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