Somatic Therapies Flashcards
What is the MOA of SSRI’s?
Selective Serotonin Reuptake inhibitors in the presynaptic neuron
Where are SSRI’s metabolized?
In the liver
What is the normal dosing regimen for SSRIs?
Once per day except fluvoxamine (2x)
Which SSRIs have active metabolites?
Fluvoxetine and Sertraline
What are the early signs of serotonin syndrome?
Lethargy, restlessness, confusion, flushing, diaphoresis, tremor
What are later effects of serotonin synd?
Hyperthermia, hypertonicity, rhabdomyolysis, renal failure, death
What is the effect of SSRIs on Cyt P450?
Inhibits enzymes: Decreases mets of other drugs
What are the indications of SNRIs?
Depression, Anxiety, Chronic Pain
What are the dosing traits of venlafaxine?
SSRI at low dose
SNRI at higher doses
What are the traits of Desvenlafaxine?
Metabolite of Venlafaxine
Better tolerated
Equal RI of S and N
What are indications for Buproprion?
MDD, SAD, ADHD, Smoking Cessation (NOT ANXIETY)
What are the traits of Buproprion?
Inhibits Reuptake of Dopamine and NE
Structure of Stimulant
What are the SA of Buproprion?
HA, Nausea, Anx, Tremor, insomnia, Seizure at high dose
What is the MOA of Vilazodone?
SSRI and 5HT1A rec part agonist
What are the SA of Vilazodone?
Min sexual dysfunction
N/V Insomnia
What is the MOA of Trazadone?
Weak Inhib of SE and 5HT2
What are indications for Trazodone?
MDD but significant sedation better for insomnia
What is the MOA of Mirtazapine? Indications?
5HT2 and 3 and a1 antagonist
Sleep aid
What are the SA of Mirtazepine?
Sedation, Weight gain
What are the SA of TCAs?
Sedation, Wt gain (Antihist)
Constipation, urinary hesit, retention, dry mouth, vision blurring (Antichol)
What are the Cardio effects of TCAs?
Orthostatic Hypotension, Reflex Tachcardia. Don’t use in a Heart block. Fatal arrhythmia in OD
What are the Monoamines degraded by MAO?
Tyramine, SE, DO, NE (Not degraded in presence of MAO-I) MAO-A:: SE and NE
What drugs are best at achieving remission from depression?
SNRIs however not as well tolerated
What are considerations when switching Antidepressants?
Taper off original drug Use drug with diff MOA COnsider pre-existing Medical Conditions Med that fits Sx Min drug interactions
What are traits of the best medication?
Cost, Tolerability, Sx types
Prescriber experience and comfort
Which MDD meds have danger during pregnancy, nursing?
Paroxetine: Cardiac Abn
Sertraline Safest
PPHN (Persistent pulm Htn)
