Antidepressants Flashcards
Imipramine
TCA
Amitriptyline
TCA
Desipramine
TCA
Nortriptyline
TCA
Clomipramine
TCA
Maprotoline
TCA
Tranycypromine
MAOI
Phenelzine
MAOI
DI with MAOIs
Phenylpropanolamine, pseudoephedrine, meperidine
Selegiline
MAOI (B more than A)
Fluoxetine
SSRI
Paroxetine
SSRI
Sertraline
SSRI
Citalopram
SSRI
Escitalopram
SSRI
Venlafaxine
SNRI
Desvenlafaxine
SNRI
Duloxetine
SNRI
Levomilnacipran
SNRI
Bupropion
Mixed Action
Mirtazapine
Mixed Action
Trazodone
Mixed Action
Vilazodone
Mixed Action
Vortioxetine
Mixed Action
1st generation antidepressants
TCAs and MAOIs
2nd generation antidepressants
SSRIs, SNRIs, Mirtazapine, Bupropion
TCA CIs
BPH, arrhythmias, narrow angle glaucoma, dementia
TCA OD
lethal (cardiotoxic)
Amitriptyline AEs
Anticholinergic, sedation, cardiotoxic
Imipramine AEs
orthostatic hypotension, cardiotoxic
TCA class AEs
anticholinergic, sedation, orthostatic hypotension, cardiotoxic, lower seizure threshold, weight gain
Clomipramine max dose
250 mg due to seizure risk
Serum drug concentrations with these antidepressants
TCAs (1 wk stable dose - trough 12 hours after last dose)
SSRI and MAOI washout period
14 days, except Fluoxetine which is 5 weeks (long t1/2)
“Cheese Reaction” symptoms
BP 220/130, HA, flushing, palpitations, diaphoresis, N/V
SSRI AEs
Short term: HA, N/D, increased anxiety
Long term: weight gain, sexual dysfunction
Citalopram max dose
40 mg qd due to QT prolongation
Paroxetine AEs:
mild anticholinergic (avoid elderly), discontinuation syndrome (worst - requires tapering)
Least discontinuation syndrome of SSRIs
Fluoxetine (no tapering needed)
SSRI DIs
Most with fluvoxamine, fluoxetine, sertraline (class DI with tramadol and linezolid)
Serotonin syndrome symptoms
(due to result of overstimulation of 5-HT1a) TRIAD: mental, autonomic, neurological - confusion, agitation, insomnia, fever, diaphroesis, myoclonus, tremor, hyperreflexia, cardiovascular collapse, coma, death
Serotonin syndrome treatment
5-HT2A #s (cyproheptadine, olanzapine)
SSRI AEs
Lethality, insomnia, anticholinergic, sexual dysfunction, increased blood pressure (don’t give venlafaxine, levomilnacipran to uncontrolled HTN patients), discontinuation syndrome (venlafaxine)
Bupriopion AEs
Moderate agitation (peps people up), seizures (avoid if eating disorders or epilepsy)
Mirtazapine and Trazodone AEs
severe sedation
Trazodone AEs:
orthostasis, pripaism