L7 Anti-D Flashcards
Anti-depressants Classification
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-Norephenephrine reuptake inhibitors (SNRIs)
- Tricyclic Anti-depressans
- Monoamine oxidase inhibitors
- Atypical antidepressants
Note.
H2-receptors inhibitors are anti-antidepressants
Most currently used anti-depressants primarily act on ?
metabolism or re-uptake of nor-adrenaline, or serotonin or both & increase stores & release
Amine Re-uptake Inhibitors (ARIs) :
-A. Tricyclic anti-depressants
-B. Heterocyclic (atypical) anti-depressants
-C. Serotonin & Nor-adrenaline Re-uptake Inhibitors (SNARI):
-D. Selective Serotonin Re-uptake Inhibitors: (SSRI)
A. Tricyclic anti-depressants :
(Ami-triptyline, Nor-triptyline, Pro-triptyline, Imipramine, Clomipramine,Doxipine , Maptroline)
• Mechanism of Tricyclic anti-depressants ?
• decrease reuptake of NE, & 5-HT. ↑ in synaptic amines possibly related to anti-depressant effects
• Therapeutic Uses of Tricyclic anti-depressants ?
• Moderate to severe major depression
• Imipramine is used to control bed-wetting in children
• Migraine headache
• Chronic pain (neuropathic pain)
Tricyclic anti-depressants Adverse effects?
-Antimuscarinic:
Blurred vision, dry mouth, tachycardia, confusion constipation & urine retention
(Not used in glaucoma & BPH)
interactions. Direct acting sympathomimetic drugs (enhance activity), MAO inhibitors (enhance activity)
D. Selective Serotonin Re-uptake Inhibitors: (SSRI)
1st ( Drugs of choice for depression)
• (Paroxitine , Fluoxetine, Fluvoxamine, Citalopram Ecitalopram, Sertraline)
• Mechanism:
• More selectively inhibit reuptake of 5-HT( Serotonin).
Therapeutic uses of SSRI?
OCD( Fluoitine, flavoxamine )
Panic
post-traumatic stress disorder,
Depression
Generalized anxiety disorder,
SSRIs produce antidepressant effect at least after 2weeks.
Bulimia nervosa treated by?
(Only fluoxitine is approved)
-has anti-psychotic effect ,block D 2 receptors, more suitable for depression in psychotic patients ?
Amoxapine
B. Heterocyclic (atypical) anti-depressants MOA?
Dec. reuptake of NE & 5-HT.
Bupropion also dec. reuptake of DA
anti-depressants can aggravate psychosis & seizures?
Bupropion
Serotonin & Nor-adrenaline Re-uptake Inhibitors:
(SNARI):
Venlafaxine, Duloxitin
More effective in painful depression specially duloxitine
Dec. reuptake of 5-HT & to lesser extent NE
In low doses works like SSRIs & higher doses as TCAs.
Adverse effects of SNARI ?
hypertension , cause constipation, increase in heart rate
Indications (Uses) of anti-depressants ?
Depression
Anxiety disorders
Chronic pain
Enuresis
• Obsessive-compulsive disorders we use?
• SSRIs (fluoxetine & fluvoxamine)
• Chronic pain we use?
TSAs & venlafaxine
• Enuresis we use?
TCAs
• Attention deficit hyperkinetic disorder we use?
Imipramine & Atomoxetine
Treatment of mania & bipolar disorder?
Lithium.(Mood stabilizer).
Lithium adverse effects?
Polydipsia, polyurea, Polyphagia
fine hand tremors, sedation
II. Mono-amine oxidase Inhibitors (MAOIs):
• Tranylcypromine
• Selegiline, Moclobemide ( inhibit MAO-B )
(cause hypertensive crises, if taken with cheese), also ( inhibit MAO-A & B) ?
Tranyl-cypromine
………………..depletes stores of nor-adrenaline &
serotonin in axonal terminals of central neurons
& causes depression
Reserpine
• Adverse effects of Heterocyclic AD
• Moderate anti-muscarinic & sedative effects
• Amoxapine can cause parkinsonism, akathesia
• & ↑ in prolactin
• Maprotiline can cause seizures & arrhythmias
• Trazodone is more sedating & induces sleep
• Bupropion can aggravate psychosis & seizures
