E1- Antidepressants Flashcards
What drugs are classified as TCAs?
Amitriptyline
Imipramine
Nortriptyline
Desipramine
What is the MOA of TCAs?
Inhibit reuptake of NE and 5-HT; also block alpha, histamine, and muscarinic receptors
What are the uses of TCAs?
Depression (2nd to last choice)
Chronic pain (TMJ) Fibromyalgia
Enuresis
What are the tertiary amine TCAs?
Amitriptyline
Imipramine
What are the secondary amine TCAs? (primarily block NE re-uptake)
Nortriptyline
Desipramine
Do tertiary or secondary amines produce more seizures and are more sedating?
Tertiary amines
How are TCAs metabolized?
What should you avoid?
CYP2D6 (do not take with Fluoxetine- inhibits 2D6)
What are SE of TCAs?
Weight gain Antihistamine effects Anticholinergic effects Alpha blocker effects Analgesia SIADH Sexual dysfunction Decreased seizure threshold
Are TCAs safe in pregnancy?
Yes
What is seen with TCA OD? How is it treated?
Torsades de pointes
Magnesium, isoproterenol, and cardiac pacing
What are TCA drug interactions?
Fluoxetine (inhibits metabolism) MAOIs (serotonin syndrome) SSRIs Amphetamines (HTN) Alcohol/CNS depressants (sedation) Anticholinergics
What drugs are classified as SSRIs?
Fluoxetine Sertraline Paroxetine Citalopram Escitalopram
What is the MOA of SSRIs?
Selectively inhibit the reuptake of 5-HT
What are the uses of SSRIs?
Depression Panic disorder Bulimia Alcoholism Obsessive-compulsive disorder & social anxiety = Paroxetine
What are SE of Fluoxetine?
Inhibits CYP2D6 (most drug interactions of SSRIs) Impairs blood glucose in diabetics
Which SSRI is least likely to cause drug interactions and preferred in the elderly?
Sertraline
What is DOC for depression?
Citalopram
What are SE of SSRIs?
Weight gain/loss
GI: nausea, loss of appetite, constipation
Anxiety/insomnia (Fluoxetine or Sertraline)
Sexual dysfunction
Photosensitivity
Because SSRIs inhibit CYP3A4 and 2D6, what drug interactions should you watch for?
TCAs
Phenytoin
Carbamazepine
What drug interactions of SSRIs can cause serotonin syndrome?
St. John’s Wort
Amphetamines
MAOIs
Meperidine (opioid)
What drug interaction of SSRIs can cause heart block and hypotension?
B-blockers
Fluoxetine can inhibit the conversion to the active compound of what drug?
Codeine (opioid)
What drug interaction of SSRIs can increase risk of seizures?
Tramadol
What drugs are classified as SNRIs?
Venlafaxine
Duloxetine
What is the MOA of SNRIs?
Inhibit reuptake of NE and 5-HT
What are the uses of SNRIs? (3)
Depression
Neuropathic pain
Post-menopausal hot flashes
What drugs are classified as MAOIs?
Phenelzine
Selegiline
What is the MOA of MAOIs?
Irreversibly inhibit MAOs
MAO-A metabolizes what?
NE, DA, and 5-HT in both the CNS and GI tract
MAO-B metabolizes what?
DA in the CNS, but not the GI tract
What is the MOA of Phenelzine?
Inhibits both MAO-A and MAO-B (increases NE, 5-HT and DA)
What is the use of Phenelzine?
Depression that has not responded to other drugs (LAST choice)
What is the MOA of Selegiline?
Selectively inhibits MAO-B (increases DA)
What are the uses of Selegiline?
Depression that has not responded to other drugs (LAST choice)
Parkinson’s
What are SE of MAOIs?
HTN crisis (Phenelzine) -Avoid foods with tyramine (red wine, beer, aged cheese) Orthostatic hypotension Weight gain Anticholinergic effects
What drug interactions of MAOIs can lead to serotonin syndrome/hyperpyrexia?
TCAs
SSRIs
Meperidine
Dextromethorphan
What drug interactions of MAOIs can lead to severe HTN?
OTC cold/cough medications Phenylephrine
Ephedrine
Amphetamines
What is the MOA of Bupropion?
Inhibits DA reuptake
What are uses of Bupropion?
ADHD
Alcoholism
Extended release for smoking cessation (Zyban)
What are SE of Bupropion?
Seizures
Anxiety, insomnia, restlessness, tremor, psychosis
Tachycardia
What is the MOA of Mirtazapine?
Blocks presynaptic alpha2 receptors –> increase release of NE 5-HT
What are uses of Mirtazapine?
Eliminates SE associated with SSRIs
good choice for depressed pt with insomnia and anxiety
What is the MOA of Atomoxetine?
Selective inhibitor of NE reuptake
What is the use of Atomoxetine?
First non-stimulant tx of ADHD (good choice for addicts, no euphoria)
What is the MOA of Trazodone?
5-HT2A receptor antagonist
What are the uses of Trazodone?
Sleep aide and pain management
What is a SE of Trazodone?
Priapism
What may be effective in the tx of mild depression?
St. John’s Wort
What is a SE of St. John’s Wort?
Photosensitivity
What are drug interactions of St. John’s Wort?
DO NOT combine with other antidepressants (serotonin syndrome) Oral contraceptives Digoxin Protease inhibitors Warfarin
