Q2 Antidepressants Module Flashcards
depression is a result of which neurotransmitters
- low: serotonin, NE, and dopamine
MOA of MAOIs
- irreversible inhibition of MAO-A and MAO-B
- slows down metabolism of neurotransmitters
what else does monoamine oxidase break down
what happens if it can’t break it down
- tyramine
- excess tyramine displaces serotonin, NE, and DA.
- excess NE and DA causes vasoconstriction leading ot hypertensive emergency
what does MAO-A break down
- tyramine
- serotonin
- NE
- dopamine
what does MAO-B break down
- dopamin
examples of MAOis
- Selegiline
- Tranycypromine
- Phenelzine
MAO TPS
importance of Selegiline at lose doses
how do you give it
- just MAO-B inhibitor
- bypasses GI tract
- it’s a patch
negative effect of MAOi combined with SSRI
- serotonin syndrome
symptoms of serotonin syndrome
- hyperthermia
- autonomic instability
- delirium
- muscle rigidity
when switching from an SSRI to an MAOi, how long must you wait
what about when switching from Fluoxetine specifically
what is the big risk
- 2 weeks
- 5 weeks
- serotonin syndrome
what do we use MAOIs to treat
- atypical depression
what class of drug is Clomipramine
what do we use it to treat
- TCA
- OCD
what do we use to treat OCD
- Clomipramine
what are examples of tertiary TCAs
- amitriptylline
- imipramine
- clomipramine
IM AM CLO
what are examples of secondary TCAs
- nortriptylline
- protriptylline
- desipramine
DES NO PRO (Dis no problem)
adverse effects of TCAs
- cardiotoxicity
we use low dose TCAs for what
- neuropathic pain
- migraine prophy
- insomnia
when SSRIs are used for MDD, it can take how long to see a response
what symptoms improve first
what symptoms improve last
- 3-4 weeks
- energy level
- anhedonia, mood, cognitive symptoms
warning with SSRIs
- may cause suicidal thoughts and behaviors in children and young adults
shorter half-life of SSRIs can cause
- withdrawal syndrome
non transient adverse effects of SSRIs
- SIADH
- sexual adverse effects
SIADH adverse effect of SSRIs is most common in what population
- elderly
what are some examples of SSRIs
half lives
what is the benefit/bad part with half lives
- paroxetine (less than 24 hours)
- citalopram (24 hours)
- escitalopram (24 hours)
- sertraline (24 hours)
- fluoxetine (a week)
- short half lives can result in withdrawal syndrome
transient effects of SSRIs
- GI upset
- headache
