Pharm II, antidepressants Flashcards
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
PARQ for MAOI
Diet restrictions - limit tyramine foods because they won’t be broken down - risk of serotonin syndrome
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
what does MAOI potentiat the effects of
sympathetimemtics like NE
MOA or tricyclic antidepressants
unknown - diminish reuptake of monoamine neurotransmitters with possible down regulation of post synaptic receptors.
indications for tricyclic anti-D
obsessive compulsive- enuresis- panic attacks and chronic pain
what is a side effect of tricyclic anti-D
severe insomnia and depression
what tricyclic Anti-D is also used for bed wetting
Amitriptyline
side effects of tricyclic?
benadryl like- dry mouth- urinary hesitancy
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
Tricyclic antidepressant
Amitriptyline/Elavil
indication for tricyclic antidepressant
major depression- bipolar- tension headaches- chronic pain
MOA tricyclic- elavil
CNS modulation of serotonin and NE- increasing levels of each
Side effects of ELAVIL
Dizziness -drowsey - benadryl like symptoms - dry mouth.
what class is Elavil/amitriptyline
tricyclic antidepressant
what is the withdrawl like symtpms of Elavil called
discontinuation syndrome - nausea - HA - flu like
name the tetracyclic anti D
trazodone - desyrel
some major side effecs of both tri and tetracyclic anti-D
insomnia and depression
MOA of tetracyclic anti D
serotonin reuptake inhibition (presynaptic cleft) - partal antagonist. This increases serotonin in cleft increasing SE availble at post synapse
indication of tetracyclic anti D
trazodone-desyrel - major depression - anxiety- panic - insomnia
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