antidepressants Flashcards
mechanism of antidepressants
potentiate action of ne and serotonin in the brain
as depression is due to deficiency of monoamines
antidepressants
SSRI SNRI TCA ATYPICAL ANTIDEPRESSANTS MAOI
SSRI
CITALOPRAM ESCITALOPRAM FLUOXETINE PAROXETINE SERTALINE LESSER SIDE AFFECTS AS COMPARED TO OTHER ANTIDEPRESSANTS needs 2 weeks for action in mood change,ocd,gad,PMS,bulimia cause hepatic toxicity
fluoxetine
treat bulimia
SSRI very long half life 50 hrs
potent inhibitor of cyp system with paroxetine
doesn’t cause discontinuation syndrome
SSRI increased with food
sertraline
serotonin adverse effects
agitation sexual dysfunction headache sweating insomnia diarrhea vomit nausea WEIGHT CHANGE HYPONATREMIA
SSRI USED FOR DIFFICULT SLEEPING
FLUVOXAMINE PAROXETINE
SSRI USED IN EXCESSIVE SOMNOLENCE
FLUOXETINE
SERTALINE
SSRI LESS SEXUAL DYSFUNCTION
bupropion
mitrazapine
fluoxetine
sertraline
fluvoxamine
treat OCD in children
treat child depression
fluoxetine escitalopram
citalopram
SSRI
causes long QT syndrome cardiac arrythmias
serotonin syndrome
SSRI used with MAOI
hyperthermia, muscle rigidity, myoclonic seizures ,altered mental status
dec seizure threshold with antidepressants
discontinuation syndrome
all ssri can cause after abrupt withdrawal specially with lower half lives
headache malaise flu like symptoms agitation disturbed sleep
SNRI
used when depression with chronic pain usually diabetic neuropathy, fibromyalgia,low back pain venlafaxine levomilnacipran duloxetine ppt discontinuation syndrome
venlafaxine
low dose serotonin uptakeinhibitor and at moderate dose NE UPTAKE inhibited
duloxetine
typical NSRI
moderate inhibitor of CYP system
levomilnacipran
treat depression in Europe
cyp substrate
atypical antidepressants
BUPROPION MITRAZAPINE NEFAZODONE TRAZODONE VILAZODONE VORTIOXETINE
BUPROPION
dec cravings not used with bullimic pt
attenuate nicotine withdrawal symptoms
inc risk of seizure
weak dopa and NE reuptake inhibitor
mirtazapine
enhance serotonin and NE by antagonizing alpha2 adrenergic and 5HT2 +H1 antihistaminic causing sedation and antidepression
WEIGHT GAIN
help depressed people to sleep
nefazodone and trazodone
weak serotonin reuptake inhibitor block 5HT(2alpha) receptor and h1 antihistamine trazodone PRIAPISM nefazodone HEPATIC TOXICITY alpha 1 antagonist sedative effects
vilazodone
serotonin uptake inhibitor 5HT(1A)
PARTIAL AGONIST SSRI
VORTIOXETINE
5HT1A agonism
5HT3/7 antagonism
perfect treat depression
TCA
TERTIARY AMINES elevate mood euphoria alertness and inc muscle activity 2 weeks to work block NE n serotonin uptake sensitive to CYP system AMITRYPTALINE IMIPRAMINE CLOMIPRAMINE DOXEPIN DESIPRAMINE(ONLY NE) NORTRPTALINE MAPROTILINE(ONLY NE) AMOXAPINE
AMOXAPINE
BLOCK 5HT2 and D2 receptor
imipramine
control bed wetting in children above 6 years replaced by desmopressin
least likely to cause orthostatic hypotension
amitryptaline
prevent migraine headache and rate chronic pain syndromes
doxepin
low dose TCA treat insomnia
TCA SIDE EFFECTS
CONTRAINED IN BIPOLARS
narrow therapeutic index
avoid In BPH,epilepsy,preexisting arrhythmia
long qt may b
last line agents MAOI
MAO inhibit excess release of neurotransmitters which may leak out do MAOI accumulates NT’S in the synapse
phenelzine(irreversible)
trancylpromine
selegiline(transdermal anti parkinsonian)
isocarboazid
as found in gut n liver a lot inhibition cause toxicities
used in pt where none of other antidepressants work(atypical depression )
tyramine products
cheese chicken liver pickled/smoked fish red wine inactivated by MAO
HYPERTENSIVE CRISIS SEEN IF TYRAMINE
+MAOO
HYPERTENSIVE CRISIS
tyramine +maoi
occipital headache, stiff neck, tachycardia,hypertension arrhythmia,seizures stroke
treat with PHENTOLAMINE AND PRAZOSIN
TREAT MANIA AND BIPOLAR
lithium
very toxic at high dose renal
best with liver failure patients
lithium adverse effects
headache dry mouth polydipsia polyruria polyphasic gi distress hand tremor dizziness dermat Rxn THYROID FUNCTION REDUCED
