Depression Pharmacology Flashcards
SSRI’s
First line tx of depressive disorders.
No difference in efficacy, but difference in SE
SSRI MOA
Block presynaptic serotonin uptake pump.
When do SSRI’s reach peak plasma level?
1-8 hrs
Where are SSRI’s cleared?
Well absorbed in GI tract and
Cleared in the Liver
Which SSRI’s inhibit the CyP450 less than others?
Citalopram (celexa)
Escitalopram
SSRI SE
Sexual Dysfxn Drowsiness Weight gain DIzziness Insomnia Anxiety
SSRI withdrawl symptoms
Dysphoria Dizziness GI distress Fatigue Chills Myalgias
Response time for SSRI’s
From 2 wks to 6 wks
Citalopram brand name
Celexa
Citalopram dose, indications
20-40 mg
Good to use when concerned about drug interactions
Citalopram SE
QT prolongation in doses over 40mg.
Hepatic impairment
Age> 60 yrs
Escitalopram brand name
Lexapro
Escitalopram indications, dose
10-20mg
Similar to citalopram
Fewer drug interactions
Fluoxetine brand name
Prozac
Fluoxetine dose
20-40 daily
or
90mg slow release weekly
Fluoxetine advantage
Least problems with weight gain.
Fluvoxamine brand name
Luvox
Fluvoxamine dose, SE
50-200mg daily
Weight gain, nausea, sedation more common
Paroxetine brand name
Paxil
Paroxetine dose, indications
20-40 mg daily
Nausea, sedation likely.
Weight gain
Significant withdrawl sx
Which SSRI causes the most weight gain?
Paroxetine (paxil)
Sertraline brand name, dose
Zoloft
50-200mg
Which med is more likely to cause diarrhea than others?
Sertraline (Zoloft)
SNRI’s (three)
Venlafaxine (effexor)
Duloxetine (cymbalta)
Desvelafaxine (Pristiq)
SNRI MOA
Inhibit reuptake of both norepi and serotonin
Which SNRI has more drug interactions?
Duloxetine (cymbalta)
Venlafaxine brand name
Effexor
SNRI
Duloxetine brand name
Cymbalta
SNRI
Desvenlafaxine brand name
Pristiq
SNRI
SNRI SE
Nausea
DIzziness
DIaphoresis
Sexual dysfxn
Which SNRI most commonly causes nausea?
Desvelafaxine (pristiq)
Monitor patients on pristiq for?
Elevation in BP
Duloxetine (cymbalta) SE
- CI in acute angle closure glaucoma.
- Liver, renal impairment
- Weight gain (high doses)
Which SNRI is indicated for diabetic peripheral neuropathy?
Cymbalta (duloxetine)
Which SNRI causes weight gain?
Duloxetine (cymbalta)
Why are TCA’s generally avoided in practice?
Anticholinergic SE
Highly sedating
TCA MOA
Inhibit uptake or serotonin and norepi
TCA SE
- Heart block, arrhythmias, sudden death
2. Lower seizure threshold
Patients over 40 starting TCA must be screened for?
Conduction system disorder
TCA’s are not well tolerated in which age group?
elderly
TCA names
Amitriptyline
Doxepin
Desipramine
Nortryptaline
MAOi names
Phenelzine (Nardil)
Tranylcypromine (Parnate)
MAOi’s
Multiple interactions
Poorly tolerated
Leave prescribing to psychiatrist
Which food must be avoided with MAOi’s?
Tyramine containing foods such as: Aged cheese Cured meet Soy sauce others
Trazodone brand name
Desyrel
Trazodone (desyrel)
Serotonin antagonist and reuptake inhibitors.
Good for sleep at low doses.
Antidepressant at high doses.
Trazodone (desyrel) SE
Sedation
Orthostasis
Priapism
Bupropion brand name
Wellbutrin
Bupropion MOA
Inhibits reuptake of dopamine
Bupropion SE
Anxiety
Lowers seizure threshold
Avoid in bulemia
No withdrawl symptoms
Bupropion uses
Adjunct to SSRi for sexual dysfxn.
No weight gain
Mildly stimulating
Mirtazepine (Remeron)
Increases release of norepi and serotonin
Sedation (insomnia)
Weight gain
Good for pts with nausea
Serotonin syndrome S/S
Hyperthermia Agitation Ocular clonus Tremor, hyperreflexia Muscle rigidity DIlated pupils, dry mucous mems Diaphoresis
HARM
for serotonin syndrome Hyperthermia Autonomic instability (delerium) Rigidity Myoclonus
Serotonin syndrome tx
DC agents
Sedate using benzos (loraz)
O2, fluids
Avoid APAP
Antidote for setotonin syndrome if benzos fail?
Cyproheptadine
How long does it take for serotonin syndrome to resolve?
About 24 hrs
MAOi’s have worse outcome and longer recovery
