anxiety meds Flashcards
how many weeks does it take to see full effects of an antidepressant?
12 weeks
how many weeks does it take to see some/ most benefits of an antidepressant?
6-8 weeks
why does it take so long to see the effects of antidepressants?
immediate chemical effects but clinical response takes a few weeks because of down regulation of receptors
TCAs moa
block the reuptake of norepinephrine and serotonin; also interact with muscarinic (M1), histamine (H1), and adrenergic (alpha1) receptors
metabolism of TCAs
cyp450 through liver
adverse effects of TCAs (6)
Anticholinergic – dry mouth and constipation
Antihistamine – sedation
Norepinephrine, alpha blockade –orthostatic hypotension, dizziness
Cardiac arrhythmias and seizures – especially in overdose due to block of ion channels (inhibition of fast sodium channels – QT prolongation)
Sexual side effects, sweating
Serotonin syndrome
TCA toxicity
emergency with 3Cs (convulsions, coma, cardiotoxicity); treat with supportive measures, no antagonists available
amitriptyline indications & moa
TCA
Indications – depression
MOA – equally blocks reuptake of norepi & 5ht
nortriptyline indications & moa
TCA
Indications – MDD, anxiety, insomnia
MOA – predominantly blocks reuptake of norepi
imipramine & desipramine indications & moa
both TCAs – imipramine is a metabolite of desipramine
Indications – MDD, nocturnal enuresis (desipramine)
Imipramine MOA – blocks the reuptake of both norepi & serotonin
Desipramine MOA – predominantly blocks reuptake of norepi
what special step do you need to take when treating with imipramine & desipramine?
check therapeutic blood levels
clomipramine indications
TCA
indications - OCD & cataplexy
MAO-A breaks down…
serotonin, melatonin, epinephrine, NE, DA
MAO-B breaks down…
breaks down phenylethylamine, trace amines, and dopamine
serious adverse effects of MAOIs (3)
Hypertensive crisis (when used with tyramine)
Serotonin syndrome (when combined with other serotonin based drugs)
Hepatotoxicity
phenelzine indications & moa
MAOI
Indications – depressed patients characterized as atypical, nonendogenous, neurotic
MOA – irreversibly blocks MAO from breaking down norepi, serotonin, dopamine (so more transmission)
selegiline indications & moa
MAOI
Indications – MDD (transdermal), parkinson’s (oral)
MOA – irreversibly inhibits both MAO-A and B, patch is more selective of B so less reaction with tyramine foods in the gut
buspar indications & moa
azapirone (buspirone)
Indications – management of anxiety disorders
MOA – partial agonist at the serotonin 5HT postsynaptic receptor
what side effects does buspar not have common in many other psych drugs?
No sedation, sexual dysfunction, or weight gain
which benzos should be used in people with poor liver function?
LOT (lorazepam, oxazepam, temazepam)
moa of benzodiazepines
acts at the GABA-A receptor between alpha 1 and gamma 2 subunits; increase the flow of chloride through the channel; high density in the amygdala
antagonist used in Benzo OD?
flumazenil
clonazepam
benzo, aka klonopin
Indications – panic disorders
Long acting, good for people who need benzo long term (good adjunct to SSRIs)
lorazepam
benzo, aka ativan
Indications – anxiety disorder, status epilepticus, preanesthesia
Good for use in treatment of agitation with haloperidol
