Antidepressants Flashcards
How long can it take to see antidepressant work? How long before you can see a maximal response?
1-3 weeks, maximal response=3 months
If an antidepressant isnt effective what are the steps to take?
increase dosage
switch to another drug in same class
Switch to another drug in a different class
add a second drug (lithium or atypical antidepressant)
Can you DC an antidepressant immediately?
no, must taper
SSRI examples
celexa, lexapro, prozac, paxil, zoloft
celexa, lexapro, prozac, paxil, zoloft
SSRI
SNRI examples
Cymbalta, Effexor
Cymbalta, Effexor
SNRI
Nardil, Marplan
MAOI
MAOI examples
Nardil, Marplan
what is wellbutrin?
an atypical antidepressant
what adverse effects are not seen with SSRIs
hypotension, sedation, cardiac toxicity
Half life of Prozac is long so what do we have to remember about this SSRI?
patient may think they are ok if they stop taking it but will have withdrawal symptoms later
Adverse effects of SSRI
sexual dysfunction, nausea, headache, insomnia, nervousness, weight gain, anxiety, Bruxism (teeth grinding)
SSRI mechanism of action
Causes serotonin to accumulate in the synaptic space by blocking the reuptake pump
When does serotonin syndrome begin?
2-72 hours after treatment
serotonin syndrome s/s
altered mental status, tremor, fever, hyperflexia, excessive sweating
what do you do if serotonin syndrome develops?
DC drug, will resolve spontaneously
SSRI drug interactions
MAOI (increases risk for serotonin syndrome), Antiplatelet drugs, Warfarin (start warfarin at a low dose)
How do SSRIs effect warfarin
it increases it so start warfarin at a low dose
SNRI (effexor) mechanism of action
blocks NE and serotonin uptake
adverse effects of SNRIs
weight loss/gain, liver function toxicity, insomnia, headache, sleepiness
Tricyclic antidepressants adverse effects
sedation, orthostatic hypotension, cardiac toxicity, Seizures
Tricyclic antidepressants are best used for which disorder?
major depression
What foods must you avoid when taking an MAOI and why
Tyramine because it can trigger hypertensive crisis
aged cheese, red wine, chicken liver, sauerkraut
MAOI mechanism of action
converts monoamine neurotransmitters (NE, serotonin and dopamine) into inactive products
Sodium nitroprusside, phentolamine are used for what?
hypertensive crisis from too much tyramine while takin an MAOI
