Antidepressants Flashcards
Name the tertiary amine (tricyclic) antidepressants
I CAD’T: Imipramine, clomipramine, amitriptyline, doxepin, trimipramine.
Describe tricyclic and tetracyclic antidepressant side effects
Anticholinergic side effects ass’c w/ tricyclics: Xerostomia, blurry vision, urinary retention, constipation, QT prolongation, orthostatic hypotension (alpha-adrenergic blockade), weight gain (anti-histamine 1 side effect). Tricyclics are also very sedating.
Which tricyclic antidepressant is specifically useful for OCD?
Clomipramine. Also useful for depressive features in OCD.
Name the secondary amine antidepressants.
DNP: Desipramine, nortriptyline, protriptyline.
Which secondary amine antidepressant can cause psychomotor stimulation?
Protriptyline
Name the tetracyclic antidepressant and its dangerous potential side effects.
Amoxapine. Can cause extrapyramidal syndrome and neuroleptic malignant syndrome (metabolite of loxapine).
How do tricyclic and heterocyclic antidepressants work?
Reducing reuptake of serotonin and norepinephrine which increases synaptic monoamine levels.
Why are tricyclics dangerous in overdose?
Narrow therapeutic index can cause fatal cardiac arrhythmias through QT prolongation.
Name the SSRI’s
Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro)
Name the SNRI’s
Venlafaxine (Effexor) & duloxetine (Cymbalta)
Review specific SSRI side effects
Sertraline causes diarrhea more often than others. Paroxetine is mildly anticholinergic. Fluvoxamine causes nausea and vomiting more commonly. Citalopram possibly has fewer sexual side effects.
Name common side effects in all SSRI’s
Most important: GI disturbance and sexual dysfunction. Can increase suicidal thoughts in pts under age 24. Also akathisia, anxiety, panic, insomnia, headache.
Name the MAOI’s
Naming the MAOI’s “IS PT”: Isocarboxazid (Marplan), selegiline (Eldepryl), phenelzine (Nardil), tranylcypromine (Parnate).
What dietary restrictions must be observed when taking MAOI’s?
No tyramine-containing foods, eg red wine and aged cheese.
What meds can’t be prescribed concurrently with MAOI’s and why?
Concurrently prescribing SSRI’s can cause serotonin syndrome; MAOI prescription must be min. 5 weeks after cessation of SSRI.
Name four “miscellaneous” antidepressants
BMNT: Buproprion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), and trazodone (Desyrel).
What is trazodone?
Antidepressant. Serotonin-2 antagonist and serotonin reuptake inhibitor (avoid with MAOI’s). Sedating, also used as sleep aid. Can cause priapism and hypotension.
What is mirtazapine?
Antidepressant. Remeron; noradrenergic and specific serotonin antagonist. Sedating, also used as sleep aid. Can cause weight gain. Does not interfere with sexual function. No nausea or diarrhea.
What is buproprion?
Antidepressant. Wellbutrin. Norepinephrine and dopamine reuptake inhibitor. Often used for smoking cessation. Lowers seizure threshhold, contraindicated in pts with seizure disorders. Causes anorexia, contraindicated in pts with eating disorders.
What is nefazodone?
Antidepressant. Serzone. Serotonin-2 antagonist and serotonin reuptake inhibitor (avoid with MAOI’s). Can cause sedation and hepatotoxicity.
