TCA Flashcards
Amitriptyline can be used for
- Depression
- Neuropathic pain
- Migraine prophylaxis
Common side effect of TCA:
- GI and sexual dysfunction
- Anticholinergic
- Sedation
- Wt gain
- Arrhythmia
- Sz
- Fetal on overdose
SSRI, E.g.
- Fluxetine
- Fluvoxamine
- Escitalopram
- Citalopram
- Paroxetine
- Sertraline
Fluoxetine, can be used for
- Depression
- OCD
- BULIMIA nervosa
S/e of escitolopram and citalopram
- Prolonged QTc if high dose in elderly
- GI and sexual dysfunction
- Hyponatremia
- EPSE
Mirtazapine, is
- NaSSA (NorA and specific Serotonergic antidepressant)
- Used for depression
- Help to reverse GI and sexual dysfunction from SSRI OR SNRI
- S.e. sedation, increase appetite and wt gain
3 med, FDA approved for treatment of general anxiety
- Alprazolam
- Diazepam
- Lorazepam
Serotonergic agent + serotonergic agent or + high dose tramadol, would lead to
Serotonin syndrome
S/s of serotonin syndrome:
Mild: insomnia, anxiety, nausea, diarrhoea, high BP, tachycardia, hyperreflexia
Mod: agitation, myoclonus, tremors, mydriasis, flushing, diaphoresis, low fevee
Servere: severe hyperthermia, confusion, rigidity, coma, resp failure, death
Which Antidepressant is CYP450 inhibitor and with marked increase AUC
- Fluvoxamine
- Paroxetine
- Bupropion
Pt who suddenly discontinue antidepressant treatment(e.g. venlafacine, paroxetine), would develop:
- Antidepressant discontinuation syndrome “FINISH”
F: FLU LIKE syndrome
I: INSOMNIA
N: NAUSEA /VOMITING
I: IMBALANCE
S: SENSORY DISTURBANCE ( burning, tingling electric like sensation)
H: hyperarousal (anxiety, irritability, agitation, mania, jerkiness)
S/e of venlafaxine
HYPERTENSION
Bupropion
1.No serotonergic effects (no sexual dysfunction)
2. Not suitable for h/o sz, eating d/o
3. Used for smoking cessation
When start antidepressant for young pt <24yr old, need to watch out for:
- Suicidality risk
- Need to counsel pt and carers
Antidepressant with low risk for CYP interactions:
- Mirtazapine
- Escitalopram