CNS Part 3 Flashcards
What are the SNRIs
Meds that affect both serotonin and norepinephrine
Venlafaxine
Duloxetine
Desvenlafaxine
What can SNRIs be useful for other than depression?
Chronic pain associated with central and neuropathic pain conditions
How Does venlafaxine work?
Blocks serotonin and and dopamine
Low doses act like SSRI
High doses act like SNRI
When is venlafaxine indicated
Migraine headache prophylaxis (off label)
When does venlafaxine show therapeutic effect?
2-4 weeks
What are the AEs of venlafaxine
CNS headache, nervousness, somnolence, insomnia
GI - nausea, weight loss
Sweating, sexual dysfunction, diastolic hypertension, hyponatremia in elderly, neonatal withdrawal syndrome
What is duloxetine indicated in
Neuropathic pain, fibromyalgia, chronic musculoskeletal pain
What affects duloxetine absorption
Food reduces the rate and it is highly albumin bound
What are the AEs of duloxetine
Nausea, headache, dry mouth, sweating, blurred vision
What drugs inhibit duloxetine
Cimetadine, Luvox, Coro, TCAs, and quinidine
How long does it take for the full SNRI response?
8-12 weeks
Which SNRI has the worst withdrawal
Venlafaxine
What are the atypical antidepressants
Bupropion, megadome, trazodone, mirtazapine, maprotiline
Which atypical anntidpressant is a tetracycline antidepressant
Maprotiline
What are the indications for bupropion?
Stimulant, appetite suppressant, depression, SAD, smoking cessation, obesity, low libido
What are the AEs of bupropion
Seizures, dry mouth, nausea, insomnia, dizziness, anxiety, tremor
How long should the washout period between MOAI and bupropion be?
2 weeks
Which MOAI blocks MAOa and MAOb
Phenelzine
Which MOAI acts similar to amphetamine and blocks reuptake of serotonin and catecholamines
Tranylcypromine
Which MAOI is a non selective
Isocarboxazide
Which MAOI is MAOa inhibition at low doses and MAOb at higher
Selegiline
What is the MOA of MAOI
degraded NE, serotonin, and dopamine into inactive products.
It is irreversible
What can MAO inhibition accidentally result in?
Tyramine toxicity which leads to a hypertensive crisis
What food cause high tyramine levels
Plants, and animals, cheese, bananas, avocados, pineapple
What are the second line uses of MAOI
Bulimia, OCD, and panic attacks
What happens when MAOIs are given with other antidepressants
Hypertensive crisis or serotonin syndrome
