Unit 3-Antidepressants Flashcards
Tranylcypromine
Drug class
MAOi
Tranylcypromine
Mechanism
Irreversibly inhibit both MAOa and MAOb
Tranylcypromine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Tranylcypromine
Side effects
- Hypertensive crisis (with tyramine-rich foods);
- serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures
- Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation
Phenelzine
Drug class
MAOi
Phenelzine
Mechanism
Irreversibly inhibit both MAOa and MAOb
Phenelzine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Phenelzine
Side effects
- Hypertensive crisis (with tyramine-rich foods)
- serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures
- Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation
Desipramine
Drug class
Tricyclic
Desipramine
Mechanism
- Block reuptake of NE or 5-HT at varying potencies and selectivity;
- also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
Desipramine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Desipramine
Side effects
- Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
- Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
- Not very safe; rarely used anymore
Imipramine
Drug class
Tricyclic
Imipramine
Mechanism
- Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
- forms active metabolite (desipramine)
Imipramine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Imipramine
Side effects
- Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
- Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
- Not very safe; rarely used anymore;
Amitriptyline
Drug class
Tricyclic
Amitriptyline
Mechanism
Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
Amitriptyline
Uses
- Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism;
- prevention of tension headaches, migraines
Amitriptyline
Side effects
- Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
- Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
- Not very safe; rarely used anymore;
- forms active metabolite (nortriptyline)
Nortriptyline
Drug class
Tricyclic
Nortriptyline
Mechanism
Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
Nortriptyline
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Nortriptyline
Side effects
- Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
- Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
- Not very safe; rarely used anymore
Fluoxetine
Drug class
SSRI
Fluoxetine
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Fluoxetine
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Fluoxetine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; pre-menstrual dystrophic disorder
Fluoxetine
Side effects
- Serotonin syndrom (with MAOIs)
- Fewer than tricyclics;
- mostly nausea, decreased sexual function
- Potent P450 inhibitor;
- forms active metabolite (norfluoxetine)
Paroxetine
Drug class
SSRI
Paroxetine
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Paroxetine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Paroxetine
Side effects
- Serotonin syndrome (with MAOIs)
- Fewer than tricyclics;
- mostly nausea, decreased sexual function
- Potent P450 inhibitor
Sertraline
Drug class
SSRI
Sertraline
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Sertraline
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Sertraline
Side effects
- Serotonin syndrome (with MAOIs)
- Fewer than tricyclics;
- mostly nausea, decreased sexual function
Escitalopram
Drug class
SSRI
Escitalopram
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Escitalopram
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Escitalopram
Side effects
- Serotonin syndrome (with MAOIs)
- Fewer than tricyclics;
- mostly nausea, decreased sexual function
Citalopram
Drug class
SSRI
Citalopram
Mechanism
Inhibit reuptake of 5-HT (and NE to lesser extent)
Citalopram
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Citalopram
Side effects
- Serotonin syndrome (with MAOIs)
- Fewer than tricyclics;
- mostly nausea, decreased sexual function
Duloxetine
Drug class
SNRI
Duloxetine
Mechanism
Inhibits reuptake of 5-HT and NE
Duloxetine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Venlafaxine
Drug class
SNRI
Venlafaxine
Mechanism
Inhibits reuptake of 5-HT and NE
Venlafaxine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Buproprion
Drug class
Atypical
Buproprion
Mechanism
Blocks DA and NE reuptake
Buproprion
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; maintain nicotine abstinence in quitting smokers
Buproprion
Side effects
Lowers seizure threshold
Mirtazapine
Drug class
atypical
Mirtazapine
Mechanism
5HT2a antagonists; also inhibit 5HT reuptake
Mirtazapine
Uses
Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
Lithium
Mechanism
Unknown; lithium depletes secondary messengers IP3 and DAG, important in a-adrenergic and muscarinic-cholinergic transmission
Lithium
Uses
- Anti-manic/mood-stabilizing (bipolar);
- long-term cluster headache prevention
Lithium
Side effects
- If elevated levels: neurotoxicity, cardiac toxicity, renal dysfunction
- Drowsiness, weight gain, tremor, polydipsia, polyuria
- Nausea and vomiting early sign of lithium OD;
- indomethacin and Na-depleting diuretics should be avoided (increase [Li])