Antidepressants Flashcards
Phenelzine
Non-selective, irreversible MAOI
Inc. synaptic conc. of Ad, NA, DA and 5HT
Precautions: Rizatriptan & Sumatriptan use, angina, epilepsy, bipolar, serotonin toxicity.
ADEs: orthostatic hypotension, sleep disturbances, weight gain & anticholinergic effects.
Counselling: last dose
Tranylcypromine
Non-selective, irreversible MAOI
Inc. synaptic conc. of Ad, NA, DA and 5HT
Precautions: Rizatriptan & Sumatriptan use, angina, epilepsy, bipolar, serotonin toxicity.
ADEs: orthostatic hypotension, sleep disturbances, weight gain & anticholinergic effects.
Counselling: last dose
Citalopram
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression, anxiety disorders, premenstrual dysphoric disorder & bulimia.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity. *may prolong QT interval >40mg. *CYP2C19
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
Escitalopram
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression, anxiety disorders, social phobias & OCD.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity. *may prolong QT interval *CYP2C19
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
Fluoxetine
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression, premenstrual syndrome & OCD.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity. *may prolong QT interval *CYP2C19
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
*long half life (up to 16 days)
Fluvoxamine
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression & OCD.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity. Cisapride use contraindicated.
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
Take with food.
Paroxetine
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression, anxiety disorders, social phobias, PTSD & OCD.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity. Renal insufficiency.
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
Take with food.
Sertraline
SSRI - Selectively inhibit presynaptic reuptake of 5HT.
IND: Major depression, anxiety disorders, social phobias & OCD.
PREC: Bipolar, high bleeding risk, high hyponatraemia risk & serotonin toxicity.
ADEs: agitation, insomnia, sexual dysfunction, weight changes.
Mechanism of action of TCAs
Inhibit the reuptake of 5HT and NA into presynaptic terminals.
Precautions of TCA use.
Prostatic hypertrophy - may precipitate urinary retention
Hyperthyroidism - may have enhanced response to TCAs
Epilepsy - TCAs may increase risk of seizures (so may depression)
Coronary heart disease - TCAs may precipitate angina
May prolong Q-T interval
Orthostatic hypotension may be exacerbated.
High abuse potential.
Common ADEs of TCAs
Sedation Dry mouth Blurred vision Weight gain Orthostatic hypotension Reduced GI motility
Cardiac ADEs of TCAs:
Slowed cardiac conduction
T-wave inversion
Sinus tachycardia
Prolonged QT interval
Counselling points for TCAs
Side effects such as blurred vision, dry mouth and drowsiness that should resolve within 7 days
Take at night to reduce daytime drowsiness
Orthostatic hypotension
Avoid driving or operating heavy machinery if affected
Don’t stop taking this medicine abruptly.
Alternate indications for amitriptyline:
Nocturnal enuresis
Adjuvant in pain management
Migraine prophylaxis
Urinary urge incontinence
Indications for clomipramine:
Major depression
OCD (drug of choice)
Cataplexy associated with narcolepsy