Depression Flashcards
5 SSRI’s
fluoxetine sertraline paroxetine citalopram escitalopram
ADR of SSRI’s
Sexual Wt gain long QT SIADH Serotonin Syndrome FINISH syndrome
what is finish syndrome?
flue like sxs insomnia imbalance sensory disturbances hyperarousal
what drug specifically causes FINISH syndrome
paroxetine
what SSRI can be used in pregnancy
sertraline
SSRI with shortest 1/2 life
paroxetine
SSRI with highest risk of QT prolongation with high dose
citalopram
SSRI’s that inhibit 2D6
Fluoxetine
Paroxetine
what CYP does citalopram inhibit
2C19
what drugs shouldn’t be combined with citalopram
omeprazole/esomeprazol
3 SNRI’s to know
venlafaxine
desvenalfaxine
duloxetine
MOA of SNRI
inhibit serotonin and NE reuptake
what SNRI’s have ghost tablets
venlafaxine
desvenlafaxine
ADR of SNRI’s
increase BP/HR Nausea Constipation Insomnia Serotonin syndrome
specific ADR of duloextine
hepatotoxicity
what is discontinuation syndrome?
after 1 missed dose–anxiety, dizziness, flu-like symptoms
what SNRI causes discontinuation syndrome
venlafaxine
what SNRI inhibits 2D6
duloxetine
Theory behind SSRI and 5HT agonist drugs MOA
Provide direct stimulation of postsynaptic cleft in addition to blocking reuptake of serotonin -> QUICKER than SSRI (reuptake only)
What the 3 things to know about SSRI and partial 5HT agonists?
- Names (vilazodone, vortioxetine)
- NOT quicker
- NOT more efficacious
- May have less side effects (esp. sexual dysfunction)
Bupropion should be avoided in what pts
anxious pts (it is amphetamine-like) seizure pts
what CYP does bupropion inhibit?
2D6
Trazadone MOA
SSRI
agonist @ 5HT
antagonist of histamine
alpha-1 antagonist
what is trazadone really good at treating w/ depression
insomnia
ADR’s of trazadone
QT prolongation
hypotension
**Priapism
sedation
what does trazadone induce?
P-gp
MOA of mirtazapine
antagonist of Alpha-2 receptors and serotonin receptors-increase NE and serotonin
Mirtazapine is good in patients with depression + ?
anorexia–helps old ppl eat
insomnia
Tertiary Amine TCAs
imipramine
Clomipramine
Amitriptyline
Doxepin
Secondary Amine TCAs
Desipramine
Nortiptyline
3* TCA ADR
orthostasis
sedation
wt gain
anti-cholinergic
use of imipramine not in depression
nocturnal enuresis in kids
TCA used with insomnia
doxepin
TCA used with OCD
clomipramine
unlabeled use of TCA’s
neuropath pain
TCA used in migrane prophylaxis
amytripyline
monitoring for TCA’s
ECG if >40 y/o
signs of TCA OD
cardiac arrhythmia d/t QT prolongation
why do ppl die of TCA od?
d/t hypotension and ventricular arrhythmia b/c fast Na+ channels get blocked
which TCA’s are better tolerated
secondary
extra ADR’s of 2* TCA’s
gynecomastia
sexual function
SIADH
3 MAOI-A
isocarboxazid
tranylcypromine
phenelzine
MOA of MAOI
increase NE, dopamine, serotonin
clinical indications for MAOI-A use
MDD w/ hyperphagia or hypersomnia
ADR’s of MAOI-A
dizziness
xerostomia
nausea
HA
what foods need to be avoided while on MAOI-A’s?
tyramine rich foods
what drugs can you not combine MAOI-A’s with?
serotonin drugs, CNS depressants, sympathomemetics
MAOI-B drug
Selegilne
what pts is selegine best for? why?
parkinson pt’s who cannot swallow pills b/c this is a PATCH
what foods need to be avoided when selegiline is taken at high doses?
tyramine rich foods
Step 1 of depression Tx
lifestyle changes
step 2:
SSRI; adults= citalopram or sertraline kids; fluoxetine OR SNRI; bupropion/mirtazapine
mild-mod depression tx
antidepressant
severe depression tx
antidepressant + psychotherapy
depression + psychotic symptom tx
antidepressant + psychotherapy + atypical antipsychotic
how long should pts be on depression meds
minimum 6-9months for 1st episode
best drug for depression + anxiety
SSRI
drugs with lowest wt gain
fluoxetine
bupropion
drugs with lowest sexual dysfunction
bupropion> mirtazapine
drugs that increase energy w/ depression
bupropion or SNRI
what can anti-depressant induce..
mania
how do we avoid inducing mania
screen for bipolar before starting antidepressants
drugs for postpartum depression
Sertraline or escitalopram
when do we screen kids for depression
12 years old
after 4-8wks of optimization that isn’t working how do we handle tx
can switch to other SSRI or SNRI
when do we have to cross-taper?
SSRI or SNRI–> bupropion, mirtazapine, or TCA
when do we refer?
when we start to use more than 1 agent
switching to TCA or MAO-I
atpical antipsych use
what drug can you not taper fluoxetine to?
MAOI
how long do you need to give fluoxetine to be 100% gonezo?
7 days
