Depressants Flashcards
Monoamine Oxidase Inhibitors? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone Sertraline
Phenelzine
Tricyclic Antidepressants? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone Sertraline
Amitriptyline
Clomipramine
Selective Serotonin Reuptake Inhibitors? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone Sertraline
Fluoxetine
Sertraline
Paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Venlafaxine
Duloxetine
Atypical Antidepressants? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Bupropion
Trazodone
Mirtazapine
Treats Depression due to hazards, 2nd/3rd line option off label: OCD, bulimia, ADHD, anxiety Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
MECHANISM OF ACTION inhibition of monoamine oxidase (MAO) non-selective- results in (increased or decreased?) catecholamines! Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
increased
Adverse Reaction- Increased Norepinephrine- which is (more or less)dangerous than Serotonin Syndrome Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
More
Hypertensive Crisis- Drug interaction and food (low or high) in Tyramine can increase norepinephrine. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
High
Which are examples of Tyramine Food?
Cheese
Alcohol- Beer and Wine
Fresh, frozen, and canned meats (salami, pepperoni, fish, etc.)
Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
Fermented foods (sauerkraut, kimchi)
Unfermented food Fermented foods (sauerkraut, kimchi)
Fava beans
Avocado
Caffeine!!
Cheese Alcohol- Beer and Wine Cured/Aged/smoked meats (salami, pepperoni, fish, etc.) Fermented foods (sauerkraut, kimchi) Fava beans Avocado Caffeine
Drug Interactions Patients should not take any drugs unless it is approved by the same prescriber. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Adverse Reactions Serotonin Serotonin (Increased) Syndrome: This is a dangerous build up of serotonin, however not nearly as dangerous as hypertensive crises. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Adverse RE S/S Shivers- Shivering, Hyperreflexia, Increased Temp, Vital Signs, Encephalopathy, Restlessness, Sweating. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Monoamine Oxidase Inhibitors- Phenelzine -S/S Shivers S- H- I- V- E- R- S-
Shivering Hyperreflexia Increased Temp Vital Signs, Encephalopathy, Restlessness, Sweating.
Adverse RE S/S Smart- Sweating, Myoclonus, Autonomic instability, Rigidity, Temperature Increase, Seizures. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Monoamine Oxidase Inhibitors- Phenelzine -S/S Smart S-- M- A- R- T- S-
Sweating Myoclonus Autonomic instability Rigidity Temperature Increase Seizures.
Monoamine Oxidase Inhibitors- Phenelzine
Onset:
Fast Onset- within ? hours, Resolves by ? the exacerbating medication/s.
24
stopping
Avoid because they increase serotonin! Serotonin Drugs Antidepressants Opioid (Tramadol, Meperidine) Other medication (dextromethorphan, linezolid), St. John's Wort!
Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
CNS Stimulation: S/S: anxiety, insomnia, agitation, hypomania, mania Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Monoamine Oxidase Inhibitors- Phenelzine
Washout period: When switching from MAO-I you must want ? week/? days to use another antidepressant.
2
14
2nd/3rd line option off label: OCD, bulimia, ADHD, anxiety Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Treat: Depression◦off label common : Neuropathic pain, insomnia Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
Treat: Depression, Bipolar Disorder, Obsessive Compulsive Disorder (OCD), bulimia nervosa, Social Anxiety. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Sertraline Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Treat: Depression, Diabetic Neuropathy, GAD, Obsessive Compulsive Disorder (OCD). Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
D. Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Treat: Depression, SAD (seasonal affective disorder), Smoking cessation, Weight loss, sexual dysfunction Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
E. Atypical: Bupropion
Treat: Used for sleep and weight gain/appetite stimulant Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
ATYPICALS: Mirtazapine
Treat: Used for sleep only! Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
ATYPICALS: Trazodone
MIRT= Man, I’m Really Tired? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
ATYPICALS: Mirtazapine
Adverse side Effect: UNIQUE SIDE EFFECT: PRIAPISM Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
ATYPICALS: Trazodone
MECHANISM OF ACTION Block neuronal reuptake of NE and 5-HT, therefore increasing their concentrations at synapses. Also potential to block cholinergic, histaminergic, and α1 receptors. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
B. Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
MECHANISM OF ACTION: Selectively block neuronal reuptake of serotonin Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
C. Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
MECHANISM OF ACTION: Potent inhibitors of neuronal serotonin and norepinephrine reuptake (and weak inhibitors of dopamine reuptake*) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
D. Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Adverse RE Which has Serotonin syndrome Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
AD E Cardiac Toxicity: EKG Before treatment! fatal if a patient were to overdose and take their whole Rx bottle Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
lower seizure threshold, Anticholinergic properties, paradoxical sweating. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
hyperhidrosis”, Histamine blocking- sedation (use it for sleep!), weight gain. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
Prevents the uptake on platelets results in More Bleeding! Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Adverse Side Effects Serotonin Syndrome (2-72 hours after treatment) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
INCREASED NOREPINEPHRINE Weight Gain, Increased anxiety, Insomnia, Hypertension- Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Which deal with weight gain? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Which deals with weight lost? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
E. Atypical: Bupropion
ADVERSE EFFECTS Hallucinations, delusions, vivid dreams- especially for smoking cessation, increased seizure risk, anticholinergic like- constipation, dry mouth, weight loss Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Atypical: Bupropion
Withdrawal Syndrome Dizziness, headache, anxiety, tremor, etc ? is believed to have least due to long half-life Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
fluoxetine
MNEMONIC SSRI/SNRI S- S- R- I-
MNEMONIC SSRI/SNRI Sexual Dysfunction/Sodium loss Serotonin Syndrome/Sick Stomach/ Size Increase(CHRONIC T(Therapy)) Restlessness Insomnia
Don’t forget the Sodium Loss/Hyponatremia, this can be seen in geriatrics for? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Which drug have a 14 day washout period and vis versa? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Phenelzine
St. John’s Wort (Inducer) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
DRUG-DRUG INTERACTIONS Other drugs that increase serotonin levels GI Bleed risk- NSAIDS, anticoagulants Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Tri Depresents Mnemonic- TCA T- C- A-
T-think
Think how the drug works- Increase serotonin and Norepinephrine
C- Cardiac◦
Watch out for the heart, also alpha-1 blockade- orthostatic hypotension/dizziness
A- Anti- A lot◦
Antidepressant (suicidal Ideation)◦Anticholinergic (delirium, seizures)◦Antihistamine (sleepiness, weight gain)
Monitor for weight gain Monitor for history of GI Bleeds◦Watch out with NSAIDS + Anticoagulants Patients should be educated to report any sexual functions problems to their provider Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Patients should be monitored for hypertension Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Monitor for weight loss Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
E. Atypical: Bupropion
take in the morning to avoid insomnia issues Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
E. Atypical: Bupropion
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Take with food to avoid sick stomach. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
E. Atypical: Bupropion
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
Understand Hypertensive Crisis Symptoms ( High Tyramine- Drug interaction- St. John's Wort. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
CNS stimulation Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Suicidal Ideation Orthostatic hypotension SLOW to work!- Several weeks Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Monoamine Oxidase Inhibitors- Phenelzine
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine
Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine
E. Atypical: Bupropion
Monitor baseline EKG for patients Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
TAKE AT BEDTIME! THEY CAUSE DROWSINESS Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine
inistration: Takes minimum 1 month to maximum of 3 months to see benefit (if no response after 1 month, try alternative agent) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone
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