Pharm Flashcards
Antidepressant Classes
SSRI SNRI TCA MAOi others: mirtazapine, buproprion, trazadone Atypical Antipsychotics
SSRI:
- first line tx for what?
- med names
- MOA
First line tx for depressive disorders.
Med:
- Prozac (fluoxetine) (1st line for children)
- Zoloft (sertraline)
- Paxil (paroxetine
- Celxa (Citalopram)
- Luvox (Fluvoxamine)
- Lexapro (Escitalopram)
- all of these begin at 20mg except for lexapro you start at 10mg.
MOA:
block reuptake of serotonin, increasnig the serotonin in the synaptic cleft and down regulating 5HT1A receptors on post synaptic neuron, so less inhibition of that neuron leading to more firing and increased serotonin release.
*efficacy of all of these drugs is the same, its the half life and SE that differ.
SSRI
- half lives; longest and shortest
- which SSRIs have the least drug interactions d/t their decreased inhibition of liver enzymes?
- what are some medications to use caution with d/t drug interactions?
- which Med is CI?
Longest: Prozac up to 3 days, shortest is Luvox 15hrs
Citalopram (Celexa) Escitalopram (lexapro)
Use caution with:
- azole antifungals
- macrolide abx
- omeprazol e
- hepatic impairment
MAOis are CI if taking within 2wks d/t risk of serotonin syndrome.
SSRI:
- SE
- withdrawal sx
- which medications are more common to have withdrawal sx? why?
- time to effect?
- administration directions
- duration of therapy
SE:
- sexual dysfunction
- drowsiness
- dizziness
- wt gain
- insomnia
- anxiety
- diaphoresis
- hyperprolactinemia
- n/v/d
- increased appetite
Withdrawal:
- dysphoria
- dizziness
- GI distress
- fatigue
- chills
- myalgias
Fluvoxamine (Luvox) and Paroxetine (Paxil) are more likely to have withdrawal sx d/t such short half lives.
4-6wks
Admin:
-QD dosing, if makes sleepy take at night, if insomnia take in AM
-duration of thearpy is lifelong, if you d/c the med make sure to continue it for 1 yr after resolution of sx for recurrence of severe depressive episode.
Which SSRI has least problems with wt gain? Most wt gain?
Which SSRI is most likely to cause diarrhea?
T/F SSRI increase the risk of abnormal bleeding?
Least prob w/ weight gain = prozac.
Most wt gain = Paxil
Diarrhea = Zoloft
True, they inhibit platelet function. ..also they increase bone fxs..
SNRI
- medications
- act on what NT?
- MOA
- when to use these?
- what can decrease the rate of absorption of these?
Meds:
- effexor (Venlafaxine)
- Cymbalta (duloxetine)
- Pristiq (desvenlafaxine)
-act on Serotonin and NE
MOA: inhibit reuptake of NE and serotonin, acts same as SSRI otherwise.
Use as 2nd line therapy if unable to use SSRI.
Taking these with food will decrease the rate of absorption but not the degree of absorption.
SNRI:
-SE
SE:
- nausea*
- dizziness*
- diaphoresis*
- sexual dysfunction
Pristiq
-MC SE
Cymbalta:
- CI
- indications
- SE
Effexor:
- SE
- whats unique about this one?
Pristiq SE: nausea, HTN
Cymbalta:
-CI: uncontrolled angle closure glaucoma, severe or renal or liver impairment.
Indicated: diabetic neuropathy and fibromyalgia
SE: weight gain!!!!
Effexor:
- SE: HTN, QT prolongation
- unique: at low doses this is basically an SSRI, you need higher doses to pick up the NE component.
TCAs:
- what are the meds
- do we prescribe these?
- MOA
- half life
- cardiac SE
Tertiary amines:
- Amitriptyline
- Clomipramine
- Doxepin (silenor)
- Imipramine
- trimipramine
- more potent at blocking uptake of serotonin
2ndry amines:
- desipramine
- nortriptyline
- protroptyline
- more potent at blocking uptake of NE.
No, try to avoid them.
MOA: inhibit reuptake of serotonin and NE.
Half life 24hrs
Cardiac SE:
-heart block, ventricular arrhythmias, sudden death
TCAs
-SE
SE:
- sedation
- increase appetite
- confusion
- anticholinergic
- orthostatic hypotension
- Lethal in overdose.
MAOi’s
- meds
- why are these dangerous?
Meds: Phenelzine (Nardil) Tranylcypromine (Parnate)
Dangerous: drug-drug interactions, dietary restrictions, HTN crisis, serotonin syndrome.
Other meds used in tx of depression
Trazodone (desyrel) Bupropion (Wellbutrin) Mirtazapine (remeron) Vilazodone (Viibryd) Vortioxetine (Brintellix)
Trazodone
- good for tx of what at low and high doses?
- SE
Wellbutrin:
- uses
- avoid use with what disorders?
- SE
Low dose = sleep
high dose = antidepressant
SE: sedation, orthostasis, priapism (prolonged erection)
Wellbutrin:
- Uses= smoking cessation, ADHD, depression
- add on therapy to SSRI (for tx of sexual SE & augmentation therapy)
Avoid with bulemia and may lower seizure threshold.
SE: no sexual SE.
Mirtazapien (Remeron)
- MOA
- SE
MOA: blocks adrenergic receptors leading to increased release of NE and serotonin.
SE: sedation, weight gain (good for elderly), less sexual SE, good for pts with nausea.
Serotonin Syndrome:
- what is this?
- cause
- what are some drugs that can cause this?
What; constellation of sx caused by excess of serotonin, ranges from mild to fatal.
Cause;
- simultaneous admin of two serotonergic agents
- initiation of a single serotonergic drug or increasing the dose.
Drugs:
Psych meds: any of them.
Pain meds: demerol, tramadol, fentanyl
Migraine meds: triptans
Neurology: levodopa, carbipoda-levodopa, valproate, carbamezepine
OTC: tobitussin
Anti-emetics: zofran
Street drugs: cocaine, meth
ADHD; amphetamine derivatives, dexxtroamphetamine
