Behavioral Health Meds 1 Flashcards
What are the SSRIs? (6)
- Sertraline
- Fluoxetine
- Citalopram
- Escitalopram
- Paroxetine
- Fluoxetine
What is the MOA for SSRIs?
Selective serotonin reuptake in the CNS
SSRIs are usually first line for what 5 conditions?
- Depression
- PTSD
- Panic Disorder
- PMDD
- Anxiety disorder
What are the main benefits of SSRIs?
-Relatively few AEs
-Less toxic in overdose
Why are SSRIs lower risk (pathophys)?
-No effects on norepinephrine, acetylcholine, histamine or dopamine
What antidepressant is approved for treatment of bulimia?
Fluoxetine
What is unique about Fluoxetine (why is it approved for Bulimia)
-Longer half life (2-4 days instead of 1-2), longer washout period for switching to MAOIs
How long is the washout period for switching off fluoxetine?
5 weeks
What is the washout period for switching off of SSRIS besides fluoxetine?
At least 2 weeks
On average, how long do SSRIs take to reach maximum efficacy?
4-6 weeks
What is the first response to non-efficacy to an SSRI?
Try a different SSRI before moving to second line
What are the main 3 adverse effects of SSRIs?
- GI
- Sexual dysfunction
- Weight changes
What are constitutional side effects of SSRIs? (3)
-GI
-Headaches
-Energy changes (fatigue or restlessness)
What are mental adverse effects of SSRIs? (2)
-Anxiety
-Insomnia
What are chemical side effects of SSRIs? (2)
-SIADH
-Serotonin syndrome
What is the black box warning for SSRIs?
Increased suicidality in children / young adults
What is a specific side effect of Citalopram?
QT prolongation
What are the SNRIs? (3)
- Duloxetine
- Venlafaxine
- Desvenlafaxine
What is the MOA of SNRIs?
Inhibits neuronal uptake of serotonin, norepinephrine and dopamine
Duloxetine can be used as first line especially in patients with ____ and ____
Fatigue / neuropathy pain, depression
_____(SNRI) is good for depression and anxiety disorder
Venlafaxine
What is the general side effect profile of SNRIs?
Similar to SSRIs plus hyponatremia
What are the side effects of SNRIs specific to norepinephrine?
Hypertension
Sweating
Dizziness
Dry mouth
Constipation
What are contraindications to SNRIs? (4)
- MAOI use
- Renal impairment
- Hepatic impairment
- Seizures
Be careful with SNRIs in pts with ____
HTN
SNRIs + (herbal) can cause serotonin syndrome
St. Johns Wort
What is mirtazapine?
Tetracyclic antidepressent
Mirtazapine MOA
Increases norepinephrine and serotonin release via central presynaptic alpha-2 adrenergic receptor antagonism
and
Postsynaptic 5-HT2 and 5-HT3 receptor antagonist, increases neurotransmission via 5-HT1 receptors
Why is mirtazapine sedating?
High affinity for H1 receptors
What is mirtazapine indicated for?
Depression and anxiety
When is mirtazipine a good choice in depression?
-Insomnia
-Significant weight loss (appetite stimulating)
Mirtazapine has fewer ____ side effects than SSRIs
Sexual
What are the top side effects of mirtazapine?
Sedation and weight gain
What are other AEs of mirtazipine?
(Sedation and weight gain)
-Dry mouth
-Constipation
-Tremor
-Dizziness
-Agranulocytosis
What is the contraindication of mirtazipine?
MAOI inhibitors
What are the tertiary tricyclic antidepressants? (4)
- Amitriptyline
- Clomipramine
- Imipramine
- Doxepin
What are the secondary TCAS? (2)
- Desipramine
- Nortriptyline
What are the indications for TCAs?
- Depression
- Insomnia
- Neuropathies
- Migraines
- Urge incontinence
Why are TCAs used less frequently than other options?
High AE profile, severe overdose potential
What are the main AEs of TCAs?
- Anticholinergic effects
- Weight gain
- Prolonged QT interval
- Sedation
- Lower seizure threshold
- SIADH
What are the anticholinergic effects of TCAs?
-Dry mouth
-Constipation
-Urinary retention
-Tachycardia
-Orthostatic hypotension
-Confusion/hallucinations (elderly)
What does TCA overdose look like?
The three C’s:
Cardiotoxicity
Convulsions
Coma
What does the cardiotoxicity of TCA overdose look like?
Wide complex tachycardia due to Na+ channel blocking effect
What do the convulsions of TCA entail?
Seizures or other neuro symptoms (like respiratory depression)
How do you manage TCA overdose?
Sodium bicarb for cardiotoxicity
When are TCAs contraindicated?
Use of MAOI
Recent MI
Seizure history
Which TCAs are the most anticholinergic/antihistiminic and antiadrenergic?
Tertiary amines (higher toxicity with overdose)
Which TCA is most useful in neuropathies, insomnia and chronic pain?
Amitriptyline (due to Na channel blocking properties)
Which TCA is most useful in OCD?
Clomipramine (most serotonin specific)
Doexpin is good for ____
chronic pain
