Antidepressants Flashcards

1
Q

What enzyme(s) is/are responsible for TCA metabolism?

A

CYP 2D6 (major) and 2C19 (minor)

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2
Q

Imipramine metabolism

A

N-demethylation to Desipramine (active)

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3
Q

Amitriptyline key point

A

Highest antimuscarinic and sedative SE’s of TCA’s.

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4
Q

Amitriptyline metabolism

A

N-demethylation to Nortriptyline (active)

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5
Q

Nortriptyline key point

A

Less antimuscarinic and sedative SE’s than Amitriptyline.

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6
Q

Doxepin isomeric ratio

A

85% “E” isomer, 15% “Z” isomer

“Z” isomer is more active however.

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7
Q

Doxepin metabolism

A

N-demethylation to N-desmethyldoxepin (inactive)

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8
Q

Doxepin cousins

A

Zonalon - 5% Doxepin cream: Topical antihistamine.

Silenor - Sleep aid: CNS antihistamine.

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9
Q

Maprotiline key point(s)

A

Tetracyclic ring structure.
- Added rigidity: NET > SERT, 500x

Secondary amine.
- Low sedation and antimuscarinic SE’s

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10
Q

Tranylcypromine mechanism

A

Irreversible inhibition of MAO A and B.

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11
Q

Phenelzine mechanism

A

Irreversible inhibition of MAO A and B.

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12
Q

Isocarboxazid key point

A

Prodrug.

“Amide” hydrolysis yields Benzylhydrazine (active) metabolite

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13
Q

Isocarboxazid mechanism

A

Irreversible inhibition of MAO A and B

- as Benzylhydrazine

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14
Q

Selegiline key point(s)

A

MAO-B-I

Transdermal patch for Parkinson’s Disease

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15
Q

Fluoxetine key point(s)

A
"No" antimuscarinic or sedative SE's
Long t1/2
Metabolite is active: Norfluoxetine
Fluoxetine/Norfluoxetine = 2D6 and 2C19 Inhibitors
30x selective for SERT over NET
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16
Q

Fluoxetine metabolism

A

N-demethylation to Norfluoxetine (active)

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17
Q

Sertraline key points

A
1S,4R-Enantiomer
1400x selective SERT > NET
Moderate 2C19 inhibition
Weak 2D6 inhibition
N-desmethylsertraline metabolite is active
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18
Q

Sertraline metabolism

A

N-demethylation to N-desmethylsertraline (active)

19
Q

Paroxetine key point(s)

A

3S,4R-Enantiomer
300x selective SERT > NET
*Potent irreversible 2D6 inhibitor
- 2D6 acts on Paroxetine, reactive intermediate, alkylation of enzyme

20
Q

Paroxetine metabolism

A

2D6 removal of “methylene” to form catechol metabolite (inactive)

21
Q

Fluvoxamine key point(s)

A

Can be isomerized by UV light (inactive)
Extensive metabolism (inactive)
600x selective SERT > NET
*Potent 1A2 and 2C19 inhibitor

22
Q

Citalopram key point(s)

A

Most potent SSRI: >300x selective
Racemic mixture
- “S” isomer = Escitalopram
*Weakest P450 inhibitor of all SSRI’s

23
Q

Citalopram / Escitalopram metabolism

A

N-dealkylation to N-desmethylcitalopram (weakly active)

24
Q

Trazodone key point(s)

A

Lacks antimuscarinic effects
mCPP metabolite contributes to overall effects
- 5HT2c partial agonist

25
Trazodone metabolism
3A4 cleaves mCPP (active) from alkyl chain and remainder (active)
26
Nefazodone key point(s)
Yields two active metabolites Nefazodone and alpha-hydroxy metabolite are both 3A4 inhibitors. mCPP metabolite contributes to overall effects - 5HT2c partial agonist *Possible hepatic failure / hepatotoxicity
27
Nefazodone metabolism
3A4 cleaves Nefazodone into alpha-hydroxy metabolite (active) and mCPP metabolite (active)
28
Vilazodone metabolism
3A4 dealkylation (inactive)
29
Vortioxetine metabolism
2D6 converts N-methyl to CO2- (inactive)
30
Venlafaxine key point(s)
"No" affinity for M1, H1, or alpha1 receptors | Two metabolism pathways yield two active products
31
Venlafaxine metabolism
3A4 N-demethylation to N-desmethyl metabolite (weakly active) 2D6 O-demethylation to O-desmethyl metabolite: Desvenlafaxine (separate SNRI; active)
32
Desvenlafaxine metabolism
Major - Glucuronidation | Minor - 3A4 N-demethylation
33
Duloxetine key point
Moderate 2D6 inhibition | Significant interaction with Fluvoxamine
34
Duloxetine metabolism
1A2 / 2D6 Naphthyl ring hydroxylation Glucuronidation (inactive)
35
Levomilnacipran key point
1S,2R-Enantiomer
36
Levomilnacipran metabolism
3A4 N-deETHYLation
37
Bupropion key point(s)
``` Amphetamine core structure Restlessness and Insomnia SE's No antimuscarinic or sedative SE's Has active metabolite *Bupropion and metabolite are 2D6 inhibitors ```
38
Bupropion metabolism
*2B6* hydroxylation of methyl group
39
Mirtazepine key point(s)
Tetracyclic ring structure - Basic N-bearing ring attached to 2-atom bridge - Basic N closer to tri-cyclic ring system * No antimuscarinic effects
40
SSRI P450 Inhibitors
Fluoxetine/Norfluoxetine - 2D6 and 2C19 Sertraline - 2C19 (moderate) 2D6 (weak) *Paroxetine - 2D6 (potent and irreversible) *Fluvoxamine - 1A2 / 2C19 (potent and irreversible)
41
"Multimodal" SSRI P450 Inhibitor(s)
Nefazodone and alpha-hydroxy metabolite - 3A4
42
SNRI P450 Inhibitor
Duloxetine - 2D6
43
Atypical P450 Inhibitor
Bupropion and active metabolite - 2D6