Pharm/Sketchy Flashcards
What is the best way to differentiate serotonin syndrome from neuroleptic malignant syndrome?
serotonin syndrome is more likely to present with hyper-reflexia or clonus while NMS is more likely to present with rigidity and hyporeflexia
What are the indications for SSRIs?
- depression
- GAD/Panic Disorder/PTSD
- bulimia
- social anxiety disorder
What are the indications for SNRIs?
- depression
- GAD/Panic Disorder/PTSD
- neuropathic pain
- chronic pain
What are the side effects of SSRIs? What additional side effect is seen with SNRIs?
Both: - SIADH/Serotonin Syndrome - Stimulated CNS - Reproductive Dysfunction - Insomnia SNRIs may also cause hypertension
What is SSRI discontinuation syndrome?
- a withdrawal syndrome most often seen with sudden discontinuation of paroxetine or sertraline
- characterized by flu-like syndrome (dizziness, fatigue, headache)
What is the treatment for serotonin syndrome?
cyproheptadine, a 5-HT2 antagonist
Name the TCAs and describe their mechanism of action.
- amitryptyline, nortryptyline
- imipramine, clomipramine, desipramine
- they function in a way similar to SNRIs
What are the indications for TCAs?
- treatment resistant depression
- chronic and neuropathic pain
- migraine prophylaxis
- OCD
- recall that they function similar to SNRIs
What are the side effects of TCAs?
- blocks fast sodium channels in cardiac myocytes to cause a widened QRS, torsades, and fatal arrhythmias (treat with sodium bicarb)
- anticholinergic (amitriptyline > nortriptyline, desipramine)
- anti-histaminic (sedation, weight gain, increased appetite)
- anti-a1 (orthostatic hypotension)
- serotonin syndrome
- induction of seizures
How do MAOIs function? Name four.
- tranylcypromine, phenelzine, and isocarboxazid function as irreversible inhibitors of MAO-A and B, which metabolize DA, 5-HT, and NE
- selegiline is an irreversible, selective MAO-B inhibitor which prevents the metabolism of DA
What are the indications for MAOIs?
- non-selective tranylcypromine, phenelzine, and isocarboxazid are useful in the treatment of refractory depression
- selegiline, the MAO-B selective inhibitor, is useful in the management of Parkinson’s disease
What is the relationship between MAOIs and tyramine?
- tyramine is a sympathomimetic agent that is normally degraded by MAO-As in the GI tract before being absorbed
- in the context of MAOIs, they are absorbed and induce a sympathetic response consisting of hypertensive crisis
- it should be treated with the a1/a2 antagonist phentolamine
What are the major side effects of MAOIs?
- they have very high rBates of sexual dysfunction as well as orthostatic hypertension and weight gain
- they may lead to hypertensive crisis in the context of excess dietary tyramine
- they may lead to serotonin syndrome when combined with other serotonergic agents
Describe the mechanism of action, indications, and side effect profile of bupropion.
- it acts by inhibiting the reuptake of dopamine and norepinephrine
- it is helpful in the treatment of depression in that it is weight neutral, doesn’t cause sexual dysfunction, is a CNS stimulant that can help with hypersomnia, and is indicated for smoking cessation
- side effects include seizures, especially in those with a history of eating disorders
Describe the mechanism of action, indications, and side effect profile of mirtazapine.
- it acts by inhibiting presynaptic a2 receptors, increasing the release of serotonin and norepinephrine, as well as by antagonizing 5-HT2 and 5-HT3 receptors
- it is helpful in the treatment of depression because it doesn’t impact sexual functioning and can help with sleep due to the sedation it causes
- side effects include anti-histaminic effects (sedation, weight gain)
