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Psychiatry Psychopharm > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

How do MAOIs work?

A

Irreversible inhibitors of MAO in presynaptic neurons which leads to increase in 5-HT (serotonin), dopamine, and norepi

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2
Q

What is the major side effect of MAOIs?

A

Tyramine-induced hypertensive crisis
Dietary causes - cheese, fava beans, liver, soy sauce, sauerkraut, fermented foods, cured meats
Medical causes - cold meds, pain killers

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3
Q

How does tyramine induced hypertensive crisis work?

A

MAO breaks down tyramine in gut
When it’s not broken down, it has adrenergic properties
Sudden catastrophic rise in BP

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4
Q

What are the contraindications to MAOIs? What can it lead to?

A

Co-administration with any other antidepressant except for TCAs
Serotonin syndrome

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5
Q

What are the 4 MAOIs?

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegeline (Emsam)

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6
Q

What are the minor side effects of MAOIs

A 
Most common = adrenergic - orthostatic hypotension
Second most common = insomnia
weight gain
sexual dysfunction
mania
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7
Q

How do TCAs work?

A

Antagonist at presynaptic 5-HT and NE reuptake pumps

Increases serotonin and NE in the synapse

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8
Q

How long do TCAs take to work?

A

3-4 weeks after initiation

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9
Q

What are the tertiary amine TCA drugs?

A 
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Sinequan)
Trimipramine (Surmontil)
Imipramine (Tofranil)
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10
Q

What are the side effects of tertiary amine TCAs?

A

More anticholinergic, histaminergic, and adrenergic side effects
More dangerous in overdose

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11
Q

What are the secondary amine TCA drugs?

A

Desipramine (Norpramin)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)

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12
Q

What are the side effects of secondary amine TCAs?

A

Less anticholinergic/histaminergic/adrenergic = less sedation and less orthostatic hypotension than tertiary

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13
Q

What are the characteristics of TCAs?

A

Highly protein bound - will interact with other protein bound drugs
Highly anticholinergic
Causes QTc prolongation
Sexual dysfunction

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14
Q

What are contraindications to TCAs?

A

Cardiac conduction delays
Arrhythmias
BPH - causes urinary retention and post void residual, leading to UTIs

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15
Q

What are the serious side effects of TCAs?

A

Lethal in overdose
Cardiotoxic = widened QRS, prolonged QTc, AV block, torsades
Neurotoxic = tremor, ataxia, delirium, coma, seizures

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16
Q

What are the 3 C’s of TCA overdose?

A

Convulsions
Coma
Cardiotoxicity

17
Q

Treatment for TCA overdose?

A

Sodium Bicarb, Mg

18
Q

How do SSRIs work?

A

Antagonist at presynaptic 5-HT reuptake pump

19
Q

How long do SSRIs take to work?

A

3-4 weeks after initiation

20
Q

What if you want to switch from MAOI to SSRI?

A

2 week washout in between

21
Q

What are the contraindications of SSRIs?

A

Concurrent use with MAOIs –> serotonin syndrome

22
Q

What are the signs of serotonin syndrome? What is the treatment of serotonin syndrome?

A 
Hyperthermia
Myoclonus
Autonomic instability
Rigidity
Coma
Death

Treatment = cyproheptatine = serotonin receptor antagonist

23
Q

What are minor side effects of SSRIs?

A

5-HT3 = GI, N/V/D
5-HT2C = anxiety and agitation
5-HT2A = anxiety, agitation, akathisia, insomnia, sexual dysfunction
Serotonin discontinuation = headache, dizziness, irritability, fatigue
weight gain
mania
Rare hyponatremia

24
Q

What is the mechanism of SNRIs?

A

Antagonism at presynaptic 5-HT and NE reuptake

At higher doses, also inhibits DA reuptake

25
Q

How do SNRIs and TCAs differ?

A

SNRIs have no anticholinergic, antihistaminergic, and antiadrenergic effects

26
Q

What are the side effects of SNRIs

A

Increased NE = tachycardia, hypertension, agitation, anxiety, akathisia, tremor, myoclonus
Increased serotonin = GI symptoms, sexual dysfunction
Insomnia
Rare seizures
Contradication = concurrent MAOI for serotonin syndrome

27
Q

What are are the SSRI drugs?

A 
Fluoxetine (Prozac/Sarafem)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)
28
Q

What are the SNRI drugs?

A

Venlafexine (Effexor)
Duloxetine (Cymbalta)
Desvenlafexine (Pristiq)

29
Q

How do NaSSAs work?

A

Noradrenergic and Specific Serotonergic Antidepressant
Antagonist at alpha2 adrenergic receptors = disinhibits NE and 5HT release
Agonist at alpha 1 = increases 5HT release

30
Q

How do SARIs work?

A

Serotonin Antagnoists and reuptake inhibitors
Antagonist at presynaptic 5HT reuptake pump
Antagonist at post-synaptic 5-HT2A receptors = no sexual side effects!

31
Q

How do NDRIs work?

A

Antagonist at presynaptic NE and DA reuptake pumps

Psychiatry Psychopharm (6 decks)

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