Chapter 21 - Antidepressant Agents Flashcards
Imipramine (I) (A)
Tricyclic Antidepressant
I: Relief of Symptoms of Depression; enuresis in children over 6 years, offlabel: control of chronic pain
A: Inhibits presynaptic reuptake of NE and serotonin; anticholinergic at CNS and peripheral receptors; sedating.
Imipramine (AE)
Sedation
Anticholinergic effects
Ortho HOTN
Bone Marrow depression
Imipramine (CI-DD)
CI: Recent MI
myelography within the next 48 or previous 24 hours
MAOI
Manic depressive PT
BLACK BOX: increased suicide in adolescents and children
DD: Oral anticoags (^ effect and bleeding)
sympathomimetics
MAOIs and TCAs
Phenelzine (I)
Monoamine Oxidase Inhibitors
Treatment of patients with depression who are unresponsive to other antidepressive therapy or in whom other antidepressive therapy is CI
Phenelzine (A)
Irreversibly inhibits Monoamine Oxidase allowing NE, 5HT, and dopamine to accumulate in the synaptic cleft
Phenelzine (AE)
Overactivity
Hyperreflexia
potential for hypertensive crisis
tremors
Phenelzine (CI-DD)
CI:Pheochromocytoma CV disease, CAD, CHF Abnormal CNS vessels, headaches Psychiatric PT BLACKBOX: suicide in adolescents and children
DD: MOAI and other Antidepressants lead to HTN crisis, coma, convulsions with TCAs
SSRIs: serotonin syndrome
wait 6 weeks to start them
Insulin (hypoglyc effects)
Fluoxetine (I)
SSRI Treatment of... Depression OCD Bulimia Premenstrual dysphoric disorder Panic disorders OFFLABEL: chronic pain, alcoholism, neuropathies, obesity
Fluoxetine (A)
Inhibits CNS neuronal reuptake of 5HT, with little effect on NE and little affinity for cholinergic, histaminic, or alpha adrenergic sites.
Fluoxetine (AE)
Nervousness
Insomnia
Upper resp infections
Sexual dysfunction
Fluoxetine (CI-DD)
CI: Diabetes
Severely depressed or suicidal PT (increased risk)
DD: MAOIs (allow 2-4 weeks)
TCAs increased therapeutic and toxic effects
