Pharm 13 Flashcards
MAOI should not be administered with SSRI’s or potent TCA’s due to development of this condition
Serotonin syndrome
Tach, sweating, dilated pupils, myoclonus, hyperreflexia, hyperthermia
Sedation is a common side effect of these drugs.
Lower seizure threshold.
Uses = BAD, acute panic attacks, phobias, enuresis, and chronic pain
Overdose = lethal
Tricyclic antidepressants (TCA)
Three C’s associated with TCA toxicity
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
Agents having higher sedation and antimuscarinic effects than other TCA’s
Tertiary amines
A hypnotic & TCA used in chronic pain, that has marked antimuscarinic effects
Amitriptyline
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
Doxepin
TCA used in OCD.
Most significant of TCA’s for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
Clomipramine
Secondary amines that have less sedation and more excitation effect
Nortriptyline, Desipramine
Antidepressant associated with neuroleptic malignant syndrome
Amoxapine
Antidepressant associated with seizures and cardiotoxicity
Maprotiline
Antidepressant having stimulant effects similar to SSRI’s and can increase blood pressure
Venlafaxine
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
Venlafaxine
Antidepressant used for sleep that causes priapism
Trazodone
Antidepressant which is an inhibitor of CYP450 and may be associated with hepatic failure
Nefazodone
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
Mirtazapine
SE of mirtazapine
Liver toxicity, increased serum cholesterol
Except for these agents all SSRI have significant inhibition of CYP450 enzymes
Citalopram and its metabolite escitalopram
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
Fluoxetine
SSRI indicated for premenstrual dysphoric disorder
Fluoxetine (Sarafem)
Some of SSRIs’ therapeutic effects beside depression
Panic attacks, social phobias, bulimia nervosa, and PMDD premenstrual dysphoric disorder), OCD
SSRI less likely to cause a withdrawal syndrome
Fluoxetine
Activation of these receptors open K+ ion channels to cause membrane hyperpolarization
Postsynaptic Mu receptors
All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction
Meperidine
SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone
Opioid Analgesics
Strong opioid agonists
Morphine, methadone, meperidine, and fentanyl
Opioids used in anesthesia
Morphine and fentanyl
Use of this opioid + MAOI –> hyperpyrexic coma
Use of this opioid + SSRIs –> serotonin syndrome
Meperidine
Weak opioid agonist, poor analgesic
Overdose –> severe toxicity including respiratory depression, circulatory collapse, pulmonary edema, and seizures
Propoxyphene
