depression Flashcards
TCA examples
amitriptyline, imipramine, dothiepin, clomipramine
TCA moa
blocks reuptake of NE & 5HT.
- antichol
- H1 & alpha adrenergic antagonism
classes causing GI and sexual dysfunction
TCA, SSRI
ssri examples
fluoxetine, fluvoxamine, escitalopram, sertraline, paroxetine
ssri/snri se
gi and sexual dysf
transient nervousness during initiation
hyponatremia (SIADH)
risk of bleeding
ssri moa
selective blocking of 5ht
tca se
FATAL ON OVERDOSE
- gi & sexual dysfunction
- antichol
- sedation
- weight gain
- orthostatic hypot
- arrythymia
- seizure
paroxetine
short t1/2 (leads to highest withdrawal syndrome), sedating, weight gain
mirtazapine moa
alpha 2 adrenoceptor antagonist
antagonist of H1 and 5HT2/3
mirtazapine se
somnolence, increased appetite, weight gain
mirtazapine benefit
reversal of gi and sexual se of SSRI/SNRI
snri examples
venlafaxine, desvenlafaxine, duloxetine
bupropion moa
blocks reuptake of ne & da
bupropion se
seizure, insomnia, psychosis
bupropion avoid in
eating disorders, seizures, psychosis
bupropion benefit
decrease sexual se of SSRI/SNRI, smoking cessation
moclobemide moa
reversible maoi-a
duloxetine benefit
diabetic neuropathy, chronic MSK pain
adjunctive tx
second generation antipsych: aripiprazole, brexpiprazole, quetiapine
herbal-drug interactions
st john wart
neuropathic pain preferred agents
amitriptyline, nortriptyline
when switching from maoi to other antidep, washout?
24h
when switching from other antidep to maoi, washout?
at least 1 week
what does hyponatremia result in
siadh - urinary retx/seizures
preferred antidep for late pregnancy
nortriptyline
preferred antidep for breastfeeding
mirtazapine, sertraline
preferred antidep for bipolar depression
lithium, lamotrigine, quetiapine
what drugs to avoid in elderly
tca, antichol, hypoT
top counselling points
suicidality risk (under 24)
not to mix concurrent usage of alcohol with drug
antidep causing weight gain
mirtazapine
drugs causing serotonin syndrome with ssri/snri
triptans, opioids, linezolid, MAOi
bleeding risk with which medication
ssri
antideps which are cyp2d6 inhibitors
fluox
parox
bupropion
fluvoxamine inhibitor of ?
1a2, 2c19
common drugs that are substrates of 2d6
metoprolol, codeine, tramadol
warfarin is a substrate of?
2c19,1a2
antideps with fever cyp interactions
mirtazapine, escitalopram, venlafaxine, vortioxetine
symptoms of antidep discontinuation syndrome
Flu
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal
antideps with long half lives
fluoxetine, bupropion
antideps that can reduce se of sexual function
mirtazpine, bupropion, agomelatine
which drug can worsen htn
venlafaxine
medical disorders predisposing to depression
hypothyroidism, t2dm, cad, chf, mi, electrolyte imbalances
psychiatric disorders predisposing to depression
anxiety, eating disorders, schizophrenia
recite INSADCAGES
Interest
Sleep: insomnia/hypersomnia (minimally needs 3 hours, otherwise maybe bipolar mania)
Appetite / weight loss
Depressed (Adults) / irritable (children)
Concentration
Activity
Guilt
Energy (fatigue)
Suicidal thoughts/attempts
duloxetine se
urinary retention
first line for suicidality risk
lithium
how long is the acute phase trial for antideps
4-8 weeks
agomelatine cyp
1a2
