Quiz #7 Flashcards
anti-depressant categories and drugs
MAOIs:
- phenelzine
- tranylcypromine
- isocarboxazid
- selegeline
TCAs:
- amiltriptyline
- nortriptyline
- protryptiline
- imipramine
- desipramine
- trimipramine
- clomipramine
- doxepin
SSRIs:
- fluoxetine
- citalopram
- escitalopram
- fluvoxamine
- sertraline
- paroxetine
SNRIs:
- venlafaxine
- desvenlafaxine
- duloxetine
- levomilnacipran
Antypical NDRI:
- buproprion
Atypical serotonin modulator:
- trazadone
- mirtazepine
- nefazodone
- vilazodone
- vortioxetine
- maprotiline
- amoxapine
MAOIs
Monoamine oxidase inhibitor
this enzyme breaks down all monoamines – in depression we focus on MAO-A (not B)
- oldest class of ADs, no longer used for first line, long half lives
- phenelzine, tranylcypromine, isocarboxazid – non-selective (A and B)
- selegeline - selective for MAO-B
Side effedts:
- sex dys
- weight gain
- insomnia
- sedation
- orthostatic hypotension
- seizure
- serotonin syndrome
- hypertensive crisis - tyramine (cheese & wine)
TCAs
tricyclic antidepressants
block reuptake of NE and serotonin
- tertiary - sert>NET
- –imipramine
- –amitriptyline
- –clomipramine
- –doxepin
- secondary – NET>SER
- –desipramine
- —nortriptyline
- –protrytiline
toxic OD – cardiotox, CNS tox (seizures), respirtaory dep, hyperpyrexia
AEs: - anticholinergic: dry mouth, blurry vision, constipation, urinary rentention - antihistamine: sedation, weight gain - alpha 1 -- orthostatic hypotension QT prolong sex dys ``
SSRIs
reuptake inhibition of serotonin
fluoxetine citalopram escitolopram paroxetine sertraline fluvoxamine (OCD)
- **First line treatment
- few SEs
- low tox (harder to OD)
SNRI
block reuptake of serotnin and NE - venlafaxine - desvenalafaxine - duloxetine - levomilnaciprain -
— reduced drug-drug intereavtions compared to SSRIs
Best drugs for insomnia
fast onset, oral route, short half life (sleep only)
Zopidem Eszopiclone zaleplon trizolam (early insomnia) flurazepam quazepam temazepam (mid-late insomnia)
best drugs for anxiolysis (panic dx and GAD)
intermediate onset, oral route, intermediate half life (all day coverage)
alprazolam clonozepam lorazepam diazepam clorazepate chlorodiazepozide estazolam prazepam
best drugs for emergency sedation and procedures
fast via delivery. IV or IM if uncooperative, short to intermeidate half life –> only during procedure
diazepam (status epilepticus), lorazepam (acute agitation, violence, PCP,)
midazolam (procedural)
best drugs for detox
PO or IV, long continuous 24 hr coverage, lower potency
chlorodiazepoxide
diazepam
oxazepam (liver disease OK - no active metaboliteis)
lorazepam (liver disease OK - no active metaboliteis)
BZs most prone to addiction
fast onset, PO, short half life - wears off and promotes craving, high potency
alprazolam
triazolam
others?
most versatile BZs
lorazepam:
oral, IV EtOH
- insomnia (sort of..)
tolerance to BZs
develops quickly to sedation, muscle relaxation and anticonvulsant effects,
intermediate to anxiety
slowly or not at all: cognitive impairement, motor incoordination —> can see patients who arent that sedated but are still quite cognitively impaired because tolerant
best drugs to treat panic disorder
clonazepam - longer half life, less frequent dosing, less intense withdrawl
alprazolam: shorter half life, more frewuent dosing, more interdose anxiety, more addictive
conventional antipsychotics (FGA)
dopamine antagonists
phenothiazines:
- chloropromazine
- thioridazine
- fluphenazine
- perphenazine
- trifluoperazine
- mesoridazine
non-phenothiazines: - loxapine - molindrone thioxanthenes - thiothixene butyrophenones - haloperidol diphenlbutylamine - pimozide aminobenzamides - metaclopramide
atypical antipsychotics - second generation
dopamine and serotnin antagonists
clozapine olanzapine risperidone quetiapine ziprasidone paliperidone asenapine iloperidone lurasidone
