Mehl. Depression medications + serotonin syndrome 04-05 (1) Flashcards
SSRI. some names?
Fluoxetine, escitalopram, sertraline, etc.
SSRI. adverse regarding sex and sleep?
Cause sexual dysfunction (anorgasmia) and sleep disturbance.
SSRI. causes one adverse, that is beneficial for what disease?
The fact that they cause anorgasmia actually makes them the Tx for premature ejaculation.
SSRI. do not combine with what drug group?
Do not combine with drugs such as monoamine oxidase inhibitors or St John wort, as this can cause serotonin syndrome (discussed below).
SSRI. Do not combine with drugs such as monoamine oxidase inhibitors or St John wort, as this can cause …….??
serotonin syndrome (discussed below).
SSRI. unique adverse. sertraline is more likely to cause ??
diarrhea
SSRI. unique adverse. fluoxetine?
fluoxetine has a stimulating effect and is more likely to cause insomnia
SSRI. unique adverse. citalopram?
citalopram can prolong QT interval at higher doses.
SSRI. unique adverse. But USMLE doesn’t give a fuck. xddddd
nu bet vis tiek sukeliau i kortas :D
SSRI. Used for a variety of psych conditions external to depression, e.g., fibromyalgia, OCD, etc.
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SSRI. how long it takes to achieve effect?
It can take 4-6 weeks for an SSRI to achieve desired effect.
SSRI. what to do if after 4-6 week no effect?
If after this time point the drug isn’t working, the first step is increasing the dose.
SSRI. what to do if after 4-6 week no effect -> incr dose -> no effect?
If this doesn’t work, the next step is switching to a different SSRI –> if still not effective –> followed by switching to a different class agent.
SNRIs.
Serotonin and norepinephrine reuptake inhibitors.
- Desvenlafaxine, duloxetine, etc.
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SNRIs. what can incr at higher doses?
Can increase blood pressure at higher doses.
TCAs. mechanism?
Block reuptake of both serotonin and norepinephrine.
TCAs. Amitriptyline, nortriptyline, clomipramine, doxepin, etc.
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TCAs. HY for what pain????
High-yield on USMLE as 1st-line for diabetic neuropathic pain; can also be used for neuropathic pain in general (e.g., from trauma).
Gabapentin is otherwise frequently used.
TCAs. what nasty adverse?
Have nasty anti-cholinergic side-effects (anti-DUMBBELSS; see HY Neuro PDF for discussion of anti-cholinergic vs pro-cholinergic effects if you’re confused).
TCAs. what nasty adverse. HY 3 cases in nbme.
Three HY anti-cholinergic side-effect vignettes are
1) palpable suprapubic mass in an older male -> full bladder as a result of anti- cholinergic med + BPH.
2) Hot, red, dry patient (as a result of anhidrosis).
3) Confusion + dilated pupils (anti-cholinergic delirium + mydriasis).
TCAs. 3 adverse in general?
Coma, convulsions, cardiotoxicity.
TCAs. Sometimes the Q can just mention prolonged QT interval in patient on an anti-depressant, and the answer is the TCA, since they’re cardiotoxic.
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TCAs. why in elderly use nortriptiline?
If elderly, use nortriptyline, since decr. BBB penetration and anti-cholinergic side-effects.
TCAs. TCAs, such as imipramine, for nocturnal enuresis are wrong on USMLE.
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TCAs. Doxepin is asked on 2CK Psych form, where the Q rides on you knowing it’s a TCA to get it right (i.e., the only drug listed that causes anti-cholinergic effects). I mention this because students get the Q wrong and then are like wtf is doxepin.
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MAOIs. Phenelzine, tranylcypromine.
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MAOIs. why in general avoided as first line?
Avoided 1st-line overwhelming majority of the time because of risk of serotonin syndrome.
MAOIs. adverse what syndrome?
risk of serotonin syndrome.
This can be in isolation, but also when commenced too soon following discontinuation of SSRI.
MAOIs. what drug used for Parkinson disease?
Selegiline is MAO-B inhibitor used for Parkinson disease.
Answer on NBME where they ask which Parkinson med caused serotonin syndrome in a patient.
MAOIs. what drug cause serotonin syndrome in parkinson patient?
Selegiline
Bupropion. class, what effect has?
Dopamine + norepinephrine reuptake inhibitor; has anti-depressant effects.
Bupropion. also affects some receptors, for what condition?
Also antagonizes nicotinic receptors, which disincentivizes smoking, since doing so won’t produce rewarding effects.
Bupropion. lowers what?
Lowers seizure threshold. Don’t give to patients with eating disorders (electrolyte abnormalities increase seizure risk).
Bupropion. dont give for what patients, what disorder?
Lowers seizure threshold. Don’t give to patients with eating disorders (electrolyte abnormalities increase seizure risk).
Bupropion. does not cause what side effects?
Doesn’t cause sexual side-effects, unlike SSRIs.
Mirtazapine. what group?
for what condition?
a2-antagonist;
stimulates appetite; used for patients with depression and anorexia.
Trazodone. Serotonin antagonist and reuptake inhibitor (SARI). used in what?
Used for depression, but is frequently used for insomnia due to strong sedative effect
Trazodone. can cause what syndrome?
Can cause serotonin syndrome.
SEROTONIN SYNDROME. CP?
Flushing, tachycardia, diarrhea following drug-drug interactions (i.e., MAOI + SSRI; SSRI + St John wort) or high-risk drugs in isolation (e.g., MAOI, trazodone, lithium). Lithium sounds unusual, but on new 2CK NBME.
SEROTONIN SYNDROME. drug combinations????
MAOI + SSRI;
SSRI + St John wort
SEROTONIN SYNDROME. what isolated drugs?
high-risk drugs in isolation (e.g., MAOI, trazodone, lithium).
Lithium sounds unusual, but on new 2CK NBME.
SEROTONIN SYNDROME. Can cause high fever, i.e., 105F+.
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SEROTONIN SYNDROME. how to Dx?
Diagnose with urinary 5-hydroxyindole acetic acid (5-HIAA).
SEROTONIN SYNDROME. How to Tx?
Can be treated with cyproheptadine (blocks serotonin receptors).
SEROTONIN SYNDROME.
Often confused with carcinoid syndrome, which is due to carcinoid tumors (serotonin-secreting tumors) of the lung, small bowel, or appendix. Carcinoid syndrome isn’t due to drugs. Additionally, it can cause tricuspid vegetations, whereas serotonin syndrome does not. It is still diagnosed with urinary 5-HIAA
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