Pharm 5 Anti-Depressants Flashcards
Reserpine
Deplete NE, 5-HT, DA
Causes depression
Amine hypothesis
Depression due to lower 5-HT & NE
NTs affected:
MAOIs
Tricyclics
SSRIs
DA, NE, S
NE, S
S
Mirtazapine MOA
A2a inhibitor
Tricyclic SE (3)
Antihistamine - sedation
Antimuscarinic - dry mouth, constipation
Alpha-1 blockade - orthostatic hypotension
Reflex tachycardia (NE) can be FATAL
2 prototypical tricyclics
Metabolites
Imipramine. ->. Desipramine
Amitriptyline. ->. Nortriptyline
Desipramine SE
Sudden death in children
Tricyclic compliance problem
Impotence
Tricyclic drug interaction
Increased cardiotoxicity with MAOI
Next gen tricyclic AD
Less toxic, same efficacy
Bupropion (Wellbutrin)
2nd gen TCA
Indication: nicotine withdrawal
MOA: Mostly DA stimulator (psychomotor activation)
SE: Seizure risk
Less cardiotoxicity & less impotence
Venlafaxine
3rd gen TCA
MOA: NE & 5-HT
SE: Increase in diastolic BP
No cardiotoxicity
Trazodone
Nefazodone
Sleep aid (sedation) Bad antidepressant
SE: Priapism
SSRI side effects
NO cardiotoxicity
NO sedation
Fluoxetine (prozac)
SSRI
SE: Increased risk for suicide
Sexual dysfunction
Initial weight loss
Inhibit CYP450
200 hour t1/2
Sertraline
SSRI
Like fluoxetine but
No CYP450 inhibition
Shorter half life
Paroxetine, Fluvoxamine
SSRI
Similar to sertraline, but some CYP450 inhibition
Citalopram
SSRI
Similar to sertraline
Most selective
Serotonin syndrome
After switching from SSRI -> MAOI or triptans (headache), excessive 5-HT in synapse
Lethal (hyperthermia, myoclonus, HTN)
MAOI interaction
Tyramine from food
2 long acting MAOIs
Phenelzine, Tranylcypromine
Nonselective (MAOI A & B)
2 newer MAOI
Moclobemide
-Reversible inhibitor of MAOI A (no DA)
Selegiline
-MAOI B - used for Parkinson’s Disease
MAOI advantage
Much quicker than SSRIs
Mood elevation in depressed AND normal
MAOI SE
Hypomania
Hypotension (DA)
Sexual dysfunction
