Antidepressants Flashcards
Fluoxetine
SSRI (depression, atypical depression, anxiety). Longest half life (give to alleviate SSRI withdrawal symptoms). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)
Paroxetine
SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)
Sertraline
SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)
Citalopram
SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)
Patient with depression has hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
Serotonin Syndrome (SSRI, SNRI, MAOI, TCA)
Serotonin Syndrome
Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
Venlafaxine
SNRI (inhibits 5HT and NE reuptake)
*Also used for GAD and panic
Tox: HTN, stimulant effects, sedation, nausea
Duloxetine
SNRI (inhibits 5HT and NE reuptake)
*Also used for Diabetic peripheral neuropathy
Tox: HTN, stimulant effects, sedation, nausea
SSRIs
Fluorescence Paralyzes Senior Citizens
Fluoxetine, Paroxetine, Sertraline, Citalopram
SNRIs
Venlafaxine, Duloxetine
Amitriptyline
TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Amitryptiline is tertiary TCA, therefore has more anticholinergic side effects thatn secondary (nortriptyline).
Nortriptyline
TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Nortriptyline is less anticholinergic SE than Amitryptiline, therefore good for elderly.
Imipramine
TCA (blocks 5HT and NE reuptake) Used for major depression, fibromyalgia *Imipramine also used for bedwetting Tox: Tri-C's (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia. Treat cardiovascular tox with NaHCO3.
Desipramine
TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Desipramine is less sedating and has higher seizure threshold.
Clomipramine
TCA (blocks 5HT and NE reuptake) Used for major depression, fibromyalgia *Clomipramine also used for OCD Tox: Tri-C's (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia. Treat cardiovascular tox with NaHCO3.
Doxepin
TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
Amoxapine
TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
TCAs
Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine.
*All end in -iptyline or -ipramine, except for Doxepin and Amoxapine
TCA Toxicity
Tri-Cs: Convulsions, Coma, Cardiotoxicity (arrhythmias). Also, respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic SE (use Nortriptyline)
Treat cardiovascular tox with NaHCO3
Tranylcypromine
MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.
Phenelzine
MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.
Isocarboxazid
MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.
Selegiline
MAOI (increases NE, 5HT, DA).
*Selective MAO-B-I (and used for Parkinson’s)
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.
MAOIs
MAO Takes Pride In Shanghai:
Tranylcypromine, Phenylzine, Isocarboxazid, Selegiline
MAOI Toxicity
HTN crisis (with tyramine), CNS stimulation, Serotonin Syndrome (with SSRI, TCA, St. John’s Wort, Meperidine, Dextromethorphan)
Bupropion
Antidepressant: Increases NE and DA via unknown mech
Used for depression, smoking cessation, or added to SSRI to alleviate sexual side effects.
Tox: Lowers seizure threshold, stimulant effects (tachycardia, insomnia), headache.
Mirtazapine
Antidepressant: Alpha2-antagonist that increases NE and 5HT release, and potent 5HT-2 and 5HT-3 receptor antagonist.
Used for depressed old lady who is not eating or sleeping.
Tox: anti-histamine side effects of sedation, increased appetitie, weight gain, dry mouth
Maprotiline
Antidepressant: Blocks NE reuptake
Tox: Sedations, Orthostatic hypotensions
Trazodone
Antidepressant: Inhibits 5HT reuptake.
Used for insomnia, as high doses are needed for antidepressant effects. Often added to SSRI to alleviate sexual side effects.
Tox: Sedation, nausea, priapism, postural hypotension. “TrazoBONE”
