Antidepressants Flashcards
What is the goal of most antidepressants?
Increase NTs in the synapse
Out of the 2 theories about how antidepressants work, which one is more accepted?
Eventual down-regulation of pre-synaptic receptors - it takes 3-4 weeks for them to work
Name 2 nonselective MAOIs.
Phenelzine and Tranycypromine
What is the original and oldest class of drugs intended to treat depression? How did they discover them?
MAOIs
Iproniazid - tx of TB that improved mood
What NTs do MAOIs increase? A vs. B?
A - Epi, NE, 5-HT
B - DA
What is the major limitation of MAOIs? What foods/drugs should you avoid regarding this issue?
potential for HTN crisis
AVOID
1. Foods high in tryamine
2. Alpha agonist (sudafed- sympathomimetic amine)
What is the main difference between phenelzine and tranylcypromine?
Phen - sedating (like phenergan)
Tanyl - activating
Precautions with MAOI apply up to ________ following D/C of MAOI.
3 weeks
what other drugs should you avoid like taking an MAOI? Does the wash out period apply?
TCAs
SSRI
Meperidine (narcotic)
YES - avoid for 3 weeks
T or F. Because of all the precautions with MAOIs, they are not considered first line.
T.
What is the father of the TCAs? What was their old name?
Imipramine - historically referred to as the thymoleptics
TCAs are highly effective and inexpensive, so why aren’t these used as readily any more?
They are dirty and toxic.
What does TCA stand for (tox)? What is the antidote to TCA overdose?
T - tonic clonic seizsure
C - cardiac arrythmia
A - anticholinergic
antidote - bicarb
Secondary amines are metabolites of tertiaries, and are generally ____________ tolerated when compared to tertiary amines.
BETTER TOLERATED
T or F. Secondary amines are metabolized into tertiary amines.
F. Tertiary are metabolized into secondary.
What are the side effects of TCAs?
ANTICHOLINERGIC - anti parasympathethic - sympathetic
tachycardia
sedation
peristalsis stops = constipation, dry mouth
urinary retention
orthostatic hypotension, visual disturbances, conduction disturbances
Using TCAs in patients with histories of __________ is dangerous.
(ASS)
Arrythmias
Seizure
Suicidal ideation/attempts
TCAs interact with what 3 drug classes?
MAOIs
antiarrythmics
CNS depressants/stimulants
Patients are told that TCA anticholinergic effects may subside in ___ weeks and that the antidepressant effect may take up to __ weeks to develop.
2-3 weeks
2-4 weeks
Name 3 off label uses of TCAs. Are TCAs more commonly used for these things?
YES
- insomnia
- Neuropathic pain
- enuresis
What is the father of the SSRIs?
Fluoxetine (Prozac) “wonder drug”
name some other brand name SSRIs.
Paxil
Zoloft
Celexa
Lexapro
What is the big advantage/disadvantage of SSRIs compared to TCAs?
Lacks anticholinergic, CV, toxic effects
more $$$
What is the most common AE of SSRIs? Keep in mind that there are other AEs related to specific drugs. What about drug reactions?
sexual dysfunction
some CYP inhibition
Patient presents with confusion, sweating, fever, rigidity, tachycardia, hypotension. They were taking a SSRI and a MAOI. What is going on?
Serotonin syndrome
How does Bupropion work? What is the major benefit of using this drug over SSRI?
Weak inhibitor of DA reuptake with little/no effect on NE or 5HT
little effect on CV or sexual dysfunction
Bupropion increases/lowers seizure threshold.
Lowers
T or F. Bupropion causes weight gain.
F. weight loss
What antidepressant drug is also used for smoking cessation?
Bupropion
How does Trazodone work? It seems illogical…
Serotonin 2 receptor antagonist and weak SSRI.
What group of people may benefit the most from Trazodone?
People with depression and insomnia (it is highly sedating)
How does Venlafaxine (Effexor) work?
Blocks reuptake of NE and 5HT
not chemically related to TCAs or SSRIs
What are the major AEs of venlafaxine?
CV effects - HTN, tachycardia, increases serum lipids
sexual dysfunction
Which drug is typically reserved for last line/Pre-ECT therapy?
Venlafaxine.
How does Duloxetine (Cymbalta) work?
SSRI with NE blocking properties
What 3 conditions are Duloxetine used for other than depression? (claim to fame)
peripheral neuropathy, fibromyalgia, incontinence
Mirtazepine has what 3 side effects?
sedation
weight gain
no sexual effects
What herbal remedy is a weak SSRI, MAOI?
St. John’s Wart
Sometimes, people are given 5-10mg of _________ to get over the hump when starting an antidepressant.
Ritalin - amphetamine
What Abx has weak MAOI properties?
Linezolid
