Antidepressants Flashcards
What are the ways for antidepressants to work?
Down regulation of receptors or increased concentration of neurotransmitters
How long does it take antidepressant to work?
3-4 weeks
What are they MAO-I names? What do they do to the level of awarness?
Phenelzine (sedating) and Tranycypromine (activating)
Are Phenelzine and Tranycypromine selective?
NO, non selective MAO
Major limitation of MAO-I?
HTN crisis (not first line therapy)
How do MAO-I work?
Block MAO, increasing NE, Epi, Dopamine within CNS synapses
What is tyramine?
Biologically active amine which is normally metabolized intestinally by MAO-A. It is a vasoactive peptide
What is precaution of MAO-I?
Alpha agonists
What should you avoid with MAO-I?
TCA, SSRI, Meperidine
What is the father of TCAs?
Imipramine, historically referred to as thymoleptics
Are TCAs effective?
Yes, and inexpensive, but dirty and toxic.
What came first, secondary or tertiary amines?
Tertiary, they are metabolized to the less toxic secondary amines.
A/E of TCAs?
Tonic Clonic seizures
Cardiac arrhythmias (QRS prolongation)
Anticholinergic
TCA overdose?
HCO3-
Use caution in what patients with TCA?
Seizure disorder, suicidal ideations
Off-label uses of TCA?
- Insomnia
- Neuopathic pain
- Enuresis (bed wetting)
How do SSRI work?
inhibit uptake of serotonin
Benefit of SSRI over TCA?
Less anticholinergic, cardiovascular, and toxic effects of TCA (but more expensive)
Common a/e of SSRI?
sexual dysfunction
SSRIs also cause what?
CP450 (CPY) inhibition
Big caution with what for SSRI
Serotonin syndrome
Sweating, fever, rigidity, tachy
What is Bupropion?
Weak inhibitor of Dopamine uptake
NO effect on serotonin, NE, so few CV effects
Most significant a/e of Bupropion?
seizures, may cause weight loss also
Other use for Bupropion?
smoking cessation
