Mood Med practice COPY Flashcards
SSRI MOA
decrease action of 5-HT reuptake pump which causes increased serotonin levels in the synapse
SSRI Dosing AND CLEARANCE
Typically QAM can be halved if SE are bad. Metabolized mostly by the liver so caution in hepatic impairement.
SSRI SE
GI (N/D/anorexia) sleep change, headaches, dizziness, decreased libido, anorgasmia, ED, anxiety, increased suicide risk, prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome
SSRI CI
allergy to SSRI, use of MAOI within 2 weeks. Fluoxetine must wait 5 weeks.
SSRI drugs
fluvoxamine
fluoxetine
sertraline
Citalopram/Escitalopram
Paroxetine
Fluvoxamine special notes
SSRI with shortest half life, increased somnolence, DDIs
The 3 S Sounds
“Short, Somnolence, Cytochrome inhib”
Fluoxetine special notes
SSRI with Longest halft life, increased insomnia, DO NOT TAKE w Tamoxifen
basically the opposite of fluvoxemine
sertraline special notes
SSRI with increased GI upset mostly diarrhea, increased insomnia, decreased QT prolongation
Citalopram/Escitalopram special notes
SSRI with MOST associated with QT prolongation, least impact on liver!
Paroxetine special notes
SSRI with Only one to cause anticholinergic SE, orthostatis hypotension, weight gain, sexual dysfuntion are all increased. DO NOT TAKE w tamoxifen.
SNRIs MOA
Blocks reuptake of 5-HT and NE, increasing their levels in synapse.
SNRI dosing AND CLEARANCE
takes a few weeks to see full effects. Typically taken QD. Cleared through liver and kidneys.
SNRI SE
N/V/D constipation, dry mouth. Sleep changes, HA, dizziness, anorgasmia, anxiety, suicide, diaphoresis, hypertension, serotonin syndrome.
SNRI CI
allergy to SNRIs; use within 2 weeks of an MAOI, caution if using other serotonergic drugs, caution with angle closure glaucoma.
SNRIs drugs
duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran/Levomilnacipran
Duloxetine Special notes
Only SNRI with hepatic cytochrome inhibitors which leads to DDIs, LEAST associated w HTN, indicated for chronic pain relief
Venlafaxine special notes
SNRI with higher risk of SE than others. MOST associated w HTN
Desvenlafaxine special notes
SNRI with synthetic of venlafaxine, Less risk of HTN and other general SE than venlafaxine
Milnacipran/Levomilnacipran special notes
SNRI with Greater effects on NE. most likely to have Psuedo anticholinergic SE (UR, const, dry mouth).
Bupropion MOA
acts as dopamine-NE reuptake inhibitor (also antagonizes nicotinic receptors)
patients with depression that may also want to quit smoking
bupropion
Bupropion SE
Dry mouth
Insomnia
Nausea
Increased Seizure risk
SI
not associtated with weight gain or sesx dysf
cytochrome inhib!=DDI
CI Bupropion
includes hepatic cytochrome inhibition causes DDIs
allergy
seizure disorder (HIGH RISK OF SEIZURE)
anorexia/bulemia ( causes weight loss and decreased appetite
use within 2 weeks of MAOI
patients with depression who also have insomnia
mirtazapine
Mirtazapine MOA
antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors which causes increased release of serotonin and NE.
Mirtazapine SE
Dry mouth, increased appetite, weight gain (more than SSRI/SNRI), drowsiness, sedation, sexual dysfunction (less than SSRI).
LOWER HTN RISK
NO HEPATIC CYTOCHROME INHIB.= FEW DDIs
Mirtazapine CI
Allergy
MAOI w/i 2 weeks.
what are the atypical antidepressants
bupropion and mirtazapine
Serotonin Modulators MOA
blocks the reuptake of 5-HT = increased serotonin
Nefazodone and trazodone also antagonize the 5-HT pump = increased serotonin
Vilazodone and Vortioxetine partially antagonize 5-HT pump = mimic serotonergic effects
Serotonin Modulators Dosing AND CLEARANCE
QD or BID, Cleared through liver
Serotonin Modulators SE
nausea, diarrhea, headache, suicide, serotonin syndrome.
Serotonin Modulators CI
allergy
MAOI use W/I 2 weeks
caution with other serotonergic drugs
What are the Serotonin Modulator medications
Nefazodone
Trazodone
Vilazodone
Vortioxetine
SE: nefazadone
No sexual dysfunction, Less GI. increased Xerostomia, HA, Dizziness, insomnia or drowsiness, agitation, hypotension.
Hepatic Cytochrome enzyme inhibition = MOST DDI RISK OF ALL 5-HT inhib.
BBW = hepatotoxicity.
Trazodone SE:
nausea, constipation, dry mouth, sedation, fatigue, sexual dysfunction (less than SSRIs or SNRIs.)
Rare: priapism and cardiac arrhythmias
Vilazodone
SE: Nausea, Diarrhea, HA, sexual dysfunction (less than SSRIs or SNRIs)
Ketamine/Esketamine MOA
opioid and glutamate agonist. NMDA antagonist. mechanism for antidepression is unknown
Ketamine/Esketamine use
for severe, refractory depression w/o psychosis that is not respondant to ECT. short term use only!
ketamine/esketamine Dosing
ketamine - IV
esketamine - Nasal
rapid effects but effects end in about 2 weeks.
Ketamine/Esketamine SE
abuse potential becuase of euphoric/intoxicated effects
N/V, HA, dizziness, neurotoxicity, hepatotoxicity, bladder toxicity, tachycardia, HTN and abuse/addiction
Ketamine/Esketamine CI
allergy
aneurysmal disease or AV malformation
hx of intracerebral hemorrhage
inability to tolerate increase in BP
MAOIs Use
usually only for treatment-resistant or atypical depression. selegiline = low dose used for parkinsons
MAOI MOA
MOAa breaks down serotonin and NE
MOAb works w MOAa to break down dopamine
MAOI SE
hypotension, GI upset, urinary hesitancy, HA, myoclonic jerks, edema, suicidal ideation, hypertensive crisis w some foods (cheese, beer, tofu, cured meats)
MAOI CI
includes allergy, CVD, pheochromocytoma (adrenal gland tumor), hepatic/renal impairment, use w serotonergic drugs. LOTS OF DDIs
what medications are the MAOIs
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
Tricyclic antidepressant MOA
inhibits reuptake of 5-HT and NE
tricyclic antidepressants SE
includes: Anticholinergic, drowsiness, SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk
this tricyclics antidepressants MOA includes more potent blocking of 5-HT reuptake rather than NE reuptake
tertiary amines
amitryptiline
doxepin
imipramine
clomipramine
trimipramine
SE Tetra cyclic antidepressants
includes: Anticholinergic (less than TCAs), drowsiness (more than TCAs), SD, Diaphoresis, tremor, weight gain, increased appetite, SI, prologned QT (cardiotoxicity), OD risk
Maprotiline MAOI
this tetracyclic antidepressant blocks reuptake of NE and 5-HT
Amoxapine MAOI
this tetracyclic antidepressant blocks reuptake of NE and blocks dopamine receptors
