CNS Pt 2 Flashcards
What is the one SSRI used to treat bipolar depression
Fluoxetine and do not use as mono-therapy
What should you do prior to diagnosing bipolar disorder?
File out mimicking conditions like substance use, schizophrenia, dementia, hypothyroidism, HF
What drug classes are used for acute mania?
Antipsychotics and mood stabilizers
What is the common maintenance therapy if bipolar disorder?
Lithium with or without valproate and quetiapine
How should fluoxetine be dosed?
Avoid at night due to sleep impairment
How long does is take depression to respond to fluoxetine?
6 months at most
How should SSRIs be discontinued?
Dose should be gradually reduced
What are the FLUSH symptoms from SSRI withdrawal
F- flu like
L- lighthead
U- uneasiness
S- sleep disturbance
H - headache
What is the most selective SSRI with less side effects?
Citalopram
What is the active enantiomer of escitalopram
Citalopram
When is sertraline indicated?
MDD, OCD, Panic disorder, PTSD, PMDD, social anxiety
What drug does sertraline interact with?
Cimetidine
What are the AEs of sertraline
Male sexual dysfunction , drowsiness, GI complaints, insomnia
What SSRI has less risk in pregnancy?
Fluoxetine
Which SSRI has more pregnancy risk
Paroxetine
What are the TCAs?
Amitriptyline and nortriptyline
How do TCAs work?
The block neuronal reuptake of norepinephrine and serotonin
What are TCAs in?
Depression, bipolar, neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD, and nocturnal enuresis
What are the AEs of TCAs
Over dose, anticholinergic symptoms , QRS widening, arrhythmias , and cardiac arrest
What do TCAs interact with
MAOI, epinephrine, vasoconstrictors , anyicholinergics, CNS depressants, SSRIs, and bupropion
What does the combo of bupropion and TCAs cause?
Seizures
What patients is TCAs contraindicated in?
MI, conduction blocks, hepatic and renal impairment, glaucoma, urinary dysfunction, and thyroid disease
What can TCAs cause in patients with thyroid disease?
Cardiac dysrhythmias
What should patients taking TCAs be educated on?
Take at bedtime due to sedative effects, sexual dysfunction, and anticholinergic effects may cause urinary retention or worsening BPH
In what condition should you consider a TCA over a SSRI
Neuropathic pain
