Pharma of anti depressants* Flashcards
Selective serotonin reuptake inhibitors examples
used to treat what
fluoxetine, paroxetine, citalopram, escitalopram, serafine, fluvoxamine
depression, panic disorder, social anxiety disorder, PTSD, OCD, chronic pain, eating disorders, stroke recovery, premature ejaculation
mechanism of action of SSRI
increase synaptic 5HT within hours
effect takes 2-3 weeks
why is the effect of SSRIs delayed
5-HT(1a) receptors are auto receptors found throughout the CNS
they are inhibitory
this may be why there is a delayed effect
clinical aspects of SSRIs
almost all can be started off at a therapeutic dose from day 1
tolerated fairly well
safe in overdose
fluoxetine and paroxetine inhibit CYP450 which can cause interaction with other drugs
adverse effects of SSRIs
sexual dysfunction - can be reversed by 5HT2 antagonist or 5ht1a portal agonist such as trazodone
GI - nausea, dyspepsia, constipation, diarrhoea
short term anxiety
in young people <25 there is a increased risk of self harm and suicide in the first few weeks
TCAs clinical aspect
individualised dose titration
at higher doses patients may need ECGs - QTc
TCA adverse effects
constipation dry mouth blurred vision effect on cardiac function postural hypotension
Monoamine oxidase inhibitors mechanism of action
irreversible inhibitors inhibit monoamine oxidase A and B
MAO A metabolises NE, 5HT and tyramine
MAO B metabolises DA, tyramine and phylthylamine
increased storage and availability for release of 5HT and NA
examples of MAOIs
phenelzine
isocarboxazid
tranylcypromine
MAOIs clinical aspects
used less commonly
good for atypical depression
used 3rd or 4th line
MAOIs adverse effects
hypertensive crisis can occur with tyramine containing foods (cheese, yoghurt, meat, alcohol) and some drugs (sympathomimetics)
symp include - flushing, headache, increased BP, rarely CVA
treatment is with alpha blockade - phentolamine, chlorpromazine
can SSRIs be prescribed with aspirin
no as SSRIs have an increased bleeding risk
