AntiDepressants Flashcards by Beth Cocker

SSRI means

Serotonin-Selective Reuptake Inhibitors

How well did you know this?

Not at all

Perfectly

SSRI MOA

Selectively inhibit reuptake of serotonin from synaptic cleft and increase levels of 5-HT

How well did you know this?

Not at all

Perfectly

SSRI time of action

8 weeks

How well did you know this?

Not at all

Perfectly

***SSRI Side Effects

No anticholinergic toxicity
No "cheese syndrome" 
Mainly just serotonin syndrome
Can push a suicidal person over the edge
Agitation, anxiety, panic attacks
Restlessness, psychomotor retardation, mild PD
Rapid muscle movement at night
***Sexual dysfunction (COMMON)
N/V
Diarrhea, GI cramps 
HYPONATREMIA

How well did you know this?

Not at all

Perfectly

SSRI work on

Negative affect pts: depressed mood, guilt, disgust, anxiety, irritability
- Dont relieve symptoms of decreased positive affect

How well did you know this?

Not at all

Perfectly

Positive affect means

Joy, happiness, enthusiasm, alertness, self confidence

How well did you know this?

Not at all

Perfectly

So if you have not enough 5HT then you see

Depression, OCD, panic, bulimia

How well did you know this?

Not at all

Perfectly

If you have too much serotonin, then you see

Anxiety, insomnia, sexual dysfunction, GI probs, serotonin syndrome (fever, tremor, seizures) and possibly cardiac valve stuff

How well did you know this?

Not at all

Perfectly

Serotonin Syndrome can happen more often if

SSRI + MAOI

How well did you know this?

Not at all

Perfectly

Who is at higher risk for hyponatremia with SSRIs

Older
Female
Lower Na
Diuretics use
Lower weight

How well did you know this?

Not at all

Perfectly

SSRI Serious ADRs

NE Reuptake blockade and DA reuptake blockade

How well did you know this?

Not at all

Perfectly

Fluoxetine Brand

Prozac

How well did you know this?

Not at all

Perfectly

Fluoxetine classes

SERT (serotonin transporter) Reuptake Blockade

5HT 2C antagonism

How well did you know this?

Not at all

Perfectly

What does fluoxetine do through 2c blockade?

Dis-inhibits NE And DA (increase their levels) which leads to energizing and fatigue reducing effects
Also anorexia and anti-bulimia effects (high dose)

How well did you know this?

Not at all

Perfectly

High dose inhibition and other inhibitions with Fluoxetine (Prozac)

NET and 2D6/3A4 (many drug interactions)

How well did you know this?

Not at all

Perfectly

Sertraline

Zoloft

How well did you know this?

Not at all

Perfectly

Sertraline classes

DA Reuptake Blockade (weakly)

Sigma 1 Agonist

How well did you know this?

Not at all

Perfectly

What does sertraline’s classes mean it does?

DA - improve energy and motivation (weak activating)

Signma- Anxiolytic effect

How well did you know this?

Not at all

Perfectly

Paroxetine

Paxil

How well did you know this?

Not at all

Perfectly

Paroxetine effects

Anxiolytic

Weak NET inhibition (good to fight depression)

How well did you know this?

Not at all

Perfectly

Down sides to paroxetine

Inhibits 2D6
Blocks NOS (sexual dysfunction)
Big withdrawal symptoms!

How well did you know this?

Not at all

Perfectly

Fluvoxamine

Luvox

How well did you know this?

Not at all

Perfectly

Fluvoxamine treats

OCD and anxiety

How well did you know this?

Not at all

Perfectly

Fluvoxamine class

Sigma 1 agonists (anxiolytic)

How well did you know this?

Not at all

Perfectly

***Down sides to Fluvoxamine

Metabolized by 3A4 and 1A2 which are induced in smokers

Citalopram

Cipramil

Citalopram classes

SERT | Mild H1 blocker

Pros of citalopram

Better tolerated

Cons of citalopram

Mild 2D6 inhibition

S-Citalopram

Escitalopram

S-Citalopram class and pros

No anti H1 No 2D6 PURE SERT inhibitor (SSRI)

SSRI Problems with Dosing

``` Delayed effects Difficult to monitor Long half life and active metabolites Inter-individual variations Interactions! CI with MAOIs ```

SNRI means

Serotinin NE Reuptake Inhibitors

Venlafaxine

Effexor

Down sides to venlafaxine

Substrate for 2D6 and primary metabolite is also 2D6 (desvenlafaxine)

Venlafaxine side effects

Nausea Sexual dysfunction SSRI-like

Levomilnacipran

Fetzima

Levomilnacipran potency

NERT more than SERT | No DA

Levomilnacipran SE

``` Nausea Constipation Hyperhidrosis Tachycardia Sexual dysfunction Vomiting ```

NDRI means

NE Dopamine Reuptake Inhibitors

Buprioprion

Wellbutrin

Buprioprion works how?

Poorly defined | Weak inhibitor of both NET/DAT but metabolites are more potent

Goldilocks drug solution?

CNS activating and stimulating | Also anti-smoking drug

Down side to bupropion

2D6

Buproprion use

Pts who cannot tolerate serotonin side effects of SSRI or whose depression does not respond to 5HT boosting

Duloxetine

Cymbalta

Duloxetine

5HT and NE uptake

Duloxetine down side

2D6 inhibitor

Duloxetine used for

Chronic pain | Pain with depression

NRI means

NE Selective Reuptake Inhibitors

Examples of NRI

Atomoxetine (Strattera) | Viloxazine (vivalan)

SARI means

Serotonin Antagonist Reuptake Inhibitor

SARI MOA

Combination of SERT inhibition and 2A/2C blockade

2A/2C antagonisms + SET inhibition means

Makes serotonin output more inhibitory Potentiates gene expression stimulated by 1A Potentiates inhibitory action of 1A on glutamate release

Trazodone

Desyrel

Trazodone is used for

Short acting sedative antidepressant (3-6 hrs)

Down side to trazodone

3A4

NaSSA

Noradrenergic-Specific Serotonergic Antidepressant

NaSSA MOA

Release more serotonin and don't stop releasing

Mirtazapine

Remeron

Mirtazapine class

H1 (strong sedative) Alpha2 (enhances NE) Blocks H1, 5HT2 and 5HT3

Typical AE

Weight gain

Vilazadone

Viibryd

Vilazadone class

SSRI

Vilazadone up side

Improved mood within one week No reduction in sexual functioning No weight gain

St. John's Wort

Hypericum perforatum | - 3A4 and can cause serotonin syndrome with other antidepressants

Major depression is a result of

neuronal loss in hippocampus and prefrontal cortex and drugs stimulate neurogenesis