Depressive Disorder Drugs Flashcards
SSRIs (Selective Serotonin Reuptake Inhibitors)
(1st line of defense for depression)
fluoxetine (Prozac)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)
fluvoxamine (Luvox)
vilazodone (Viibryd)
vortioxetine (Brintellix)
SSRIs: MOA
all bock the reuptake and the degradation (breaking down) of serotonin 5 HT
SSRIs: 7 S’s
stomach upset
sexual dysfunction
sleep difficulties
stress
size increase
suicidal thoughts
serotonin syndrome. (hyperreflexia - moving a lot, VS fluctuates, seizures, muscle rigidity, coma, delirium, hyperthermia)
SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)
duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq, Khedezla)
levomilnacipran (Fetzima)
SNRIs: MOA
block the absorption of serotonin and norepinephrine in the brain
SNRIs: Side Effects
Same adverse effects as SSRIs (7 S’s)
Hypertension
Adrenergic effects
Tachycardia
TCAs (Tricyclic Antidepressants)
(2nd line of tx bc of SE, oldest antidepressants)
amitriptyline (Elavil)
amoxapine (only generic)
desipramine (Norpramin)
doxepin (Sinequan)
imipramine (Tofranil)
maprotiline (only generic)
nortriptyline (Pamelor)
protriptyline (Vivactil)
trimipramine (Surmontil)
TCAs: MOA
inhibit the synaptic reuptake of serotonin and norepinephrine
TCAs: Side Effects
dry mouth – drink water, chew gum
blurred vision
photophobia – wear glasses
tachycardia
constipation — increase fiber and activity
urinary retention and hesitancy
hypotension
sedation
TCAS: Contraindicated
for pts w/ heart issues. Need to have ECG baseline.
TCAs: Problem w/ too much of it
Can cause cholinergic blockade. When we block it, it effects cardiac and there will be toxicity when a pt tries to use it as a way to commit suicide. EKG will show dysrhythmias and b4 that there will be mental confusion, agitation, and after that there will be coma, seizures, and possible death.
~~~~these drugs will only be provided as a 1 wk med~~~~
TCAs: Info/Facts
-pts must take therapeutic doses of TCAs for 10-14 days or longer before they begin to work
-considered a risk in older adult pts w/ cardiac disease
-initial dose should ALWAYS be low and increased gradually
-pts should have a thorough cardiac workup b4 beginning TCA therapy
-overdose carries a risk of death from cardiac conduction abnormalities
MAOIs (Monoamine Oxidase Inhibitors)
(3rd line of tx bc of the SE and dietary restrictions)
isocarboxazid (Marplan)
phenelzine (Nardil)
selegiline (Emsam) PATCH [[apply to dry skin, upper torso/upper thigh/outer surface of arm. Put on same time everyday. Need a different spot each time/ rotate the spot. If patch falls off, put on another patch in a different spot]]
tranylcypromine (Parnate)
MAOIs: MOA
responsible for inactivating or breaking down monoamine neurotransmitters in the brain such as norepinephrine, serotonin, dopamine, and tyramine
MAOIs: Side Effects
insomnia
nausea
agitation
confusion
orthostatic hypotension
muscle twitching
sedation
MAOIs: Dietary Restrictions
high tyramine = will have severe hypertensive crisis- stroke, death, hemorrhage. This can happen w/in 15-90 minutes of ingesting the food. You will know pt cheated on diet.
Pt will be: irritable, anxious, sweating, fever, severe HA. Call 911. Immediate medical emergency.
MD will: do gastric lavage w/ charcoal, fluid therapy, and antihypertensive drug. Lorazepam IV to prevent seizures.
MAOIs: HIGH Foods w/ Tyramine
HIGH:
aged cheeses
red wines and beer
smoked/processed meats
dried or cured fish
caviar
shrimp paste
soy sauce
sauerkraut
MAOIs: MODERATE Foods w/ Tyramine
MODERATE:
gouda
processed cheese
mozzarella
yogurt
sour cream
avocados
bananas
colas
tea
chocolate
MAOIs: LOW Foods w/ Tyramine
LOW:
pasteurized cheeses (cream cheese, cottage, ricotta)
figs
distilled spirits
Atypical Antidepressants
buproprion (Wellbutril, Zyban)
esketemine (Spravato) - nasal spray aka ketamine
maprotiline
mirtazapine (Remeron)
nefazodone
trazadone (generic only)
vilazodone (Viibryd)
vortioxetine (Trinellix)
Pt Education for Antidepressants
-therapeutic effects may not be experienced for 1-3 wks. Full therapeutic effects may take 2-3 months.
-sudden discontinuation can result in relapse
-therapy usually continues for 6 months after resolution of manifestations and may cont for a yr or longer
-suicide prevention is facilitated by prescribing only a wks worth of medication for an acutely ill pt and only prescribing 1 months worth of meds at a time esp with TCA which has a high risk for lethality with OD
-antidepressant induced suicide is mainly associated w/ pts under the age of 25
-SE can be shown b4 therapeutic effects kick in
