drugs Flashcards
first line therapy for depression and anxiety disorder
SSRI- prefered over the other classes in children
advantages of SSRIs
easy dosing, less S/E, low toxicity in cases of overdose (because they don’t affect NE, acetylcholine, histamine, or dopamine)
side effects of SSRIs
common: GI upset, sexual dysfunction, headache, changes in energy level (fatigue, restlessness)
others: anxiety, nervousness, , insomnia, weight changes
who should you avoid prescibing citalopram to?
patients with long QT syndrome
what increases your risk of serotonin syndrome?
using an SSRI with MAOI
what is serotonin syndrome (symptoms)?
neuro (acute AMS seizures occasionally coma and death)
ANS: restlessness, diaphoresis, tremor, hyperthermia, N/V, abdominal cramps, mydriasis, sinus tachycardia
MOA of SNRIs
inhibit neuronal serotonin, NE, and dopamine
indications for using SNRIs
may be used as first line agents PARTICULARLY IN PATIENTS WITH SIGNIFICANT FATIGUE OR PAIN SYNDROMES IN ASSOCIATION WITH DEPRESSION
used as 2nd line agents in patients with no response to SSRIs
side effects of SNRIs
similar to SSRIs including hyponatremia and noradrenergic S/E: HTN** and dizziness
contraindications for SNRIs
MAOI use, renal/hepatic impairment, seizures, avoid abrupt discontinuation. Use in caution with HTN
increased risk of what if you use SNRIs with St. John’s Wort?
serotonin syndrome
MOA of TCAs
inhibits neuronal reuptake of serotonin and NE
indications for TCAs
depression, insomnia, diabetic neuropathic pain, post-herpatic neuralgia, migraine, incontinence
used less often because of their side effect profile and severe toxicity in overdose
nondepressed pts experience sleepiness, depressed patients experience elevated mood
side effects of TCAs
anticholinergic effects (dry mouth, blurred vision, constipation,drowsiness, sedation, hallucinations, memory impairment, difficulty urinating), sedation, weight gain, prolonged QT interval.
wide complex tachycardia indicates overdose of what?
TCAs (as well as sinus tach, neuro sx, ARDS)
contraindications for TCAs
use of MAO inhibitors, recent MI, seizure hx
tetracyclic compounds MOA
enhances central noradrenergic and serotonergic activity
indications for tetracyclic compounds
depression. less sexual dysfunction s/e compared to other classes
c/i if patient uses with MAOIs
s/e of tetracyclic compounds
sedation, dry mouth, constipation, weight gain, agranulocytosis
MOA of buproprion hydrochloride
inhibits the neuronal uptake of dopamine and norepinephrine
indications for buproprion hydrochloride
depression (zyban used for smoking cessation)
side effects of buproprion hydrochloride
seizures, agitation, anxiety, restlessness, weight loss,HTN, headache
major difference in S/E of buproprion hydrochloride and SSRIs
less GI distress and sexual dysfunction with buproprion hydrochloride
contraindications/ cautions with buproprion hydrochloride
seizure d/o***
avoid abrupt withdrawal, bulimia, anorexua, MAOI use, patients undergoing drug/ETOH detox
MOA of MAOIs
blocks breakdown of neurotransmitters (dopamine, serotonin, epinephrine, norepinephrine) by inhibiting monoamine oxidase
indications for MAOIs
refractory depression. effective in many types of affective and anxiety sisorders
S/E of MAOIs
**HYPERTENSIVE CRISIS-
what must all people taking MAOIs avoid?
MUST AVOID TYRAMINE-CONTAINING FOOD** (tyramine is an AA that helps regulate BP, and MAO breaks down excess tyramine in the body. tyramine can reach dangerous levels and cause a serious spike in BP- aka MAOI prevents breakdown of tyramine leading to HTN), insomnia, anxiety, orthostasis, weight gain, sexual dysfunction
aged or fermented cheese, wine, beer, aged foods, smoked meats, chocolates, coffee, tea.
contraindications for MAOIs
MAOI + SSRI = serotonin syndrome: acute AMS, agitation, diaphoresis, tremor, hyperthermia, seizures occasionally coma and death
MAOI + TCA = delirium and HTN
how long should antidepressants be continued at minimum to determine efficacy?
3-6 weeks