pyschopharm 1 Flashcards
Depression: mood disorder -
Caused by decrease level of
of NA and serotonin -
in the CNS
treatment of depression results in at least 50%*
.improvement in symptoms, it is called a
response
results in removal of*
essentially all symptoms, it is called ———for the first
several months and then——— if it is sustained for longer
.than 12 months
remission
recovery
depression returns before there is a full remission of*
symptoms or within the first several months following
.remission of symptoms, it is called a——–
When depression returns after a patient has recovered, it is*
.called ———-
relapse
a recurrence
Selective Serotonin Reuptake
Inhibitors( SSRI’s)
overdose still safe higher therapeutic index
Fluoxetine*
Sertraline*
Paroxetine*
Citalopram*
Escitalopram*
Fluvoxamine*
Thus, before shifting to non-SSRI antidepressants, it is most
Next step IN Tx
try other agents in the SSRI class for persons who did not respond
.to the first SSRI
-paroxetine increases the risk of birth defects, particularly
heart defects, when women take it during the first 3 months
of pregnancy so Paroxetine should usually not be taken
so u give —-
during pregnancy .
- Concentrations of sertraline and escitalopram are
especially low in breast milk
—————–has the most consistently demonstrated -
effectiveness in reducing symptoms of depressive disorder
in children and adolescent
Fluoxetine
OCD Tx
Fluvoxamine , paroxtine , sertraline , and fluoxetine are indicated for-
treatment of OCD in persons older than the age of 18 yrs .
Fluvoxamine and sertraline have also been approved for treatment of
children with OCD (6 – 17 yrs
1st line Tx in bulimia nervosa
ssri -fluoxetine
**SSRi has no role in TX of anorexia nervosa
Benzodiazepine augmentation is useful in the
acute symptomatic state of which disease
Posttraumatic Stress Disorder.
:Off-label Uses of SSRi
*
-Premature ejaculation: Fluoxetine and
sertraline have been shown to be
effective for this purpose.
- Paraphilias: SSRIs may reduce OCD in
people with paraphilias.
- Autism : Fluoxetine has been reported
to be effective for features of autism in
children, adolescents, and adults.
Fluvoxamine may increase theophylline levels ————–
and warfarin levels ——————–.
fluvoxamine should not be used with
clozapine ; because it raises clozapine concentration,
increasing risk for —————-.
the duration of action and severity of
zolpidem-induced side effects including ———-
Concurrent administration of SSRIs with
,MAOIs,L-tryptophan,Tramadol,lithium.increase risk of ————
3 folds
2 folds
seizures
hallucination
serotonin syndrome
serotonin syndrome Tx
cyproheptadine(serotonin antagonist )
The most common chronic side effect of SSRIs
associated with long term treatment.
if pt don’t compline with medication
sexual dysfunction
but its reversible
{switch to mirtazapine}
ANOTHER distrubant side effect of SSRi is ———– and mostly ————–so avoid in obese pts BMI > 30
One third of patients taking SSRIs will gain weight.
* Paroxitine is associated with more frequent ,rapid and
pronounced weight gain
SSRi can effect cardiovascular system by ——-mostly ———-
lengthen the QT intervals
citalopram
SSRi can cause headache mostly —————butttttttttttttt
Fluoxetine
All SSRIs are effective prophylaxis against both
migraine and tension type headaches.
other 4 side effects of SSRi
sleep disturbance we give in morning
emotional blunting
seizures
sweating we give terazosin alpha antagonist
hematologic effect of SSRi and on electrolyte balance
platlet aggregation +++hyponatremia
emerge within 1-3 days.usually resolves
spontaneously in 3 weeks.characterized by both 1-psychological symptoms are anxiety, irritability and
crying spells.
2-physical symptoms are dizziness,
nausea and vomiting, fatigue, lethargy, flulike symptoms .ur Dx
discontinuation syndrome
SNRIs have two and a half mechanisms:
🡪 boosting serotonin throughout the brain.
🡪 boosting norepinephrine throughout the brain.
🡪 boosting dopamine in prefrontal cortex
Venlafaxine
is approved for treatment of four
MDD,GAD,PANIC DISORDER,SOCIAL anxiety disorder
Higher-dose OF venlafaxine is associated with an increased risk of
sustained elevations of blood pressure\
most common reported adverse effect
contraindicated in
(monitoring of BP is
recommended. )
{nausea}
Contraindicated in patients taking
monoamine oxidase inhibitors (MAOIs) due
to the risk of pharmacodynamics interaction
( serotonin syndrome).
✔ MOAIs should not be started for at least 14
days after stopping venlafaxine.
* Overdose : HTN, arrhythmia
part of SNRi
* It is formulated as a delayed release capsule to reduce the risk
of severe nausea associated with the drug.
Duloxetine
Therapeutic indications: of duloxetine
✔ Depression
✔ Neuropathic pain associated with Diabetes and Stress Urinary
Incontinence.
Antagonist of central presynaptic α2 adrenergic which increase levels of serotonin and norepinephrine
++++Blockade of postsynaptic serotonin 5-HT2 and 5-HT3
receptors+++++antagonist of
histamine H1{relieve insomnia at night, and improve anxiety
during the day, but could also cause drowsiness during the day.
(sedation)}
***always given before sleep
Mirtazapine
which benefits of mirtazapine regarding its MOA
***always given before sleep
cause increase
.in appetite and weight gain
relieve insomnia at night,
Blocking receptors that mediates the nausea and vomiting which protect
against serotonin-induced gastrointestinal side effects
mertazapine hematologic effect
cholestrol levels oncreased by 20%in 15 % of people
absolute neutrophil count dropped to
500/mm 3 or less within 2 months of the
onset of use in 0.3 percent of persons, some
of whom developed symptomatic infections.
(risk of agranulocytosis)
