Antidepressants Flashcards
SSRI:
- Longest half-life –> No need to taper
- Safe in pregnancy, children, and adolescents
- SE:
- Insomnia
- Anxiety
- Sexual dysfuntion
- Can elevate levels of antipsychotics –> SEs
Fluoxetine (Prozac)
SSRI:
- Higher risk for GI disturbances
- Very few drug interactions
- SE:
- Insomnia
- Anxiety
- Sexual dysfunction
Sertraline (Zoloft)
SSRI:
- Highly proetin bound –> Rx interactions
- Short half-life –> withdrawal phenomena
- SE:
- Anticholinergic effects (Sedation, constipation, weight gain)
- Sexual dysfunction
Paroxetine (Paxil)
SSRI:
- Rx for OCD
- Multiple Rx interactions due to CYP inhibition
- SE:
- Nausea and Vomiting
Fluvoxamine (Luvox)
SSRI:
- Fewest Rx-Rx interactions
- Dose dependent QTc prolongation
Citalopram (Celexa)
SSRI:
- Levo-enantiomer of citalopram w/ similar efficacy and possible fewer side effects
- Dose dependent QTc prolongation
Escitalopram (Lexapro)
SNRI:
- Often used for depression, anxiety disorders like GAD and Neuropathic pain
- Low Rx interaction
- XR form for daily dosing
- Increased BP w/ High-dose
Venlafaxine (Effexor)
SNRI:
- Rx for Depression, Neuropathic pain, and Fibromyalgia
- SE similar to SSRI
- Dry Mouth and Constipation a/w Norepinephrine effects
- Hepatotoxicity in pts. w/ Liver disease or Heavey Alcohol use
- Expensive
Duloxetine (Cymbalta)
NorEpi-Dopamine Reuptake Inhibitor
- Lack of Sexual SEs
- Some efficacy in Rx for Adult ADHD
- Rx for Smoking cessation
- SE:
- Anxiety
- Risk of Seizures
- Psychosis at High-doses
- Contraindicated in pts. with Seizure or Eating disorders and those on current MAOI usage
Bupropion (Wellbutrin)
Serotonin Receptor Antagonists and Agonists (2)
- Rx for Major Depression w/ Anxiety, Insomnia
- No Sexual SEs
- No change in Rapid Eye Movement (REM) sleep
- SE:
- Nausea and Dizziness
- Orthostatic hypotension
- Cardiac arrhythmias
- Sedation
- Priapism
Trazodone (Desyrel)
and
Nefazodone (Serzone)
A2-Adrenergic Receptor Antagonist
- Rx for Major Depression w/ Significant Weight loss and/or Insomnia
- SE:
- Sedation
- Weight Gain
- Dizziness
- Tremor
- Dry mouth and Constipation
- Agranulocytosis
- Fewer Sexual SE
Mirtazapine (Remeron)
Rx for TCA overdose?
IV Sodium Bicarbonate
TCA:
- Tertiary amine
- Rx for Chronic pain, Migraine, and Insomnia
Amitriptyline (Elavil)
TCA:
- Tertiary amine
- Has IM form
- Rx for Enuresis and Panic Disorder
Imipramine (Tofranil)
TCA:
- Tertiary amine
- Most Seretonin-specific –> Rx for OCD
Clomipramine (Anafranil)
TCA:
- Tertiary amine
- Rx for Chronic pain and use for Sleep-aid in Low dose
Doxepin (Sinequan)
TCA:
- Secondary amine
- Least likely to cause Orthostatic Hypotension
- Rx in Chronic pain
Nortriptyline (Pamelor, Aventyl)
TCA:
- Secondary amine
- More activating
- Least sedating
- Least anticholinergic
Desipramine (Norpramin)
Tetracyclic
- Metabolite of Antipsychotic Loxpine
- May cause EPS
- SE similar to Typical antipsychotics
Nonspecific SE
- Antihistamine: Sedation and Weight gain
- Antiadrenergic: Orthostatic HypoTN, Dizziness, Reflex tachy, Arrhythmias, Widening QRS and QT, and PR intervals
- Antimuscarinic: Dry mouth, Constipation, Urinary retention, Blurred vision, Tachy, Narrow angle glaucoma
- Lethal Overdose: Agitation, Tremors, Ataxia, Arrhythmias, Delerium, Hypoventilation from CNS depression, Seizures
TCAs
(3) Major Complications of TCAs - 3Cs?
- Cardiotoxicity
- Convulsions
- Coma
Rx class that prevents the inactivation of Biogenic Amines, such as norepinephrine, serotonin, dopamine, and tyramine (an intermediate in the conversion of tyrosine to norepinephrine)?
MAOIs
Rx class that inhibit the reuptake of norepinephrine and serotonin, increasing the availability of monoamines in the synapse, because of long half-lives, most are dosed only daily?
TCAs
Rx class that inhibits presynaptic serotonin pumps that take up serotonin, leading to increased availability of serotonin in synaptic clefts?
SSRIs
Enzyme that preferentially deactivates Serotonin and Norepinephrine?
MAO-A
Enzyme that preferentially deactivates Phenathylamine, Dopamine, and Tyramine?
MAO-B
MAOI
- Rx for Refractory Depression
- Rx for Refractory Anxiety
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Rx for pts with Pyridoxine deficiency who develop Numbness or Paresthesias while taking MAOIs?
B6 supplement
Antidepressant Rx for OCD?
SSRI (High doses, Fluvoxamine)
TCAs (Clomipramine)
Antidepressant Rx for Panic disorder?
SSRIs
TCAs (Imipramine)
MAOIs
Antidepressant Rx for Eating disorders?
SSRIs (High Doses)
TCAs
A2-Adrenergic (Mirtazapine)
Antidepressant Rx for Persistent Depressive Disorder (Dysthymia)?
SSRIs
SNRIs (Venlafaxine, Duloxetine)
Antidepressant Rx for Social Anxiety Disorder
(Social Phobia)?
SSRIs
SNRIs
MAOIs
Antidepressant Rx for Generalized Anxiety Disorder (GAD)?
SSRIs
SNRIs (Venlafaxine)
TCAs
Antidepressant Rx for Postraumatic Stress Disorder (PTSD)?
SSRIs
Antidepressant Rx for IBS?
SSRIs
TCAs
Antidepressant Rx for Enuresis? (1)
TCAs (Imipramine)
Antidepressants Rx for Neuropathic pain?
TCAs (Amitriptyline and Nortryptyline)
SNRIs
Antidepressants Rx for Chronic pain?
SNRIs
TCAs
Antidepressants for Fibromyalgia?
SNRIs (Duloxetine)
Antidepressants Rx for Midgraine Headaches?
TCAs (Amitriptyline)
Antidepressant Rx for Smoking cessation?
Bupropion
Antidepressant Rx for Premenstrual Dysphoric Disorder?
SSRIs
Antidepressant Rx for Insomnia?
Mirtazapine
Trazodone
TCAs (Doxepin)
