Antidepressants Flashcards

1
Q

What are the 3 big classes of side effects of TCAs?

A

Antihistaminic
Anticholinergic
Antiadrenergic

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2
Q

What antihistaminic side effects are there of TCAs?

A

Sedation

Weight gain

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3
Q

What anticholinergic SEs are there?

A

Dry mouth
Dry eyes
Constipation

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4
Q

What antiadrenergic SE are there?

A

Orthostatic hypotension

Sexual dysfunction

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5
Q

How do TCAs work?

A

Side chains that bind to serotonin receptors

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6
Q

What are examples of TCAs?

A

Amitrytiline
Clomipramine
Imipramine
Doxepin

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7
Q

Heart SE of TCAs?

A

QT prolongation

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8
Q

What are secondary TCAs?

A

Metabolites of TCAs

Primarily block noradrenaline

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9
Q

How do monoamine oxidase inhibtors work?

A

Bind irreversibly to monoamine oxidase

Prevent inactivation of amines

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10
Q

What amines are stopped from being deactivated by MAOIs?

A

Dopamine
Serotonin
Norepinephrine

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11
Q

What happens with these non-inactivated amines?

A

They don’t get broken down in the gut and get absorbed to increase levels

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12
Q

Side effects of MAOIs?

A

Orthostatic hypotension
Sexual dysfunction
Sleep disturbance
Sedation

HYPERTENSIVE CRISIS
SEROTONIN SYNDROME

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13
Q

What causes a hypertensive crisis with MAOIs?

A

When consumed with tyrosine rich foods

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14
Q

Why does tyrosine cause a hypertensive crisis with MAOIs?

A

Is also an amine that is sympathomimetic

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15
Q

What must be done when switching an SSRI to a MAOI because of serotonin syndrome?

A

Must wait 2 - 3 weeks depending on SSRI halflife

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16
Q

Example of a MAOI?

A

Phenelzine

17
Q

Name 6 SSRIs?

A
Sertraline
Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
18
Q

Pros of sertraline?

A

Weak P450 interactions
Short half life
Less sedating

19
Q

Cons sertraline?

A

GI adverse SE

20
Q

Pros paroxetine?

A

Short half life

No build up if mania occurs

21
Q

Cons paroxetine?

A

CYP2D6 inhibition
Sedation
Weight gain

22
Q

Pros fluoxetine?

A

Long half life
Increases energy
Good to use to wean off SSRIs and prevent discontinuation syndrome

23
Q

What is good about a longer half life in SSRIs?

A

Less chance of discontinuation syndrome

24
Q

Cons fluoxetine?

A

Increased chance of metabolite build up

P450 interactions

MORE LIKELY TO CAUSE MANIA!

25
Q

Pro citalopram?

A

Low P450 interaction

Longer half life than fluoxetine

26
Q

Cons citalopram?

A

LONG QT

Sedation

GI effects

27
Q

Pros fluvoxamine?

A

Analgesic properties

28
Q

Cons fluvoxamine?

A

Short half life
Headache
Strong inhibitor of CYPs

29
Q

4 SNRIs?

A

Venlafaxine

Duloxetine

Mirtazipine

Bupropion

30
Q

How do SNRIs work?

A

Inhibit reuptake of serotonin and noradrenaline

31
Q

Pros venlafaxine?

A

No P450 activity
Good renal clearance
- Better for geriatrics

32
Q

Cons venlafaxine?

A

Increased BP
Bad discontinuation syndrome
QT prolongation

33
Q

Pros duloxetine?

A

Good for physical symptoms of depression

Smaller BP increase than venlafaxine

34
Q

Cons duloxetine?

A

CYP inhibitor

Study indicated high drop out rate

35
Q

Pros mirtazipine?

A

Good augmentation with SSRI
Hypnotic
Less sexual SE

36
Q

Cons mirtazipine?

A

Hella weight gain
Increased cholesterol and TAGs
Very sedating at low doses

37
Q

Pros bupropion?

A

Good augmentation
No weight gain
Low mania chance
Good in ADHD

38
Q

Cons bupropion?

A

LOWERS SEIZURE THRESHOLD

Does not treat anxiety

39
Q

Pharma regimen for treatent resistant depression?

A

SSRI + SNRI
+ Lithium
+ antipsychotic

ECT