Antidepressants Flashcards

1
Q

What are the MAOs MOA, uses, AE, and DI?

A

MOA: inactivates excess NE, dopamine, and serotonin that may leak out of synaptic vesicles when neuron is at rest

  • Phenelzine: irreversibly bind MAO-A/B
  • Isocarboxazid: irreversibly bind MAO-A/B
  • Tranylcypromine: irreversibly bind MAO-A/B
  • Selegiline: MAO-B inhibitor and MAO-A at high doses

Uses: tx of depression when unresponsive to other antidepressants; Selegiline Tx early Parkinson’s disease (transdermal)

AE: drowsiness, insomnia, N, orthostatic hypotension, weight gain, muscle pain sexual dysfunction

DI: serotonin syndrome, cheese reaction (pseudoephedrine and phenylpropanolamine)

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2
Q

How can you manage Serotonin Syndrome and Cheese Reaction?

A
  • Serotonin Syndrome: Benzodiazepine (sedation) and Cyproheptadine (serotonin antagonist)
  • Cheese Reaction: Phentolamine or Prazosin to manage tyramine-induced HTN
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3
Q

What are the TCAs MOA, AE, and what is used to Tx overdose?

A

MOA: block SERT and NET

  • Amitriptyline
  • Nortriptyline
  • Clomipramine
  • Desipramine
  • Imipramine

AE: block alpha-andrenergic, muscarinic, histamine, and cardiac fast sodium channels

OD: Sodium Bicarbonate to reverse conduction block

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4
Q

SSRI MOA, uses, AE?

A

MOA: inhibit SERT with little other activity

  • Citalopram
  • Escitalopram
  • Fluvoxamine
  • Fluoxetine
  • Paroxetine
  • Sertraline

Uses: DOC depression; OCD, PD, GAD, PTSD, SAD, Premenstrual Dysphoric Disorder, Bulemia, Premature ejaculation

AE: N/D, GI upset; less of the TCAs AE; overdose can cause seizure

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5
Q

SNRIs MOA, uses?

A

MOA: block SERT and NET without other effects of TCAs

  • Venlafaxine: potent inhibitor 5HT uptake, inhibits NE uptake at high doses, weak inhibitor of dopamine uptake
  • Duloxetine

Uses: Tx depression when SSRIs are ineffective

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6
Q

NDRIs MOA, uses?

A

MOA: inhibits NE and dopamine uptake and increase release

  • Bupropion

Uses: not associated with sexual dysfunction because it is not serotonergic and smoking cessation; overdose and cause seizures

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7
Q

SARIs MOA, uses?

A

MOA: weak inhibitors of SERT and NET and also 5HT2 antagonist

  • Nefazodone: no longer prescribed bc of hepatotoxicity
  • Trazodone: also blocks alpha1 and H1 so extremly sedating and used as a hypnotic
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8
Q

NASSA MOA, uses

A

MOA: antagonist of central presynaptic alpha2 receptors > enhance release of NE and 5HT; antagonist at 5HT2/3 receptors; H1 antagonist

  • Mirtazapine

Uses: may be useful if insomnia or agitation is prominent

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9
Q

What is Antidepressant Discontinuation Syndrome, symptoms, drugs most likely to cause it?

A
  • abrupt discontinuation of antidepressants causing symptoms:
  • Anxiety/irritability/tearfulness, dizziness, HA, lethargy, flu-like symptoms, electic-shock sensation, insomnia, N/V/D
  • By discontinuation of SSRI/SNRI specifically Paroxetine and Venlafaxine because of short half life
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10
Q

Which classes of antidepressants can be used for chronic pain?

A
  • TCAs and SNRIs mainly for neuropathic pain because block NE and 5-HT
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11
Q

Lithium MOA, Uses, AE?

A

MOA: uncompetitive inhibitor of inositol polyphosphatase and monophosphatase to block regeneration of inositol

Uses: prophylactically in treating manic-depressive pts and in tx of manic episodes

AE: tremor/sedation/ataxia/aphasia, seizure, weight gain, hypothyroidism, nephrogenic diabetes insipidus, edema, dermatitis, alopecia, leukocytosis; category D

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12
Q

How are the adverse effects of tremor and nephrogenic diabetes insipidus from Lithium treated?

A
  • Tremor: Propranolol or Atenolol
  • Nephrogenic Diabetes Insipidus: Amiloride (Thiazides and NSAIDs)
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13
Q

What should be regularly monitored when taking Lithium and what drugs reduce its renal clearance?

A
  • Monitor: Serum lithium concentrations, Thyroid function, Renal function
  • Reduce renal clearance: Thiazide, NSAIDs, ACE inhibitors, ARBs
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