Pharm II, antidepressants Flashcards by jennifer davidson

What are the major categories of antidepressants -6

monoamine oxidase inhibitors - tricyclic antidepressants - tetracyclic antidepressants - serotonin reuptake inhibitors SSRI- serotonin and NE reuptake inhibitors - NE and dopamine reuptake inhibitors

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PARQ for MAOI

Diet restrictions - limit tyramine foods because they won’t be broken down - risk of serotonin syndrome

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seratonin syndrome

hypertensive emergencies and fatal acelleration of HTN when tyramine is eaten while on MAOIs- also a risk with other drugs taken in conjunction

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what does MAOI potentiat the effects of

sympathetimemtics like NE

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MOA or tricyclic antidepressants

unknown - diminish reuptake of monoamine neurotransmitters with possible down regulation of post synaptic receptors.

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indications for tricyclic anti-D

obsessive compulsive- enuresis- panic attacks and chronic pain

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what is a side effect of tricyclic anti-D

severe insomnia and depression

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what tricyclic Anti-D is also used for bed wetting

Amitriptyline

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side effects of tricyclic?

benadryl like- dry mouth- urinary hesitancy

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Why are tricyclic anti-Ds more risky than SSRI’s

because they are lethal at 10 times daily dose causing prolonged QT interval leading to arrhythmias

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Tricyclic antidepressant

Amitriptyline/Elavil

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indication for tricyclic antidepressant

major depression- bipolar- tension headaches- chronic pain

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MOA tricyclic- elavil

CNS modulation of serotonin and NE- increasing levels of each

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Side effects of ELAVIL

Dizziness -drowsey - benadryl like symptoms - dry mouth.

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what class is Elavil/amitriptyline

tricyclic antidepressant

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what is the withdrawl like symtpms of Elavil called

discontinuation syndrome - nausea - HA - flu like

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name the tetracyclic anti D

trazodone - desyrel

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some major side effecs of both tri and tetracyclic anti-D

insomnia and depression

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MOA of tetracyclic anti D

serotonin reuptake inhibition (presynaptic cleft) - partal antagonist. This increases serotonin in cleft increasing SE availble at post synapse

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indication of tetracyclic anti D

trazodone-desyrel - major depression - anxiety- panic - insomnia

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what medication can be perscribed for just insomnia without depression

tetracyclic anti D - trazodone - desyrel

Side effects of trazodone desyrel

sedation - risk of flalling in elderly- hypotension - mania in those with bipolar - increased risk of suicide

what are the most commonly perscribed anti-Ds

SSRI - selective serotonin reuptake inhibitors

MOA of SSRI

block serotonin reuptake presynaptically to increase serotonin available for neurotransmission at post synaptic cleft

how effective are SSRIs

helpful in 50-8=70% of those with major depression - not mild or moderate

side effects of SSRIs

GI upset- diarrhea- insomnia - ED - major weight gain

what class of anti-Ds have the best benefit/rist ratio

SSRIs

what happens if quit SSRI suddenly

profound anxiety and rebound depression that is worse than the origional

what is the name of the SSRI

Fluoxetine/prozack

indications for prozac

major depression- OCD- bulimia- panic disorder

moA of SSRI

Prozac/fluoxetine - decreased serotonin reuptake at presynaptic cleft

how long for SSRI to have effect

weeks at daily doseing

side effects of SSRIs

Prozac/fluoxetine - GI upset - diarrhea- high blood pressure - ED - impotence

what OTC drugs shoulnt' be used with SSRIs

NSAID - they reduce efficacy of SSRI while increasing risk of bleeds

what OTC drugs shouldn't be used with Prozac/fluoxetine

aspirin- ibuprophen- naproxen

name the SNRIs serotinin and NE reuptake inhibitors

duloxetine/cymbalta

what depression drugs can be used for pain syndromes like peripheral neropathy/ fibromyalgia

cymbalta a SNRI - serotinin and NE reuptake inhibitor

what specific neuropathy symptom can cymbalta help with

SNRI - pain only - not for numbness or tingling

main use for cymbalta

SNRI- major depressive disorder - general anxiety and neuropathy

side effects of cymbalta

SNRI - Wt gain ED and HA - sleepwalking - drymouth - insomnia

black box warning of SNRI

Cymbalta/duloxetine - increase risk of suicide 18-24

what is NDRI

NE and dopamine reuptake inhibitors

what is the NDRI for us

bupropion/wellbutrin

why would someone pick NDRI over SNRI

bupropion/wellbutrin and NDRI has less weight gain- possible weight loss and less ED

indication for bupropion/wellbutrin

NDRI - major depression - bipolar - ADD

what is the bupropion for smokeing cessation

NDRI - zyban

side effects of bupropion/wellbutrin

anxity the opposite of pepression- insomnia- restlessness- etc

black box warning of NDRI

bupropion /wellbutrin - risk of suicide

how is Zyban worked

start 1 week prior to quit date- take 7 days to reach steady state.

what is the active form of folic acid

levomefolic acid - 5MTHF

what is MTHF the coenzyme for 3 monoamines

serotonin - dopamine - norepinephrine

what is the neutraceutical for MTHF

levomefolic acid/deplin taken at high dose with prescripton