BH pharmacology Flashcards
BZD MOA
Binds postsynaptic GABA neuron (inhibitory) -> potentiates endogenous GABA
BZD ADRs (5)
- Sedation
- Dizziness, confusion, ataxia
- Teratogenicity
- Withdrawal sx
- Abuse potential
BZD clinical pearl
Use SHORT TERM for anxiety until AD kicks in
Alprazolam indications (4)
- GAD
- Panic disorder +/- agoraphobia
- Short-term relief of anxiety
- Anxiety assoc. w/ depression
Clonazepam indications (2)
- Panic disorder +/- agoraphobia
- Seizure disorder
Lorazepam indications (4)
- Short-term relief of anxiety
- Status epilepticus
- Sedation/amnesia
- ETOH withdrawal/”agitation”
Diazepam indications (2)
- Seizure disorders
- “conscious sedation”
Midazolam indications (1)
- “conscious sedation”
First line drug for anxiety
SSRI
First step for treating pediatric patients with anxiety
CBT
BZDs BBW
Taking benzodiazepines at the same time as opioids can lead to extreme sedation, slow and ineffective breathing, comas, and even death
SSRI MOA
Blocks serotonin reuptake -> increases synaptic serotonin
SSRI BBW
Suicide (monitor @ initiation, dose changes)
SSRI ADRs (7)
- Sexual side effects (decreased libido, delayed ejaculation, anorgasmia)
- Anorexia -> wt. loss -> wt. gain
- Bruxism
- SIADH
- Long QT
- Serotonin syndrome
- Discontinuation/FINISH syndrome
Serotonin syndrome sx
- Flushing
- Hyperthermia
- Agitation
- Muscle rigidity
- Seizure
- Coma
Discontinuation/FINISH syndrome sx
- Flu-like sx
- INsomnia
- Imbalance
- Sensory disturbances (coordination)
- Hyperarousal (agitation/anxiety)
SSRI categories in pregnancy (1st trimester)
C - all others (use fluoxetine! most data)
D - paroxetine (CV malformation)
SSRI adverse events in pregnancy (3rd trimester)
- Neonatal ICU syndrome
- Withdrawal rxns
- Persistent pulmonary hypertension
Which SSRI has the longest half life? Shortest half life?
Longest: fluoxetine
Shortest: paroxetine
Fluoxetine indications (5)
- MDD
- OCD
- Panic disorder +/- agoraphobia
- Bulimia
- PMDD
Sertraline indications (6)
- MDD
- OCD
- Panic disorder +/- agoraphobia
- Social anxiety disorder
- PMDD
- PTSD
Paroxetine indications (6)
- MDD
- OCD
- Panic disorder +/- agoraphobia
- Social anxiety disorder
- GAD
- PMDD
- PTSD
Citalopram indications (1)
- MDD
Escitalopram indications (2)
- MDD
- GAD
SNRI MOA
Inhibit serotonin & NE reuptake (pain management MOA unknown)
SNRI ADRs (4)
- Nausea
- Constipation
- Dizziness
- Insomnia
- BP and HR increase
- Serotonin syndrome
- Discontinuation/FINISH syndrome
Duloxetine specific ADR
Hepatotoxicity
Which SNRI has the greatest risk of discontinuation syndrome?
Venlafaxine
Velafaxine indications (4)
- MDD
- GAD
- Panic disorder +/- agoraphobia
- Social anxiety disorder
Desvenlafaxine indications (1)
- MDD
Duloxetine indications (3)
- MDD
- GAD
- Pain* (diabetic neuropathy, fibromyalgia, chronic MSK pain) *not first line
Milnacipran (type of SNRI) indication (1)
- Fibromyalgia
Levomilnacipran (type of SNRI) indication (1)
- MDD
Bupropion MOA
“Amphetamine-like”
Bupropion indications
- MDD
- SAD
- Adjunct in smoking cessation
Bupropion ADRs (4)
- Seizure threshold lowering (esp. bulimic, anorexic pt.)
- HA
- Anxiety
- Insomnia
Bupropion pearl
Good choice if sexual function concerns
Trazadone indications (1)
- MDD (esp. if insomnia present!!!!)
Trazadone MOA
- Serotonin receptor antagonist
- Inhibits serotonin reuptake (SSRI)
- Antagonist of histamine and alpha receptors
Trazadone ADRs (4)
- Sedation
- Postural hypotenion
- QT prolongation
- Priapism
Mirtazapine MOA
Involves NE, serotonin, histamine
Mirtazapine indications
- MDD + insomnia
- MDD + anorexia
Mirtazapine ADRs
- Weight gain d/t increased appetite
- Sedation
- Dry mouth
TCAs
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