Antidepressants Flashcards
What are the first generation antidepressants?
-Tricyclics which were created in the late 1950s and named for their common molecular structure
-Monoamine oxidase inhibitors (MAOIs) which reduce enzymatic deactivation of monoamines
What the kinds of tricyclic drugs?
-Imipramine (Tofranil)
-Desipramine (Norpramin)
-Trimipramine (Surmontil)
-Protripyline (Vivactil)
-Anitriptyline (Elavil)
-Nortriptyline (Pamelor, Aventil)
-Doxepin (Adapin, Sinequan)
-Clomipramine (Anafranil)
What is the severe side effect of tricyclics?
-In large doses, they can be cardio toxic - meaning they can cause heart damage
What are the side effects of SSRIs?
-Withdrawal syndrome
-Sexual dysfunction
-Serotonin syndrome
What is fluozetine?
-SSRI
-Brand name Prozac
-It is the 1st released SSRI*
-Efficacy is comparable to TCAs without AChM or H side-effects
-Active metabolite is norfluozetine
What is sertraline?
-SSRI
-Brand name Zoloft
-As efficacious as TCAs
-Has a higher risk for serotonin syndrome and withdrawal syndrome*
What is fluvoxamine?
-Brand name Luvox
-Shortest half-life of all SSRIs (16 hrs)
-Inhibits CYP1A2 which is increased by elements of tobacco smoke; smokers may require a higher dose to experience therapeutic effects
What are SSNRIs?
-Selective serotonin norepinephrine reuptake inhibitors
-Dual-action antidepressants, similar to TCAs
-Highly selective for NT and 5-HT
-Analgesic; can relieve pain
What is nefazodone?
-SSNRI
-Brand name: Serzone
-5-HT antagonist, also blocks reuptake of 5-HT and NE
-Has increased risk for severe liver damage*
What is milnacipran?
-SSNRI
-Brand name: Savella
-Comparable to TCAs but better tolerated
-Comparable to SSRIs, no difference in tolerability
-Approved for treatment of fibromyalgia*
What is duloxetine?
-Duloxetine is an SSNRI
-The brand name is Cymbalta
-Duloxetine has a half life of 12 hours
-It reduces depressions, anxiety, pain
-It is not recommended for bipolar patients because it may induce mania*
What is mirtazepine?
-Mirtazepine is a tetracyclic
-It’s brand name is Remeron
-It has a half life of 10-20 hours
-It does not block reuptake transporters, it increases the release of 5-ht and NE
-It has side effects of increased appetite/weight gain and very few sexual side effects*
What is maprotiline?
-Maprotiline is a second generation antidepressant that is a modified TCA
-It’s brand name is Ludiomil
-It is similar to imipramine
-One of the side effects is that it is an epileptogenic (increased seizure susceptibility)
What is amozapine?
-Amozapine is a second generation antidepressant who is a NET antagonist
-It’s brand name is Ascendin
-Amozapine is better than TCAs at relieving anxiety and behavioral agittion
-It blocks DA receptors and can induce Parkinsonian-like EPS*
What is trazodone?
-Trazodone is a second generation antidepressant
-It’s brand name is Desyrel
-Trazodone is a weak NET, SERT antagonist and blocks 5-HT2A
-It has heavy sedative effects and is primarily used as a hypnotic*
What is clomipramine?
-Clomipramine is a second generation antidepressant that is a NET and SERT antagonist with a higher affinity for SERT
-It’s brand name is Anafranil
-It is used to treat anxiety and pain as well as depression, particularly OCD and panic disorder*
What is the wine and cheese effect?
-When taking MAOIs it is problematic to consume foods containing high levels of tyramine because it can increase blood pressure
-Products of fermentation
Impairment of memory is a side effect clearly associated with the use of
TCAs
Compared to SSRIs, TCAs are:
Equally effective, but have different side effects
The tricyclic antidepressants differ from Prozac and Zoloft in that they also have major effects on ________________.
Norepinephrine
An SNRI would be a good treatment choice for someone
With MDD and pain
The neurogenic theory of depression stems from recent findings that in the mature brain
Neurons are capable of being repaired and produces
What type of antidepressant is amitriptyline?
TCAs
OF the following classes of antidepressant drugs, the one associated with the highest incidence of sexual dysfunction is
SSRIs
If an SSRI is taken in conjunction with an MAOI, the levels of 5-HT can become dangerously high leading to ___________________.
Serotonin syndrome
First-generation tricyclic antidepressants are defined by a commonality in basic
Molecular structure
What is the pharmacodynamic mechanism of bupropion?
It blocks DA and NE reuptake
Orthostatic hypotension is a common side effect of
TCAs and MAOIs
Which statement below best describes the pharmacodynamics of Escitalopram
It primarily effects 5-HT systems with minimal effects on NE/DA/ACh systems
Venalfaxine is a/an
SNRI
Which neurotransmitters are effected by amitriptyline
NE, ACh, 5HT
