Antidepressants Flashcards
How do antidepressants work?
- Increase the amount of neurotransmitter in the synaptic cleft
- Inhibition of reuptake
- Enzymatic degredation
Which antidepressant increases synaptic serotonin and norepinephrine?
Tricyclics
Which antidepressant increases synaptic norepinephrine?
Tetracyclics
Which antidepressant blocks the degredation of norepinephrine, dopamine and serotonin?
MAOIs
Which antidepressant increases synaptic serotonin?
SSRIs
What is an example of a dopamine-reuptake inhibitor?
bupropion (Wellbutrin, Zyban)
What are the characteristics of bupropion (Wellbutrin, Zyban)?
- Increased risk for seizures
- Risk for emergent hypertension with concurrent nicotine patch use
- Take BP on patients using this drug
What does monoamine oxidase do?
It’s responsible for metabolism of norepinephrine, serotonin, and dopamine - MAOI’s inhibit them
What types of depression are MAOI’s used for?
- Atypical, non-endogenous, neurotic depression
- Depression associated with Parkinson’s
- PTSD
What do you do as a dentist when your patient is on MAOIs?
- Take blood pressure before anesthesia
- Caution with epinephrine
What are the MAOIs?
- isocarboxazid (Marplan)
- phenelzine (Nardil)
- selegiline (Atapryl, Eldepryl, Selpak)
- tranylcypromine (Parnate)
What are the adverse events with MAOIs?
- Causes release of endogenous catecholamines
- Results in hyperadrenergic crisis
- Severe hypertension, fever, arrhythmias
- Avoid tyramine containing foods
What are the popular SSRIs?
- fluoxetine (Prozac, Sarafem)
- proxetine (Paxil)
- sertraline (Zoloft)
Which SSRI’s are the biggest market sellers?
Paxil and Zoloft
What is the only SSRI approved for use in children with OCD?
Zoloft
What has been mandated to be put on the boxes of SSRIs?
- Antidepressants increase risk of suicidal thinking and behavior in children with depression and pyschiatric disorders
What antidepressant is not FDA approved for use in children?
Escitalopram
What are the known side effects of SSRIs?
- Agitation
- Anxiety
- Hostility
- Aggression
When taking SSRI’s for depression, when it the highest risk for suicidal attempt?
Within 6 weeks of initiating drug therapy
What are popular Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- milnacipran (Savella)
- venlafaxine (Effexor XR)
Which SNRI is used solely to treat fibromyalgia?
milnacipran (Savella)
What are some oral complications or side effects of venlafaxine (Effexor XR)?
- Xerostomia
- Stomatitis
- Loss of taste
- Taste alteration
- Tongue discoloration
What’s an example of a tetracyclic and what’s it used for?
maprotiline (Ludiomil)
Depression, anxiety with depression, dsythymic disorder
What’s unique about Tricyclics?
Adjunctive therapy for chronic pain – exhibits analgesic properties
