SNRIs + MAO inhibitors Flashcards
SNRIs - 4 drugs
Duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran
SNRIs - MOA
Selective for SER and NE, but do not activate many other receptors
SNRIs - Indications
Depression, eating disorders (bulimia and anorexia nervosa), anxiety disorders (panic disorder, phobic disorders, OCD).
Also effective for: fibromyalgia, autism, premenstrual dysphoric disorder
Duloxetine - indications
Major depressive disorder.
Diabetic peripheral neuropathic pain.
Generalized anxiety disorders.
Fibromyalgia.
Venlafaxine, desvenlafaxine - MOA
Strongly inhibit reuptake of both norepinephrine and serotonin. Do not antagonize muscarinic, adrenergic or histamine receptors
Venlafaxine, desvenlafaxine - Adverse effects
Similar to adverse effects of SSRIs.
Few autonomic, sedative or cardiovascular side effects
Milnacipran - indications
ONLY fibromyalgia
MAOIs - 5 drugs
Isocarboxazid Phenelzine Tranylcypromine Moclobemide Selegiline
Difference between MAO-A and MAO-B
Inhibition of MAO-A stops oxidation of mainly serotonin (some NE and dopamine as well).
Inhibition of MAO-B stops oxidation of dopamine.
Therapeutic effects of MAOIs are mainly from inhibition of MAO-A (except for the selective MAO-B inhibitors)
MAOIs - indications
Treatment-resistant depression
What should be avoided when taking MAOIs?
SSRIs (serotonin syndrome).
Sympathomimetics, TCAs.
Aged cheeses, beer, wines, meats and fish, rasins, broad beans, avocados, canned figs, choclate and coffie
MAOIs - adverse effects
Serotonin syndrome (agitation, restlessness, confusion, insomnia, seizures, severe hypertension, GI symptoms). Hypertensive crisis (occipital headache, palpitation, neck stiffness, soreness, nausea, vomiting, sweating, photophobia)
1st generation MAOIs
Isocarboxazid
Phenelzine
Tranylcypromine
2nd generation MAOIs
Moclobemide (RIMA - reversible inhibitor of MAO-A)
Selevtive MAO-B inhibitor
Selegiline
