Antidepressants Flashcards
tertiary amines (2)
Amitriptyline (Flavil)
Imipramine (Tofranil)
tricyclic antidepressant MOA (2)
inhibit reuptake of NE & 5-HT
block a-adrenergic, histamine, & muscarinic receptors
Amitriptyline & Imipramine MOA & SE
primarily inhibit 5-HT uptake
more seizures, more sedating than secondary amines
secondary amines (2) and MOA
nortriptyline (Pamelor)
Desipramine (Norpramin)
primarily block NE reuptake
tricyclic antidepressants interactions (4)
MAOIs: Serotonin syndrome
compete w/ SSRIs –> toxic levels of TCAs
Amphetamines: HTN
potentiate alcohol, CNS depressants, anticholinergics
TCA SE (many, related to blockades)
histamine: drowsiness, fatigue, sedation
cholinergic: blurred vision, dry mouth, decr. urine, constipation, memory problems
a1: cardiac depression, arrhythmias, postural hypotension, dizziness, reflex tachy
Fluoxetine SE (3)
more drug interactions, most likely to inhibit 450
longer half-life
impairs glucose levels in diabetics
Sertraline (Zoloft) special use
least likely to interact w/ other drugs- good for the elderly
DOC depression
Citalopram (Celexa)
Citalopram (Celexa) use
DOC depression
SSRI side effects (5)
nausea weight gain or loss CNS stimulation (anxiety, insomnia)- Prozac or Zoloft sedation w/ other drugs sexual disinterest/dysfunction
SSRI side effects related to CYP3A4 and 2D6 inhibition (2)
increased toxicity w/ TCAs, phenytoin, & carbamazepine
Warfarin: increased risk of bleeding
SSRI drug interactions (5)
increased toxicity w/ TCAs, phenytoin, & carbamazepine
Warfarin: increased risk of bleeding
MAOIs, St. John’s Wort, Amphetamines: Serotonin Syndrome
B-blockers: heart block, hypotension
Opioids: Fluoxetine inhibits conversion, no analgesia
SNRI uses (3)
depression
neuropathic pain
post-menopausal hot flashes
SNRIs (2)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Venlafaxine (Effexor) SE
may increase BP
Duloxetine (Cymbalta) SE (2)
hepatotoxicity
bilateral acute angle glaucoma
MAO-A targets
metabolizes NE, DA, & 5-HT in both CNS & periphery (GI, liver)
MAO-B targets
selectively metabolizes DA & tyramine in the CNS but not GI
MAOI MOA
irreversibly inhibits MAO, which metabolizes NE, DA, 5-HT
Phenelzine (Nardil) MOA & use
both MAO-A & B: increase NE & 5-HT
depression that hasn’t responded to other drugs- drug of last choice
actions persist longer than serum levels
Selegiline (Deprenyl) MAO & use (2)
selectively inhibits MAO-B, increases DA
also used in Parkinson’s
fewer SE
MAOI side effects (5)
hypertensive crisis- phenelzine. Avoid foods w/ tyramine
CNS excitement: tremors, sedation, excitation, insomnia
orthostatic hypotension
wt gain: common
MAOI drug interactions (3)
OTC cough & cold: can cause severe HTN
opioids, DXM, TCAs, SSRIs: serotonin syndrome
affect metabolism of SSRIs, CCBs due to CYP450 inhibition
foods to avoid on MAOIs (3)
red wine, beer, aged cheese
Bupropion (Wellbutrin) MOA & uses (3)
inhibits DA, NE, and 5-HT (minimal) reuptake
ADHD, alcoholism (decr. craving) smoking cessation (extended release- Zyban)
Bupropion (Wellbutrin) SE (4)
seizures- contraindicated in hx seizures or head trauma
CNS excitation: anxiety, insomnia, restlessness…
tachycardia
sexual SE are rare
Mirtazapine (Remeron) MOA (3)
blocks presynaptic a2 receptors, which normally inhibit NE & 5-HT release
blocks 5-HT2a & 5-HT3 receptors
blocks histamine receptors (–> drowsiness)
Mirtazapine (Remeron) unique use
sometimes used for anxiety w/o depression
Trazodone (Desyrel) MOA
5-HT2a receptor antagonist
Trazodone (Desyrel) uses (2)
sleep aid
pain management
Trazodone (Desyrel) unique SE
priapism
Atomoxetine (Straterra) MOA, use, SE
selective NE reuptake inhibitor
nonstimulant ADHD tx
liver damage- rare but possible
St. John’s Wort (hypericin) SE (3)
photosensitivity
Serotonin syndrome when combined w/ other antidepressants
may prolong general anesthesia
