Antidepressants Flashcards
Antidepressant selection is based upone what three things?
past history of response
side effect
coexisting medical conditions
What kind of drug are TCAs?
antidressants
What kind of drug are MAOIs?
antidepressants
SSRI
selective serotonin reuptake inhibitors
SNRIs
serotonin/norepinephrine reuptake inhibitors
What EKG change may you see while taking TCAs?
QT elongation
What are some examples of antihistaminic side effects?
sedation and weight gain
What are some examples of anticholinergi side effects?
dry mouth, dry eyes, constipation
What are some examples of antiadrenergic side effects?
orthostatic hypotension, sedation, sexual dysfunction
What are the active metabolites of tertiary TCAs?
desipramine
nortriptyline
Tertiary TCAs act primarily on ______________ receptor
serotonin
What are secondary TCAs?
often the metabolites of tertiary TCAs
What kind of drug is desipramine?
secondary TCAs
What kind of drug is notrtriptyline?
secondary TCAs
What kind of side effects may you see with TCAs?
antihistaminic
anticholinergic
antiadrenergic
MAOIs block the inactivation of what amines?
norepinephrine
dopamine
serotonin
MAOIs ________________ the synaptic levels of certain amines
increase
What are the AE of MAOIs?
orthostatic hypotension weight gain dry mouth sedation sexual dysfunction sleep disturbance
What should you avoid while taking MAOIs?
tyramine
What is serotonin syndrome?
it can develop if MAOIs are taking with meds that increase serotonin or have sympathomimetic action
What are the Sx of serotonin syndrome?
abdominal pain, diarrhea, sweats, tachycardia, HTN myoclonus, irritability, delirium
What can serotonin syndrome lead to?
hyperpyrexia
cardiovascular shock
death
How can you avoid serotonin syndrome?
wait 2 weeks before switching from an SSRI to an MAOI
What drug needs to have a 5 week waiting period when switching drugs d/t the long half life?
fluoxetine
What is the MOA of SSRIs?
block presynaptic serotonin reuptake
What is the MC AE of SSRIs?
GI upset sexual dysfunction anxiety restlessness nervousness insomnia, fatigue, sedation, dizziness
What is discontinuation syndrome?
happens w/SSRIs
agitation, nausea, disequilibrium, dysphoria
______________ has a short half life with no active metabolite, which means no build up (good if hypomania develops)
paroxetine
What are two pro’s of paroxetine?
short half life
sedating properties
Paroxetine has significant _______________ inhibition
CYP2D6
What are some AE of paroxetine?
weight gain
anticholinergic effects
discontinuation syndrome
Sertraline has very weak _______ interactions
P450
What length half life does sertraline have?
short half life
lower build up of metabolites
Which has more sedating properties, sertraline or paroxetine?
paroxetine
A ___________ stomach is required for the absorption of sertraline
full
Fluoxetine has a __________ half life
Long
decreased risk of discontinuation syndrome
increased risk of metabolite buildup
What is a possible initial AE of fluoxetine?
increased anxiety and insomnia
Fluoxetime is more likely to induce __________ than other SSRIs
mania
In what type of patient should you use fluoxetine cautiously? why?
hepatic illness. b/c it has a long half life and there is a risk of metabolite buildup
What are two pros of citalopram?
low inhibition of p450
intermediate 1/2 life
What is it a good thing that citalopram has a low inhibition of p450?
less drug/drug interaction
What EKG change may you see with citalopram?
QT elongation
dose dependant, doses greater than 40 not recommended
What is the MOA behind citaloprams sedating properties?
mild antagonism at H1 histamine receptor
Citalopram has __________ GI AE than sertraline
less
Escitalopram has a ________ inhibition of p450 enzems
low
escitalopram is _________ effective than citalopram in acute response and remission
more
Which SSRI has the shortest half life?
fluvoxamine
What is a unique pro of fluvoxamine?
analgesic properties
Fluvoxamine is a strong inhibitor of ___________ and __________
CYP1A2
CYP2C19
Inhibit both serotonin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects
SNRIs
What are SNRIs used to treat
depression, anxiety and neuropathic path
______________ has almost no activity against P450
venlafaxine
Why are desvenlafaxine and venlafaxine good for geriatric populations?
short half life and fast renal clearance avoids build up
Venlafaxine can cause an increase in ___________ BP
diastolic
What drug can cause significant nausea, especially with the IR tablet?
venlafaxine
Tapering of venlafaxine is recommended after ________ of administration
2 weeks
What is a con AE of desvenlafaxine?
dose related increase in total CHOL LDL and TG
There is some data that suggests _________ may have some efficacy for the physical symptoms of depression
duloxetine
Duloxetine is a _____________ and _____________ inhibitor
CYP2D6
CYP1A2
You cannot break the capsule of this drug as its active ingredient is not stable within the stomach
duloxetine
This drug is a 5HT2 and 5HT3 receptor antagonists
mirtazapine
Mirtazapine is _____________ at low doses
very sedative
MOA of buproprion
reuptake inhibition of dopamine and norepinephrine
This drug is a second line ADHD agent
buproprion
You do NOT want to give this drug to a person suffering from anorexia/bulemia d/t risk of seizure
buproprion
This drug has some abuse potential because it can iduce psychotic sx at high doses
buproprion
For a treatment naive patient, you want to start with what kind of drug?
SSRI
citalopram, fluoxetine, sertraline
Paxil and mirtazapine are poor first line choices because of thier ________ and____________ effects
sedation
weight gain
What drug is contraindicated in a pt with HTN issues
venlafaxine
What drug may help with neuropathic pain?
TCAs
_____________ has an indication for neuropathic pain, dpression and anxiety
duloxetine
