Antidepressants Flashcards
1
Q
Antidepressant Groups
A
- Tricyclic antidepressants (Imipramine)
- Selective serotonin reuptake inhibitors (SSRIs) (Fluoxetine)
- Serotonin/norepinephrine reuptake inhibitors (SNRIs) (Venlafaxine)
- Monoamine oxidase inhibitors (MAOIs) (Phenelzine)
- Atypical antidepressants (Bupropion)
2
Q
SSRIs
A
- most commonly prescribed antidepressants
- as effective as TCAs, but do not cause hypotension, sedation, or anticholinergic effects
- Prototype drug is Fluoxetine (Prozac, sarafem)
3
Q
SSRIs MOA
A
- produce selective inhibition of serotonin reuptake
- Produce CNS excitation at the post synaptic 5-HT receptors
4
Q
Therapeutic Uses of SSRIs
A
- primarily used to treat major depression
- also used to treat OCD, Bulimia, and premenstrual dysphoric disorder
5
Q
Adverse Effects of SSRIs
A
- serotonin syndrome
- withdrawl
- nenonatal effects in pregnancy
- teratogenesis
- EPS
- bruxism
- bleeding disorders
- sexual dysfunction
- weight gain
6
Q
SSRi drug interactions
A
- MAOIs (risk of serotonin syndrome)
- Warfarin (increased bleeding)
- Tricyclic antidepressants and lithium (can elevate the levels of these drugs)
7
Q
Venlafaxine (Effexor)
A
- SNRI
- used to treat depression, generalized anxiety disorder, and social anxiety disorder
- blocks NE and serotonin uptake
- does not block cholinergic, histaminergic, or alpha 1 adrenergic receptors
- causes serious reactions when combined with MAOIs
- side effects include nausea, headache, anorexia, nervousness, sweating, somnolence, insomnia, weight loss, diastolic hypertension, sexual dysfunction, hyponatremia, and neonatal withdrawal syndrome
8
Q
Duloxetine (Cymbalta)
A
- SNRI
- inhibits serotonin and NE reuptake, weakly inhibits dopamine reuptake, does not inhibit MAO
- relieves depression and pain of diabetic peripheral neuropathy
- well absorbed orally, food reduces absorption, and highly bound to albumin in blood
- adverse effects include nausea, somnolence, dry mouth, sweating, insomnia, and blurred vision
- causes effects in pregnancy and lactation
- interacts with alcohol, MAOIs, and drugs that inhibit CYP1A2 and CYP2D6
9
Q
Tricyclic Antidepressants
A
- drugs of first choice for many patients with major depression
- most common adverse effects are sedation, orthostatic hypotension, and anticholinergic effects
- most dangerous adverse effect is cardiac toxicity
- MOA is to block the neuronal reuptake of NE and serotonin
- interacts with MAOIs, sympathomimetic drugs, Anticholinergic agents, and CNS depressants
- Toxicity can be a major problem, causing anticholinergic problems
10
Q
Monoamine Oxidase Inhibitors (MAOIs)
A
- 2nd or 3rd choice antidepressants for most patients
- as effective as TCAs or SSRIs, but more dangerous
- has a risk of triggering hypertensive crisis if patient eats foods rich in tyramine
- drug of choice for atypical depression
11
Q
Mechanism of Action for MAOIs
A
- inhibits monoamine oxidase, which converts monoamine neurotransmitters (NE, serotonin, and dopamine) into inactive products
- inactivate tyramine and other biogenic amines
- two forms of MAO in the body (MAO a and MAO b)
- affected by anti depressants
- can be reversible or irreversible, but those that are in use atm are all irreversible
12
Q
Theraputic uses of MAOIs
A
- depression
- bulimia nervosa
- OCD
- Panic attacks
13
Q
Adverse Effects of MAOIs
A
- cns stimulation
- orthostatic hypotension
- hypertensive crisis from dietary tyramine
14
Q
Drug interactions of MAOIs
A
- sympathomimetic agents
- antidepressants
- antihypertensive drugs
- meperidine
15
Q
Bupropion (Wellbutrin)
A
- acts as a stimulant and suppresses appetites
- antidepressant effects begin in 1-3 weeks
- does not affect serotonergic, cholinergic, or histaminergic transmission, does not cause weight gain, but does increase sexual desire and pleasure
- adverse effects include seizures, agitation, tremor, tachycardia, blurred vision, dizziness, headache, insomnia, dry mouth, upset GI, constipation, and weight gain
- interacts with MAOIs causing toxicity
