Antidepressants Flashcards
SSRI with 1 week half life
Fluoxetine (Prozac)
What results in discontinuation syndrome
SSRI with short half life that is abruptly stopped
SE when SSRI and MAO-i are used in combination
Serotonin Syndrome
SSRI most likely to cause weight gain
Paroxetine (Paxil)
Washout period when switching from MAO-i to SSRI
2 Weeks
S-Enantiomer of Citalopram (Celexa)
Escitalopram (Lexapro)
Which SSRIs should be tapered to be discontinued and why?
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Very short half lives
Common SE of SSRI that patients are embarrassed about
Sexual Dysfunction
SNRI MOA
Serotonin NE Reuptake Inhibitor
SNRI that is a psychoactive metabolite of another
Desvenlafaxine (Pristiq)
At what dose does Venlafaxine (Effexor) block reuptake of serotonin
All (Low, moderate, high)
What does Venlafaxine (Effexor) block at very high doese?
Blocks reuptake of Dopamine at >375mg/dl
Which SNRI is used for pain in depression or diabetic neuropathy pain
Duloxetine (Cymbalta)
When do you see poop-out syndrome (relapse)?
Like with SSRIs, patients take SNRI for depression -> get initial response -> continue taking medication but then experience this
Depressed patient started on SSRI/SNRI experiences activation and agitation. What is this?
Induced Bipolar State
What weird effect for women might venlafaxine (effexor) be useful for?
Hot Flashes/Flushes in Perimenopausal women
Common, Dose Dependent Cardiac SE of Venlafaxine (Effexor)
Increased BP (HTN)
What type of antidepressant is Buproprion (wellbutrin)
NDRI
What category of antidepressant is useful for smoking cessation?
NDRI
What specific SE does NDRI NOT have that SSRIs do?
Sexual Dysfunction
What risk increase is seen with NDRI?
Seizures (increases from 0.4% to 4% at very high doses)
What is NDRIs NOT useful for treatig compared to SSRI or SNRIs?
Anxiety Disorders
What aspect of atypical depression may NDRIs be useful for?
Hypersomnia (>10 hr sleep per night)
NDRI and weight
Decrease
Besides depression, what else can NDRIs be considered for?
ADHD in children and adults due to stimulating effects
How many weeks before onset of action with NDRIs?
2-4 weeks
What does NaSSA stand for?
Noradrenergic and Specific Serotonergic Agent
NaSSA MOA
Increases NE and Serotonin via:
Presyaptic a2- adrenergic antagonist
Which antidepressants is an NaSSA Class
Mirtazepine (Remeron)
Which SE seen with SSRI and Venlafaxine may be reveresed in NaSSA and via what receptor?
GI SE (N/V/D, cramps) This is via 5HT3 antagonism
Which SE of Mirtazapine (Remeron)is not a problem if it hasn’t occured within the first 6 weeks of treatment?
Weight Gainn
When do you see Serotonin Syndrome with Mirazapine (Remeron)
When it is taken with MAO-i at same time
OR
Within 2 weeks of each other
What receptors does MIrtazapine (remeron) block?
Presynaptic Receptor
Serotonin Post Synaptic
Histamine Post Synaptic
Which problems does MIrtazapine(remeron) have an almost immediate onset of action for?
Anxiety and Insomnia
Does Mirtazapine(Remeron) affect CYP450 system?
No
TCA Pairs of tertiary and secondary amines
Amitriptyline (Elavil) -> Nortriptyline (Pamelor)
Imipramine(Tofranil) -> Desipramine{(Norpramin)
Anticholinergic SE of TCA
Blurred Vision
Urinary Hesitancy
Dry Mouth
Constipation
Which gender might TCA be more effective than SSRI with regards to treating depression?
Males
What p450 enzyme is correlated with TCA concentration?
Cytochrome P450 2D6; Blocking this may increase TCA concentration
TCA SE: Dizziness, Sedation, Hypotension is caused by blockage of what receptor?
a1-adrenergic receptor
What receptor blockade causes SE of sedation and weight gain with TCA?
H1 receptor block
TCA MOA
Serotonin and NE Reuptake Inhibitor
What is a dangerous SE of TCA
Cardiac Arrhythmias due to blockage of sodium channels
Seen with TCA overdose
