Depression Flashcards
1
Q
Fluoxetine, Paroxetine, Citalopram
A
Depression
Selective Serotonin Reuptake Inhibitors (SSRI’s)
• 1st line therapy
• *Most commonly prescribed
Therapeutic Indications:
• *Major Depression
• Bulimia
• All major *Anxiety Disorders (GAD, PTSD, OCD)
MOA
- Inhibit re-uptake of serotonin (5-HT)
ADE
• *GI symptoms (nausea and diarrhea) says n/v in podcast?
• *Headaches
• *Insomnia
• Discontinuation syndrome
o Dizziness, parethesias, other
• *Reduced sexual interest/function
C/I
- Teratogen
• Cardiac malformations 1st trimester exposure
2
Q
Venlafaxine, Duloxetine
A
Depression Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s) • *1st line therapy Therapeutic Indications: • *Major Depression • *Pain • *Urinary Incontinence (Europe) • *All major Anxiety Disorders (GAD, PTSD, OCD) MOA - Inhibit re-uptake of NE and 5-HT ADE • *Decreased sexual function (similar to SSRI) • *GI complaints (nausea) - *(Noradrenergic) HTN, Heart Rate • *CNS: insomnia, anxiety, agitation
3
Q
Amitriptyline, Nortriptyline, Clomipramine
A
Depression Tricyclic Antidepressants (TCA’s) • 2nd line therapy Therapeutic Indications: • *Major Depression • *OCD • Peripheral Neuropathy • *Chronic Pain • *Migraine Prophylaxis MOA • Inhibit re-uptake of NE and 5-HT • Non-specific inhibition other receptors (*esp. muscarinic) ADE • *(Anticholinergic) Dry Mouth, sedation, tachycardia etc. • *Orthostatic Hypotension • Weight gain sedation • *Sexual Dysfunction • *Arrhythmogentic (Convulsion, Coma, Cardiotoxicity) • *Discontinuation syndrome
4
Q
Phenelzine, Selegiline
A
Depression Monoamine Oxidase Inhibitors (MAO’s) • 2nd or 3rd line - Phenelzine - nonselective - Selegiline - MAO-B selective irreversible @ low doses Therapeutic Indications: • *Major Depression • *Parkinson’s Disease • *Anxiety MOA - Inhibit breakdown of the monoamines: DA, NE, 5-HT ADE • *Orthostatic hypotension • *Weight gain • *Sexual Dysfunction (Anorgasmia) • Insomnia/restlessness • *Hypertensive Crisis (ingestion of tyramine) • *Discontinuation syndrome (psychosis, excitement, and confusion) C/I • ***SSRI’s (and SNRI’s), TCA’s, St. John’s Wort
5
Q
Trazodone
A
Depression 5-HT Receptor Modulator Therapeutic Indications: • *Insomnia (major indication) • *Major Depression Pharmacokinetics: • *Major metabolite m-cpp, Potent 5-HT2 antagonist Antidepressant effect MOA • Selective Inhibitor of SERT • *Metabolite antagonist of 5-HT2A ADE • *Sedation • *Nausea • Postural Hypotension • Priapism • Sexual effects (uncommon)
6
Q
Bupropion
A
Depression
Atypical Antidepressants
Therapeutic Indications:
• *Major Depression
o Seasonal (winter depression)
• *Smoking Cessation
MOA
• Weak inhibitor of NE and DA reuptake transporters
• Enhance release of NE and 5-HT
ADE
• *Agitation
• *Insomnia
• Anorexia
7
Q
Vilazodone
A
Depression Atypical Antidepressants Therapeutic Indications: • *Major Depression MOA • SERT inhibitor • Partial agonist 5-HT1A receptor ADE • *Trouble Sleeping o *Nausea, Vomiting, Diarrhea o *Decreased libido, erectile dysfunction, other
