Module 7 Unit B Antidepressants Flashcards
What are examples of SSRIs?
paroxetine (Paxil)
citalopram (Celexa)
fluoxetine (Prozac)
sertraline (Zoloft)
What are the indications for SSRIs?
Depression
Anxiety
What is the MOA of SSRIs?
SSRIs block the reuptake of serotonin, resulting in an increased concentration of serotonin in the synapse and increased activation of postsynaptic serotonin receptors.
What is a rare but serious complication of SSRIs?
Serotonin syndrome is a rare but serious complication.
Symptoms: Agitation or restlessness. Insomnia. Confusion. Rapid heart rate and high blood pressure. Dilated pupils. Loss of muscle coordination or twitching muscles. High blood pressure. Muscle rigidity.
What should we monitor for in the first few weeks of a patient taking an SSRI?
Increased suicidal ideation the first 2-3 weeks.
What side effects are seen with SSRIs?
May cause n/v, insomnia, weight gain, and sexual dysfunction.
When should SSRIs be used cautiously?
Use caution with elderly. Start low and go slow.
What is the BBW associated with SSRIs?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
Which SSRI should be avoided in pregnancy?
Paxil
Which SSRI is the most studied in children?
Prozac
What are examples of SNRIs?
venlafaxine (Effexor)
desvenlafaxine SR (Pristiq)
duloxetine (Cymbalta)
What are the indications for SNRIs?
Depression
Anxiety
What is the MOA of SNRIs?
Boost serotonin and norepinephrine
When should the SNRI Venlafaxine be avoided?
Venlafaxine may cause HTN and must be avoided with MAOI.
What is the BBW associated with SNRIs?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
What is another indication for Venlafaxine (effexor) outside of A/D?
Venlafaxine can be used for post-menopausal hot flashes.
What are some examples of TCAs?
Amitriptyline (elavil)
Clomipramine (Anafranil)
Doxepin (Silenor)
Imipramine (Tofranil)
What is the indication for TCAs?
Depression
Can be helpful for those with sleep issues.
What is the MOA of TCAs?
Block reuptake of norepinephrine and serotonin.
When should TCAs be used cautiously and why?
Elderly-anticholinergic
What condition is TCAs contraindicated with?
Cardiac issues due to cardiac toxicity
What adverse effect can TCAs cause?
It may lead to dysrhythmias and may be fatal with overdose.
QT prolong
What drugs have D2D interactions with TCAs?
MAOI, CNS depressants, sympathomimetics, anticholinergic drugs.
What is the BBW associated with TCAs?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
What are examples of MAO inhibitors?
Isocarboxazid
Phenelzine
What is the MOA of MAOIs?
Increases the amount of norepinephrine and serotonin for release by inhibiting intraneuronal MAO-A.
When are MAOIs used? Who prescribes them?
It is reserved for patients who have not responded to SSRIs, TCAs, and other safer drugs.
Typically prescribed by psych.
What adverse effect is associated with MAOIs?
Risk for hypertensive crisis.
What education should be reviewed with a patient on MAOIs?
Avoid fermented or aged foods. Tyramine-rich foods.
When are MAOIs contraindicated?
It is contraindicated in elderly.
Why are MAOIs reserved for patients unresponsive to other drugs?
Higher risk and many D2D interactions
What is the BBW associated with MAOIs?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
What is the indications for Bupropion (Wellbutrin)?
Depression,
Smoking cessation
What is the MOA of Bupropion (Wellbutrin)?
Boosts norepinephrine and dopamine.
What may we see in patient with seizures who are prescribed Bupropion (Wellbutrin)?
May increase the frequency and severity of seizures in those with a seizure disorder.
What is the BBW for Bupropion (Wellbutrin)?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25 years old.
What side effects may we see with Bupropion (Wellbutrin)?
Decreased appetite, increased libido.
Improved focus and concentration can be seen.
Indication Triazolopyridine (Trazodone)
Depression
Sedative
What is an example of N-Methyl-D-Aspartate (NMDA) Receptor Antagonist?
Ketamine
What is the indication for N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine]?
Depression
What is the MOA of N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine]?
Blocks NMDA receptor, decreasing glutamate binding.
How is N-Methyl-D-Aspartate (NMDA) Receptor Antagonist [Ketamine] given and how long do the effects last?
Given intranasally. The effect lasts 1-2 weeks.
What is the indication of Brexanolone (Zulresso)?
Depression (Used in postpartum people.)
What is the MOA of Brexanolone (Zulresso)?
Modulates GABA
Why don’t we use Brexanolone (Zulresso) often?
Very expensive.
Given IV.
What are examples of stimulants?
Methylphenidate (Ritalin, Concerta)
Dextroamphetamine (Dexedrine)
What are stimulants used for?
First-line treatment of ADHD
What is the MOA of stimulats?
Amplify norepinephrine and dopamine signals that are low in ADHD.
What side effects are seen with stimulants?
May cause insomnia and restlessness, suppress appetite leading to weight loss, a small increase in heart rate and blood pressure.
What is the BBW associated with Methylphenidate (Ritalin, Concerta)?
Chronic abuse of methylphenidate can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior and possible frank psychotic episodes.
What is the BBW associated with amphetamines -Dextroamphetamine (Dexedrine)?
Amphetamines have a high potential for abuse and dependence. In patients who use amphetamines chronically, withdrawal may occur if use of these medications is suddenly stopped.
What are the second line drugs used for ADHD?
Non-Stimulants
Atomoxetine (Strattera)
Clonidine (Kapvay)
What is the MOA of Atomoxetine (Strattera) & Clonidine (Kapvay)?
Inhibits norepinephrine reuptake, increasing NE
What are the adverse effects associated with Atomoxetine (Strattera) & Clonidine (Kapvay)?
dyspepsia, n/v, decreased appetite, dizziness, somnolence, mood swings.
What adverse effect is seen with Atomoxetine (Strattera) in children and adolescents?
*Atomoxetine may cause suicidal thinking in children and adolescents but not adults
What adverse affect is associated with Atomoxetine (Strattera)?
Slight risk of severe liver injury.
What monitoring do we need to do with SNRI’s?
BP initial and occassionally
TCA monitoring
ECG baseline and plasma levels
S/E of Zulresso
dizziness, sedation/somnolence, xerostomia, loss of consciousness, and hot flashes
BBW Strattera
suicidal thinking in children and adolescents
Are non-stimulants controlled substances?
No
What schedule are our stimulants (rittalin, Adderal)?
Schedule II
BBW Zulresso
Excessive sedation and loss of consciousness.
MOA trazadone
reduces levels of neurotransmitters associated with arousal effects, such as serotonin, noradrenaline, dopamine, acetylcholine, and histamine
RIsks and cautions with trazadone
Sleepiness, dizziness, weight loss,
Serotonin Syndrome.
Low BP.
BBW trazadone
Suicide
