Test 4- Cara Flashcards
receptors for this monoamine NT are found in the gut, blood vessel walls, and brain
Serotonin
when concentrations of this NT are lowered, concentration and focus can be decreased
Norepinephrine (NE)
this NT plays a role in cognition and alertness
dopamine
How can NT deficits result?
- ) not enough made
- ) chemical precursors (ingredients) are in short supply
- ) not enough receptor sites
- ) NT being taken up too quickly
GOLD STANDARD of antidepressants due to decreased SE’s and increased safety
SSRI’s
increased availability of serotonin is available where?
to post synaptic serotonin receptors
Do SSRI’s affect histamine and Ach like TCA’s?
NO
All SSRI’s are pregnancy category C except….
Paroxetine (Paxil)
Neonatal complications due to an SSRI include…
- cardiac issues/pulmonary HTN
- LOW birth weight
- premature delivery
- poor neonatal adjustment
- risks of developmental issues
- SSRIs are NOT safe in nursing moms
What are some SE’s of SSRIs?
- weight gain (5 lbs. in a year)
- nausea
- vertigo
- sexual dysfunction
- suicidal risk
- sleep disturbance
- dry mouth and other anti-Ach SE’s
Patient Treatment on an SSRI
- follow up at 4 weeks
- goal is 70% better in the first month
- tell patient that treatment is for 6 mo. to 1 year
- March/April from Sept/October is the best time to taper
- don’t taper on anniversary of tough event
used for bulimia, panic disorder, depression, and OCD (give Sarafem)
first SSRI on the market
long half life
10-60mg daily
(Fluozetine) Prozac
used for depression
results in QT prolongation at 40mg
don’t give more than 20mg to the elderly/OCP/PPI patients (increased arrhythmias)
*stronger anti-cholinergic properties
10-40 mg
(Citalopram) Celexa
used for general anxiety anxiety and depression
less of a tapering, start on 10mg and go with it
may notice relief of symptoms within 1 week
works faster than other SSRIs
dosed 10-20mg daily
Escitalopram (Lexapro)
used for depression, PMDD, OCD (high doses), panic/social anxiety, and PTSD
dosing can be difficult
dosed 25-200mg daily
Sertraline (Zoloft)
dosed 10-40 daily
Parozetine (Paxil)
used for depression, PMDD, panic disorder, social anxiety, OCD, GAD, PTSD
very sedating and causes weight gain
dosed 12.5-37.5mg daily
Paxil CR
used for OCD
minimial anti-Ach side effects
dosed 100-300mg daily
Fluvoxamine (Luvox)
What drugs do SSRIs interact with?
other drugs that increase serotonin
St. John’s Wort
drugs that affect QT intervals
warfarin/digoxin
drugs with CNS affects
SSRI + diuretics =
HYPOnatremia
**older patients on an SSRI need to get a sodium reading
What drugs result in QT prolongation?
Macrolides/Quinolones
Sulfa agents
TCA’s
anti-fungals
anti-arrhythmics
anti-psychotics
What are the symptoms of serotonin syndrome?
agitation
hyperthermia
hyperactivity
delirium
seizures
HTN
myoclonus
How do you treat a patient who is experiencing serotonin syndrome?
fluids, hydration, and educate patients on these symptoms
an SNRI that is used for depression and GAD
Serotonin affect in low doses, NE affect in high doses
dose from 37.5-300mg
Pregnancy category C and works after 2 weeks
Venlafaxine (Effexor, Effexor XR)
What are the warning/precautions/SE’s associated with Effexor?
**associated with sustained HTN
may lower seizure threshold
suicide risk in teens
overall benefits>risks in patients (especially with recent MI)
Adverse Reactions: dizzy, bad dreams, tremor, nervousness, weight changes
All SSRI/SNRI patients need to be careful with _______ intake and not be on a __________
alcohol
MAOI
What special issues must be considered with a patient on Effexor?
take with or w/o food
caution with alcohol
***monitor BP regularly
titrate up and down
SNRI dosed 20mg (60 max) PO BID
often used for Fibromyalgia too
Cymbalta (Duloxetine)
a newer and more costly SNRI that does NOT need titration
taken as 50mg daily
Pristiq (Desvenlafaxine)
Venlafaxine off label is used for….
- ) hot flashes
- ) neuropathy
- ) insomnia
SNRI for FIBROMYALGIA, not depression
CI in HTN, liver/renal patients, alcohol abuse, suicidality, seizures, and bleeding disorders
nausea is the MC side effects, increased HR and palpitations too
interacts with diuretics, NSAIDs, and other anti-depressants
Milnacipran (Savella)
indicated for depression and SAD
**inhibitor of NE and dopamine reuptake
pregnancy category C that takes greater than 2 weeks via a tablet, sustained, or extended release tablet
Zyban is used for smoking cessation
(Buproprion) Wellbutrin
What are the contraindications for Wellbutrin?
***seizure disorder
use with MAOIs
prior diagnosis of bulimia or anorexia
What are the SE’s associated with Wellbutrin?
agitation/insomnia
N/V/C
weight loss
tremor/hallucinations/fatigue
the effect of Wellbutrin is increased with __________
Levodopa
What special issues go along with Wellbutrin?
do not D/C drug without calling provider
no excessive alcohol
monitor body weight
used in same doses for smoking cessation (caution if on nicotine)
What are the benefits of Wellbutrin?
weight loss
no anti-Ach SE’s
no sexual SE’s
no orthostasis/BP problems
more elevating that sedating
a tetracyclic that is dosed 15-45 mg at BEDTIME
impacts Histamine, Serotonin/NE receptors
Preg Cat. C
SEs: weight gain, fatigue, dizziness (worry about falls), dry mouth, constipation, BP changes
Mirtazapine (Remeron)
serotonin modulator that acts PREsynaptically
indicated for depression and commonly used for insomnia
SE: hypotension, N/V, mild anti-Ach, sedation, nightmares
warnings regarding suicidality in teens and post MI
**ADVERSE RXN: arrhythmias and priapism
Trazodone
approved for major depression
has a duel mechanism
less sexual SE’s, more GI SE’s, weight neutral
tapering schedule of 10mg, 20mg, and 40mg
Vilazodone (Viibryd)
serotonergic antidepressant with an unclear MOA
may work pre and post synaptically
warning for suicidality under age 24 and serotonin syndrome risk
Vortiozetine (Brintellix)
known as heterocyclics
inhibit a nerves ability to reuptake a neurotransmitter
some histamine and serotonin impact
HUGE anti-Ach SE’s (dry mouth, blurred vision, sedation)
adverse reaction of ORTHOSTATIC HYPOTENSION, palpitations, and lowering of the seizure threshold
Tricyclic Antidepressants
TCA’s
(Amitriptyline) Elavil and (Imipramine) Tofranil are both examples of…
TCA’s
injection or tablet
Preg. Cat. D
take 7-21 for MOA to kick in
CI’s: narrow angle glaucoma
alternatively used for: migraine prophylaxis, IBS, chronic pain, sleep
TCA’s
What are warnings associated with TCA’s?
cardiac disturbances
renal/hepatic impairment
***may give pronounced HYPOtension (fatal)
***arrhythmia (may be fatal)
try to avoid in elderly
Adverse Reactions of TCA’s
drowsiness
dizziness
HA
HYPOtension/palpitations
constipation
weight gain
weakness
What drugs should TCA’s never be combined with due to increased toxicity?
Clonidine
Warfarin
***AntiAch Drugs
CNS Depressants
SSRI’s
Special Issues of TCA’s
avoid alcohol and caffeine
may turn urine blue-green
photosensitivity can occur
altered sex drive or ability (reversible)
***NEVER ABRUPTLY DISCONTINUE
