antidepressants Flashcards
indications for anti-depressants (5 main categories)
- Major depression
- dysthmia
- chronic pain
- alz, mental retardation for agitation
- panic disorder, GAD, OCD
SA of SSRI’s
N/D and decreased appetite and weight loss; HA. Sexual dysfx; insomnia (give in AM); SIADH (retain water not Na+) = delirium, seizures…
which SSRI is sedating
Paroxetine (paxil)
which SSRI for OCD
Fluvoxamine (luvox)
inhibit sertonin and norepinephrine reuptake
TCA
SA of TCA
CNS confusion
CARDIAC tach, orthostatic, get EKG >40, avoid anti-arrthyth
GI-constipation
GU- retention, hesitancy
Wt. gain
Anti-choinergic: (M1) dry mouth, inc. IOP, xerostomia, dilated pupils, tachy, GI motility
MOAi’s do what
Inhibit monoamine oxidase leading to incr serotonon and norepi levels
MOAI interaction
Demerol death
symphathomemitics- HTN crisis
Tyramine foods (aged meats, cheeses, red wine) HTN crisis
when do you dose bupropion
morning. Incr DAT and to lesser extend NET. similar to an amphetamine for fatigue
SE of bupropion
lowers seizure threshold, incr BP, insomnia, anxiety
when to dose mirtazapine
at night, benefits insomnia
drug ass with stevens johnson rash
Lamotirgine
Anti-depressant helps with neuropathy and fibromyalgia
Duloxetine (cymbalta). (SERT and NET)
algorithm for rx of antidepressants (4 steps)
- SSRI
- Diff SSRI
- Atypical: mirtazapine or buproprion, SNRI: Duloxetine or Venlafaxine
- TCA of refer to psychiatrist
Duration of rx for
- 1st episode
- 2nd episode
- 3rd episode
- one year
- two-three years
- life
