depression and anx

Question 1

fluoxetine

Answer 1

SSRI
more serotonin
1st line D or A
weight gain, nvd, c, dry mouth, HA, nervous, insomnia, sexual dysfunction - change dosage
serotonin syndrome: 2-72 hrs, altered mental status, increased with MAOi
withdrawal syndrome: dizzy, HA, sensory disturbance, tremor, anx, dysphoria
suicide
neonatal: small risk of pulmonary htn in neonate and abstinence syndrome
2nd gen: less severe/fewer SE, few drug-drug and drug-food interactions
3-4 weeks for use

Question 2

venlafazine

Answer 2

SNRi
1st line
SE: n, HA, insomnia, anorexia, somnolence, sexual dysfunction, withdrawal syndrome, sweating, blurred vision, increased LFTs (duloxetine)
no MAOi

Question 3

amitryptaline

Answer 3

tricyclic antidepressants, TCA
block reuptake of monoamine transmitters, norepi and seotonin (intensity effect), anticholinergic effects
I: neuropathic pain, nocturnal enuresis
SE: fatal overdose, hot, dry, blind, red, sedation, orthostatic hypot, sexual dysfunction, cardiac toxicity
high interaction with MAOis - htn crisis

Question 4

phenelzine

Answer 4

MAOi
in liver, intestine wall and neuron terminal, usually convert norepi, serotonin, and dopamine to inactive, so increases
I: refractory depression, atypical
SE: htn crisis with tyramine (aged cheese, smoked meats, yeast, red wine), orthostatic hypot, can lead to rapid increase in BP, stroke, coma
drug-drug: antihypertensive, SSRI
used less often

Question 5

burproprion

Answer 5

similar in structure to amphetamine, stimulant effect, unclear
I: anx + d, x smoke, ADHD, neuropathic pain
SE: decreased appetite, seizure, agitation, HA, dry mouth, c, weight loss, GI upset, dizzy, tremor
1-3 weeks for effect

Question 6

ketamine

Answer 6

I: extreme pain, rapid suicidality and other serious depression symptoms, refractory depression
SE: perceptual disturbances, dissociation
intranasal

Question 7

trazadone

Answer 7

block serotonin reuptake
2nd line, minimal effectiveness in depression, anx, insomnia

Question 8

alprazolam
diazepam
lorazepam

Answer 8

benoz (lams and pams)
enhance inhibitory effects of GABA in CNS
I: GAD and panic - temporary
SE: CNS depression, decreased LOC, withdrawal, addictive, mem loss, respiratory depression (IV)
no pregnant, schedule 4
no grapefruit or fatty foods
antidote: flumazenil