Antidepressants Flashcards
MAO inhibitors
phenelzine
tranylcypromine
selegiline
TCAs
amitriptyline
imipramine
SSRIs
fluoxetine paroxetine sertraline citalopram escitalopram
SNRIs
venlafaxine
duloxetine
serotonin modulators
trazodone
vilazodone
vortioxetine
antidepressants
all work to inc levels of DA, NE, 5HT
all are Na+ channel blockers –> prolonged QRS
all have black box warning of sucidal thinking/behavior
MAO inhibitors
MOA?
Side effects?
inhibition of monoamine oxidase blocks degradation pathway for biogenic amines (DA, NE, 5-HT), thus inhibition increases levels these NTs
side effects: hypertensive crisis if administer w/ sympathomimetics (decongestants) or foods high in tyramine
avoid use w/ other antidepressants
rarely used today
Selegiline
MAO-B selective (DA)
tx: Parkinson’s, smaller doses for depression
black box warning that applies to all antidepressants?
suicidal thinking and behavior
unique to younger patients (adolescents)
MAO-A inhibitors selectively block ___ breakdown
MAO-A inhibitors selectively block NE breakdown
TCAs
MOA?
Side effects?
Primarily blocks re-uptake of NE (and some 5-HT)
side effects:
- some binding to muscarinic ACh receptors (dry mouth/urinary retention/constipation/blurred vision)
- weight gain
- orthostasis
- ECG changes, sexual dysfunction, hematologic abnormalities
anti-histamines also block _______ receptors
anti-histamines also block muscarinic receptors
Dissociation constant (Kd)
measure of post-synaptic receptor affinity
lower Kd –> more tightly bound drug to its receptor
the more seretogenic the drug, more likely side effect of _______________
the more seretogenic the drug, more likely side effect of SEXUAL DYSFUNCTION
TCA overdose tx
- do NOT induce vomiting (–> neuro/hemodynamic deterioration, aspiration)
- use activated charcoal/gastric lavage to bind free drug
If QRS widening…
- alkalinize serum w/ NaHCO3 to dec metabolic acidosis
- may need intubation w/ hyperventilation