trial period?

A
101
Q

non remission with AD’s
* % remission
* % response with residual symptoms
* % partial response
* % nonresponse
* % intolerant

A
  • 35–45% remission
  • 10–20% response with residual symptoms
  • 15% partial response
  • 25% nonresponse
  • 7–15% intolerant
102
Q

Symptom Remission timeline

1st week, weeks 1-3, weeks 2-4

A
103
Q

first week improvements with ADs

A

Decreased Anxiety
* Improvement in Sleep
* Improvement in Appetite

104
Q

weeks 1-3 improvements with ADs

A

Increased Activity, Sex Drive, Self-care, and Memory
* Thinking and Movements Normalize
* Sleeping and Eating Patterns Normalize

105
Q

weeks 2-4 improvements with ADs

A
  • Relief of Depressed Mood
  • Less Hopeless/ Helpless
  • Thoughts of Suicide Subside
106
Q

Maintenance Antidepressant Therapy
* first episode -
* second episode -
* > 2 episodes -
* elderly patients -

A
  • first episode - continue AD for 9-12 months
  • second episode - continue AD for 5 years
  • > 2 episodes - continue AD for lifetime
  • elderly patients - consider continuing AD for longer; maybe indefinitely
107
Q

neruotransmitter receptor hypothesis of AD action

A
  • in depressive state receptors will upregulate due to decreased NT
  • with AD there are increased NT’s (5HT and NE)
  • increased NTs will sensitize receptors and downregulate them over time
108
Q

delayed AD onset diagrammed

A
109
Q

Amitriptyline (Elavil)
Imipramine (Tofranil)
Doxepin (Sinequan)

A

Heterocyclic Tertiary Amines (TCA)

110
Q

Mixed NE and 5HT reuptake inhibition

A

Heterocyclic Tertiary Amines (TCA) moa

111
Q

Mixed NE and 5HT reuptake inhibition

50-300 mg

A

Amitriptyline (Elavil)

moa and dosage

112
Q

Mixed NE and 5HT reuptake inhibition

50-300 mg

A

Imipramine (Tofranil)

moa and dosage

113
Q

Mixed NE and 5HT reuptake inhibition

50-300 mg

A

Doxepin (Sinequan)

moa and dosage

114
Q

Nortriptyline (Pamelor)
Desipramine (Norpramin)

A

Heterocyclic Secondary Amines (TCA)

115
Q

NE>5HT reuptake inhibition

A

Heterocyclic Secondary Amines (TCA) moa

116
Q

NE>5HT reuptake inhibition

50-150 mg
75-300 mg

A

Nortriptyline (Pamelor) moa and dosage

117
Q

NE>5HT reuptake inhibition

75-300 mg

75-300 mg

A

Desipramine (Norpramin) moa and dosage

118
Q

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil, Paxil CR, Pexeva)
Fluvoxamine (Luvox, Luvox CR)
Citalopram (Celexa)
Escitalopram (Lexapro)

A

Selective Serotonin Reuptake Inhibitors (SSRI)

119
Q

5HT»>NE reuptake inhibition

A

SSRI moa

120
Q

5HT»>NE reuptake inhibition

10-80 mg

A

Fluoxetine (Prozac)

moa and dosage

121
Q

5HT»>NE reuptake inhibition

50-200 mg

A

Sertraline (Zoloft)

moa and dosage

122
Q

5HT»>NE reuptake inhibition

10-40 mg

A

Paroxetine (Paxil, Paxil CR, Pexeva)

moa and dosage

123
Q

5HT»>NE reuptake inhibition

50-300 mg

A

Fluvoxamine (Luvox, Luvox CR)

moa and dosage

124
Q

5HT»>NE reuptake inhibition

20-40 mg

A

Citalopram (Celexa)

moa and dosage

125
Q

5HT»>NE reuptake inhibition

10-20 mg

A

Escitalopram (Lexapro)

moa and dosage

126
Q

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq, Khedezla)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)

A

Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

127
Q

mixed based on the agents

A

SNRI moa

128
Q

5HT >NE»DA reuptake inhibition

37.5-225mg

A

Venlafaxine (Effexor)

moa and dose

129
Q

which SNRI has 5HT=NE reuptake inhibition?

50 mg

A

Desvenlafaxine (Pristiq, Khedezla)

moa and dose

130
Q

5HT=NE reuptake inhibition

30-120 mg

A

Duloxetine (Cymbalta)

moa and dose

131
Q

NE>5HT reuptake inhibition

40-120 mg

A

Levomilnacipran (Fetzima)

moa and dose

132
Q

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline Transdermal patch (EMSAM)

A

Monoamine Oxidase Inhibitors (MAOI)

133
Q

Nonselective MAO A and B inhibition

A

MAOI moa

134
Q

Nonselective MAO A and B inhibition

15-90 mg
10-60 mg

A

Phenelzine (Nardil)

moa and dose

135
Q

Nonselective MAO A and B inhibition

10-60 mg

A

Tranylcypromine (Parnate

moa and dose

136
Q

Selective MAO B inhibition
Nonselective MAO A and B inhibition

A

Selegiline Transdermal patch
(EMSAM) moa and dose

137
Q

Bupropion (Wellbutrin, Forfivo)
Mirtazapine (Remeron)
Trazodone
Nefazodone (Serzone)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)

A

Atypical Antidepressants

138
Q

NE and DA reuptake inhibition

A

Bupropion (Wellbutrin, Forfivo) moa

139
Q

Alpha2-NE
5HT2 presynaptic antagonist
5HT2/3 postsynaptic antagonist

A

Mirtazapine (Remeron) moa

140
Q

5HT2 antagonist / Selective 5HT reuptake
inhibitor

A

Trazodone moa

141
Q

5HT2 antagonist / Selective 5HT reuptake
inhibitor

A

Nefazodone (Serzone) moa

142
Q

Selective 5HT reuptake inhibitor/partial 5HT1A
agonis

A

Vilazodone (Viibryd) moa

143
Q

5HT3/1D/7 antagonist
5HT1B partial agonist
5HT1A agonist

A

Vortioxetine (Trintellix) moa

144
Q

Esketamine (Spravato)
Brexanolone (Zulresso

A

Novel Antidepressants

145
Q

Non-selective, noncompetitive
antagonist of the N-methyl-D-aspartate (NMDA)
receptor

A

Esketamine (Spravato) moa

146
Q

Positive allosteric modulation of GABAA
receptors

A

Brexanolone (Zulresso) moa

147
Q

which AD classes ARE NOT 1st line

A

TCAs and MAOi

148
Q

what can these lead to mixed with MAOi

– phenylephrine
– ephedrine
– pseudoephedrine
– oxymetazoline

A

decongestants causing HTN crisis with MAOi

149
Q

what can these lead to mixed with MAOi

– amphetamines
– methylphenidate

A

stims causing HTN crisis with MAOi

150
Q

what can these lead to mixed with MAOi

– TCA
– SNRI (venlafaxine, desvenlafaxine, duloxetine)
– bupropion, mirtazapine

A

AD’s causing HTN crisis with MAOis

151
Q

what can these lead to mixed with MAOi

– phentermine

A

appetite Rx causing HTN crisis with MOAi

152
Q

what can these lead to mixed with MAOi

– SSRI
– TCA (clomipramine)
– SNRI
– Mirtazapine

A

AD’s associated with SS and MAOi’s

153
Q

what can these lead to mixed with MAOi

– Cyclobenzaprine
– Carbamazepine

A

other TCA structure rx associated with SS and MAOi

154
Q

what can these lead to mixed with MAOi

– Meperidine
– Tramadol ✔
– Methadone
– Propoxyphene
– Fentanyl

A

pain meds that can cause SS when used with maoi

155
Q

what can this lead to mixed with MAOi

Dextromethorphan

A

cough suppressant associated with SS and MAOi

pharm 2 (20 decks)

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