Antidepressants and anxiolytics Flashcards
What is the mechanism of action of TCAs?
Inhibits SERT and NERT: increases levels of serotonin and norepinephrine
What are the “typical” side effects of TCAs?
- From increased NE: tachycardia, hypertension, agitation, and insomnia
- From increased 5-HT: stomach upset, sexual dysfunction, serotonin syndrome, increased bleeding
What are special side effects of TCAs?
Cardiovascular toxicity: reflex tachycardia and QT prolongation
T/F: TCAs are preferred in suicidal patients
False, they have the highest risk of death in overdose due to cardiac effects
What are names of TCAs?
Amitriptyline, desipramine, nortriptyline
What is the mechanism of SSRIs?
Inhibit SERT and increase serotonin
What are common side effects of SSRIs?
From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding
What drugs are SSRIs?
Fluoxetine, fluvoxamine, paroxetine, escitalopram, citalopram, sertraline
What is the mechanism of action of SNRIs?
Inhibit SERT and NET: increase serotonin and norepinephrine
What are common side effects of SNRIs?
- From increased NE: tachycardia, hypertension (check bp) , agitation, and insomnia
- From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding
What is a special side effect of SNRIs?
They can cause really bad high blood pressure because they have no off target effects (no alpha 1 blockade)
What drugs are SNRIs?
Duloxetine, venlafaxine, desvenlafaxine
What is the mechanism of action of NDRI’s?
Inhibits DAT and NET: increase dopamine and norepinephrine
What are the side effects of NDRI’s?
- From increased dopamine: psychosis and increased risk of seizures
- From increased NE: tachycardia, hypertension, agitation, and insomnia
What are special fun facts about NDRI’s?
- It does not cause sexual dysfunction
- It decreases appetite and can actually cause weight loss
- It is contraindicated in patients with seizure disorders (BBW)
- When combined with naltrexone, it is approved as a weight management drug (contrave)
What drug is an NDRI?
Bupropion
Mirtazapine MOA?
alpha 2 antagonist & 5-HT2A antagonist
Mirtazapine side effects GO…
Sedation and weight gain due to H1-antagonism
Trazodone MOA?
Inhibits NET and SERT; 5-HT2 antagonist & H1-antagonist
Trazzie side effects
Sedation and weight gain due to H1-antagonism; priapism
Nefazodone MOA?
Inhibits NET and SERT; 5-HT2 antagonist
Nefazodone side effects
Sedation, weight gain, and hepatotoxic (BBW)
Nefazodone side effects
Sedation, weight gain, and hepatotoxic (BBW)
T/F: There is less sexual dysfunction with atypical antidepressants
True
T/F: MAO-inhibitors are first line antidepressants
False ya dummy- They are only used for treatment-resistant depression now bc
MOA Inhibitors mechanism of action?
Inhibit MAO(A) and increase serotonin and norepinephrine
What are common adverse effects seen with MAO-Is?
- From increased NE: tachycardia, hypertension (and orthostatic hypotension d/t octopamine), agitation, and insomnia
- From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding
What are fun facts you should know about MAO-Is?
Drug food interactions can lead to hypertensive crisis so avoid tyramine-containing foods (wine and cheese)
What are examples of MAO-I’s?
Selegiline, phenelzine, tranylcypromine
What classes are good treatment options for anxiety?
SSRI, SNRI, TCA, BDZ, buspar, propanolol
What can SSRIs be used for?
generalized anxiety disorder, panic disorder, social anxiety disorder, OCD, and PTSD
What can SNRIs be used for?
generalized anxiety disorder, panic disorder, social anxiety disorder
What can TCAs be used for?
OCD (clomipramine)
What can benzodiazepines be used for?
Generalized anxiety disorder and panic disorder
What can buspirone be used for?
Generalized anxiety disorder
T/F: SSRIs are the agents of choice for long term treatment of anxiety related disorders
True
What is paroxetine used for?
generalized anxiety disorder, panic disorder, social anxiety disorder, OCD, and PTSD
What can sertraline be used for?
panic disorder, social anxiety disorder, OCD, and PTSD
What can fluoxetine be used for?
Panic disorder and OCD
What can fluvoxamine be used for?
OCD only
What can escitalopram be used for?
GAD
Buspirone
- Only anxiolytic activity
- Least effective tx for anxiety
- Most effective after 1-4 weeks of treatment
What is the MOA of buspar?
It is a partial agonist at 5-HT2A receptors
What are side effects of buspirone?
Dizziness and non-specific chest pain
