Antidepressants Flashcards
MAOi chemistry.
Reversible MAOi type A: Moclobemide
Irreversible MAOi type B: Selegiline, Rasagiline, Phenelzine and Tranylcypromine
What amino acid should be avoided with MAOi from fermented, aged food. Also explain.
Tyramine- also broke down by MAO, SE increase in BP, HTN crisis
TCA drug derivatives examples and amine types.
Dibenzocyclohepatadiene deriv: Amitriptyline (Elavil) tertiary amine 5HT=NE Nortriptyline (Aventyl) secondary amine 5HT>NE Dibenzapine deriv: Desipramine (2nd) Imipramine (3rd)
DOC for anxiety disorder (OCD)
Clomipramine
TCA structures are similar to what type of antipsychotic drugs? And drug examples.
Phenothiazines: Chlorpromazine(aliphatic)
Thioridazine Mesoridazine (piperidine)
Prochlorperazine, Fluoperazine, Thioridazine ___
Trifluoperazine (piperazine)
Serotonin Syndrome symptoms.
Agitation restlessness confusion tachy, HTN dilated pupils muscle tremors rigidity sweating diarrhea shivering seizure coma death
Common SSRI and TCA SEs. And uncommon.
Both: Anticholinergic, sexual dysfunction
SSRI: INSOMIA, no weight gain
TCA: SEDATION, hypotension
For Phenothiazines, this side chain has greater potency and highest pharmacological activity. What drug?
sc containing piperazine derivatives: Trifluoperazine
This drug class has no chemical relation to Phenothiazines, produces high incidence extra pyramidal SEs. Give drug example.
Butyrophenones: Haloperidol
Must cont. N cont. sc on N for antipsychotic activity drug.
Lack of ring N and sc.
Phenothiazines +N
Thioxanthines -N
SSRIs.
Citalopram, Escitalopram, Fluvoxamine, Paroxetine, Fluoxetine, Sertraline, Olanzapine
SNRIs.
Venlafaxine, Desvenlafaxine, Duloxetine
Fluoxetine indications and t1/2
Children, adolescents and pregnancies
SE: insomia, potent CYP2D6 inhibitor
t1/2 200h - 5 weeks washout period may not require dose tapering
Dual acting antidepressants and receptors.
Bupropion- NE & DA
Mirtazapine - NE directly & 5HT indirectly
Trazadone- 5HT2 antagonist with some 5HT reuptake inhibitory properties
Trazodone dosing and SE
50-100mg hypnotic
300-400mg excessive sedation
SE: drowsiness and priapism
Bupropion DOC and CI.
DOC: smoking cessation and depression
CI: anorexia or bulimia nervosa, head trauma or prior seizure
DOC for depression and anxiety?
Major depression?
Fluoxetine
-SSRIs, dual acting, Mirtazapine and Moclobemide-(RIMA)
Used as 2nd or 3rd line antidepressants and uses.
TCAs:
Clomi- OCD
Amitriptyline-migraine prophylaxis, chronic pain, neuralgia and depression
Nortriptyline-elderly depressed pts
For RIMA: Moclobemide, DIs?
Sympathomimetics, Meperidine, Opioids antiHTN antipsychotics SSRIs Selegiline excessive Tyramine, alcohol
Reduce dose with Cimetidine
Serotonin Syndrome occurs with which drugs?
All SSRIs, Venlafaxine, Non seletv MAO, Dextromethorphan, Linezolide, Mirtazapine, Moclobemide
also when combined with each other and with: MAOis, Li meperidine pentazocine
Drugs act directly on noradrenergic system and has low rate of GI and sexual SEs but assoc. w sedation and weight gain?
Mirtazapine
Prophilactically in treating manic-depressive pt, manic episodes and bipolar depression? And serum level?
Lithium. Should not exceed 1.5mEq/L
SSRI onset of action?
TCA?
SSRI: 2-4 weeks and optimal effects 4-6 weeks
TCA: 4-6 weeks
Depression with diabetes? Insomia?
Avoid TCA and MAOi due to weight gain
Trazodone-insomia
SSRI like Fluoxetine inhibits what cytochrome?
CYP2D6
Causes Li+ toxicity.
ACEi, NSAIDs, Thiazides, Fluoxetine SSRIs, dehydration and renal dysfunction
Li conc. varies with Na ions
High doses of Venlafaxine (225mg/day) may have effect on?
HTN
