Depressive Disorder Drugs

Question 1

SSRIs (Selective Serotonin Reuptake Inhibitors)

Answer 1

(1st line of defense for depression)

fluoxetine (Prozac)
citalopram (Celexa)
escitalopram (Lexapro)
paroxetine (Paxil)
sertraline (Zoloft)
fluvoxamine (Luvox)
vilazodone (Viibryd)
vortioxetine (Brintellix)

Question 2

SSRIs: MOA

Answer 2

all bock the reuptake and the degradation (breaking down) of serotonin 5 HT

Question 3

SSRIs: 7 S’s

Answer 3

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)

Question 4

SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

Answer 4

duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq, Khedezla)
levomilnacipran (Fetzima)

Question 5

SNRIs: MOA

Answer 5

block the absorption of serotonin and norepinephrine in the brain

Question 6

SNRIs: Side Effects

Answer 6

Same adverse effects as SSRIs (7 S’s)
Hypertension
Adrenergic effects
Tachycardia

Question 7

TCAs (Tricyclic Antidepressants)

Answer 7

(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)

Question 8

TCAs: MOA

Answer 8

inhibit the synaptic reuptake of serotonin and norepinephrine

Question 9

TCAs: Side Effects

Answer 9

dry mouth – drink water, chew gum
blurred vision
photophobia – wear glasses
tachycardia
constipation — increase fiber and activity
urinary retention and hesitancy
hypotension
sedation

Question 10

TCAS: Contraindicated

Answer 10

for pts w/ heart issues. Need to have ECG baseline.

Question 11

TCAs: Problem w/ too much of it

Answer 11

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~~~~

Question 12

TCAs: Info/Facts

Answer 12

-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

Question 13

MAOIs (Monoamine Oxidase Inhibitors)

Answer 13

(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)

Question 14

MAOIs: MOA

Answer 14

responsible for inactivating or breaking down monoamine neurotransmitters in the brain such as norepinephrine, serotonin, dopamine, and tyramine

Question 15

MAOIs: Side Effects

Answer 15

insomnia
nausea
agitation
confusion
orthostatic hypotension
muscle twitching
sedation

Question 16

MAOIs: Dietary Restrictions

Answer 16

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.

Question 17

MAOIs: HIGH Foods w/ Tyramine

Answer 17

HIGH:
aged cheeses
red wines and beer
smoked/processed meats
dried or cured fish
caviar
shrimp paste
soy sauce
sauerkraut

Question 18

MAOIs: MODERATE Foods w/ Tyramine

Answer 18

MODERATE:
gouda
processed cheese
mozzarella
yogurt
sour cream
avocados
bananas
colas
tea
chocolate

Question 19

MAOIs: LOW Foods w/ Tyramine

Answer 19

LOW:
pasteurized cheeses (cream cheese, cottage, ricotta)
figs
distilled spirits

Question 20

Atypical Antidepressants

Answer 20

buproprion (Wellbutril, Zyban)
esketemine (Spravato) - nasal spray aka ketamine
maprotiline
mirtazapine (Remeron)
nefazodone
trazadone (generic only)
vilazodone (Viibryd)
vortioxetine (Trinellix)

Question 21

Pt Education for Antidepressants

Answer 21

-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