Anxiety and Depression Flashcards
TCAs
Considered 2nd line for Anxiety, but not used often d/t SE and Overdose potential
Overdose of TCA
TORSADES de POINTE
Coma
Acidosis
Respiratory depression
TCA risk
Seretonin synd
TCAs act on what receptors
NE and Seretonin
also: histamine, a1, cholinergic (which causes the SE)
TCAs
2: Notriptyline, Desipramine
3: Amitriptyline, Imipramine
Indications for TCAs
Anxiety (2nd line)
Chronic pain
Fibro
Enuresis (bedwetting)
When using TCAs, since they act on Serotonin receptors, caution of
Seretonin syndrome
do NOT combine with MAOIs
Drugs that act on 5HT (Serotonin) receptors therefore we need to be cautious of Serotonin syndrome
TCA, SNRI, SSRI, MAOIs
Nortriptyline, Amitriptyline, Prozac, Zoloft, Paxil, Effexor, Cymbalta, etc.
Generic name: Fluoxetine
SSRI
Brand name: Prozac
Generic name: Sertraline
SSRI
Brand name: Zoloft
Generic name: Paroxetine
SSRI
Brand name: Paxil
Generic name: Citalopram
SSRI
Brand name: Celexa
Generic name: Escitalopram
SSRI
Brand name: Lexapro
Generic names:
Fluoxetine Sertraline Paroxetine Citalopram Escitalopram
are all
SSRIs
Brand names:
Prozac Zoloft Paxil Celexa Lexapro
are all
SSRIs
Fluoxetine, aka
Prozac
Sertraline, aka
Zoloft
“the S and Z at beg look the same”
Citalopram, aka
Celexa
“both have C at the beg”
Escitalopram, aka
Lexapro
“both have E towards the beg”
Unique uses of Paroxetine (Paxil)
Social anxiety
OCD
Disadv of Fluoxetine (Prozac)
More drug intxns than other SSRIs
Good thing about Sertraline (Zoloft)
Least likely for drug intxns
Preferred for Elderly
OLD PPL with depression
Zoloft/ Sertraline
DOC for Depression
Citalopram (Celexa)
Anxiety and Insomnia can occur as SE of
Fluoxetine (Prozac)
Sertraline (Zoloft)
Fluoxetine (Prozac)
more drug intxns
Can cause insomnia
Two meds to keep in mind, avoid using together
B- blockers “lol”
and
SSRIs (antidepressants)
Can cause Hypotension and Heart block
A ton of meds to be cautious of using with SSRI Antidepressants d/t caution of: SEROTONIN SYNDROME
MAOIs St Johns Wort Amphetamines Meperidine (opioid) TCAs SNRIs
Nortriptyline, Amitriptyline, Prozac, Zoloft, Paxil, Effexor, Cymbalta, etc.
If you are using SSRI: prozac, zoloft, paxil, celexa, etc…. keep in mind that _____ will not work as effectively
Codeine- its conversion to active compound is blocked
SNRIs
inhibit NE and Serotonin
The two SNRIs
NE and Seretonin
Effexor
Cymbalta
Venlaxafine, aka
SNRI
Effexor
Duloxetine, aka
SNRI
Cymbalta
Venlaxafine
Duloxetine
SNRIs
SE of Venlaxafine (Effexor)
Increase BP
SE of Duloxetine (Cymbalta)
Hepatotoxic (liver!)
Glaucoma (acute angle closure)
When can you NOT use Bupropion (Wellbutrin)?
hx of Seizures
What neurotransmitters are a/w Bupropion (Wellbutrin)
Mainly Dopamine (DA)
but minimally NE and 5HT (seretonin)
When to use Wellbutrin (Bupropion)?
When others havent worked
When pt doesn’t want the loss of Libido SE
St John Wort
for Mild depression
Mechanism unsure- may block reuptake or inhibit MAO
Photosensitivity
do NOT combine w other SSRI- risk of Serotonin synd
SSRIs that are ok while breastfeeding
Sertraline (Zoloft)
Paroxetine (Paxil)
Which of the two ok for breastfeeding is the DOC while breastfeeding?
SSRIs
Zoloft
aka Sertraline
DOC for Acute Anxiety
short term, self limiting
Benzos
DOC for GAD
1st line: SSRI, SNRI
2nd line: TCA
Abuse concern: Buspirone, Hydroxyzine
Most useful for short term insomnia
Benzos
GABA
CNS depresant
Major inhibitory neurotransmitter
Relives anxiety and promotes sedation
Activation of GABA receptors
allows Cl- to enter cell, hyperpolarizing
causing depression of electrical activity
Drugs that work independently of GABA
Buspirone
Ramelteon
What is Hydroxyzine’s business in Anxiety?
It’s an Antihistamine used as anti-anxiety med
No abuse potential, good for recovering addicts
DOC for Recovering Addicts suffering from Anxiety
Hydroxyzine
Buspirone
low abuse potential
Hydrozyzine (Vistaril) is also used in _____ in addition to Anxiety
Parkinson
Barbs
independent of GABA
Marked CNS depression, causes Euphoria
Drug of ABUSE!!
CONTRA of Barb
Porphyria (abnormal heme synthesis)
Pulmonary insuff
Supra-additive effects when combined w other depressants (i.e. Alcohol)
When to use Barbs?
Short acting: Induction of anesthesia
Long acting: Anticonvulsants
for SEIZURES
Barbs
Thipental- induce anesthesia
Phenobarbitol- tx Seizure, it’s an Anti convulsant
Why are Barbs so dangerous?
NO ceiling effect
Coma, resp depression, dec BP
DO NOT GIVE STIMULANT to combat these effects
How to treat Barb OD?
Supportive
Diuretics, Alkalization of urine
Benzos indication
Anxiety
Insomnia
but dec in Anxiety often accompanied by drowsiness
Short acting Benzo
Midazolam
Intmdt acting Benzo
Alprazolam
Oxazepam
Lorazepam
Long acting Benzo
Diazepam
Flurazepam
Do NOT use Benzos to treat Anxiety if any of these other things are present
OCD
Panic disorder
PTSD
Anxiety in child/teen
instead, use SSRI
Benzo that’s used in prep for Anesthesia for Short surgical procedures
Midazolam
Benzos DOC for Status Epilepticus
Diazepam
Lorazepam
The Z drugs used just for Insomnia
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
strong and rapid sedative effects
Which of the Z drugs have short duration of action, therefore NO DROWSY MORNING
Zolpidem (Ambien)
Zaleplon (Sonata)
Which Z drug stands out for having drowsy morning effect bc it has a longer duration of action
Eszopiclone (lunesta)
Overall, the safety of the Z drugs is
GOOD
high margin of safety
Ramelteon (Rozerem)
Melatonin analogue, resets sleep wake cycle
Promotes sleepy w/ no GABA effect
Buspirone
agonist for Seretonin
Indications: GAD or Anxiety w Depression
ADHD
PMS
Low addiction potential
Buspirone and Breastfeeding
“Caution”
not enough data
SSRI to reach for if you are breastfeeding
Zoloft (sertraline)
SE of Effexor
aka Venlaxafine
Increase BP –> HTN
SE of Cymbalta,
aka Duloxetine
Hepatotoxic
Glaucoma
