Psych meds Flashcards
What are the antidepressant categories?
SSRIs, SNRIs, MAOIs, TCAs, and atypical
How long does it take to start seeing some improvement of symptoms when patients are started on an antidepressant?
1-3 weeks
How long does it take for optimal results to peak when patients are started on an antidepressant?
12 weeks
When should we begin to titrate/reassess for need for titration when starting a patient on an antidepressant?
1 month
What are the 1st line antidepressants?
SSRIs, SNRIs, Buproprion, Mirtazapine
What is the black box warning that ALL antidepressants carry?
They may increase suicidal thoughts or actions, increased suicide risk
What patient population is at highest risk to the BBW for suicide risk?
Patients less then 25 y/o
What is the mechanism of action of the SSRIs?
They inhibit the reuptake of serotonin, thus allowing for more in the synaptic space
What are the adverse effects of the SSRIs?
nausea, headache, sexual dysfunction, CNS stimulation, weight gain, serotonin syndrome
What are the patient education points for SSRIs?
Avoid use with alcohol, avoid OTC medications that can cause CNS depression
What is the pregnancy category for SSRIs?
Category C
What are the therapeutic uses for SSRIs?
Depression, bipolar disorder, panic disorder, OCD, bulemia
What are the symptoms of serotonin syndrome?
shivering, sweating, tachycardia, mydriasis, AMS, delirium, tremors, hyperreflexia, HTN, hyperthermia
What are the two most common SSRIs?
Sertaline (Zoloft) and Fluoxetine (Paxil)
What is the mechanism of action of the SNRIs?
Inhibit the reuptake of norepinephrine and serotonin, leaving more in the synaptic spaces
What are the adverse effects of the SNRIs?
headache, somnelence, dizziness, insomnia, fatigue, dry mouth, orthostatic hypotension, can increase blood glucose levels, anorexia
What are the therapeutic uses for the SNRIs?
depression, generalized anxiety disorder, panic disorder, social anxiety
What are the common SNRIs?
Duloxetine (Cymbalta) and Venlafaxine (Effexor)
What medications should be avoided with use with the SNRIs?
Fluoroquinolones, MAOIs, OTC medications as they can have many interactions depending on the medication
What is the mechanism of action of the TCAs?
They act on many neurotransmitters to prevent reuptake
What are the adverse effects of the TCAs?
anticholinergic effects (dry mouth, weight gain, dizziness, ortho hypotension, etc), sedation, hypotension, diaphoresis, QT prolongation
What are the TCA’s most commonly used today?
Amitryptyline, Nortryptyline, Imipramine
Who are TCAs contraindicated in?
Patients with heart disease due to risk of QT prolongation
Why are TCAs falling out of favor?
The development of SSRIs and SNRIs
They are easy to overdose on (lethal dose is only 8 times the therapeutic dose)
How should TCAs be stopped?
Need a taper dose, don’t abruptly stop
What are the therapeutic uses for TCAs?
2nd line treatment normally
depression, bipolar disorder, neuropathy, insomnia, ADD/ADHD, panic disorder, OCD
What is the mechanism of action of the MAOIs?
Irreversibly inhibit MAO to prevent norepinephrine, serotonin, and dopamine reuptake
What are the adverse effects of the MAOIs?
HTN crisis (very large risk), orthostatic hypotension, insomnia, diarrhea