Week 1 Flashcards

1
Q

MAOIs

A

(phenelzine, tranylcypromine, isocarboxazid)

irreversible inhibition of oxdiase

increases 5HT, NE, and DA in synaptic cleft–downregulation

SE: hypertensive crisis with high tyramine diet, delayed effectiveness, serotonin syndrome, sexual dysfunction

*helpful in treatment-resistant depression and anxiety

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2
Q

TCAs

A

(amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline)

blocks reuptake of 5HT and NE

*very effective antidepressants

SE: antihistaminergic actions (sedation, weight gain), anticholinergic actions (dry everything), a-1 adrenergic blockage, weak blockade of voltage-sensitive Na channels in heart and brain (prolongation of Q-T interval on EKG)

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3
Q

SSRIs

A

(fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, vilazodone)

*drugs of choice for most anxiety disorders

inhibition of 5HT transporter–overtime = downregulation (accounts for therapeutic action and tolerance to side effects because of the flood of serotonergic pathways)

SE: sexual dysfunction, sedation, insomnia, delayed effectiveness, discontinuation syndrome, agitation, myoclonus, akathasia, serotonin syndrome

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4
Q

fluoxetine

A

SSRI

(Prozac)

antagonist action on 5HT2C receptor = slight increase in disinhibition of NE and DA release

makes this drug an activating SSRI (increased risk of suicide in suicidal patients!)

good for anhedonia, hypersomnia, psychomotor retardation, apathy, fatigue, and poor concentration

*10 day half-life

weekly capsule

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5
Q

sertraline

A

SSRI

(Zoloft)

weakly inhibits DA transport which slightly increases DA

improves hypersomnia, low energy, and mood reactivity

often paired with bupropion to maximize increase in DA

sigma-1 receptor binding makes it advantageous in psychotic depression

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6
Q

paroxetine

A

SSRI

(Paxil)

preferred in anxiety patients due to calming, sedating properties (anti-cholinergic effects)

SE: discontinuation withdrawal syndrome, heart effects in fetus if taken during pregnancy!

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7
Q

fluvoxamine

A

SSRI

(Luvox)

used for treatment of anxiety and OCD

potent at sigma-1 site–may be reason for calming properites and usefulness in psychotic depression

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8
Q

citalopram/escitalopram

A

SSRI

(Celexa/Lexapro)

citalopram is a racemic mixture of R and S enantiomers–escitalopram contains only the R enantiomer

escitalopram– more effective at lower doses and is the purest SSRI and best tolerated SSRI

–> acts only on serotonin transporters

SE: GI upset for first 3-5 days

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9
Q

vilazodone

A

SSRI

(Viibryd)

partial agonist at 5HT1A receptor

first line for depression and anxiety

SE: nausea, vomiting, diarrhea, insomnia

**very low weight gain and sexual side effects

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10
Q

SNRIs

A

increases both 5HT and NE in synergistic way (weak DA increase in prefrontal cortex)

activating drugs

SE: sexual dysfunction

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11
Q

venlafaxine

A

SNRI

(Effexor)

potency: 5HT > NE

may cause intense discontinuation withdrawal symptoms, HTN

***take this medication on time!

also useful for anxiety, fibromyalgia/chronic pain at higher doses

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12
Q

desvenlafaxine

A

SNRI

(Pristiq)

5HT>NE activity

may be useful in postmenopausal women with depression; also useful in chronic pain/fibromyalgia

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13
Q

duloxetine

A

SNRI

(Cymbalta)

both 5HT and NE activity at lower doses

useful in chronic pain/fibromyalgia at higher doses

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14
Q

milnacipran

A

SNRI

(Savella)

approved for fibromyalgia only in the US

NE>5HT activity

–> higher NE activity may account for improvement in cognition seen in chronic pain patients

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15
Q

levomilnacipran ER

A

SNRI

(Fetzima)

L enantiomer of milnacipran

NE>5HT activity

SE: GI upset, sweating, insomnia, increased HR and BP

shows significant improvement on Sheehan Disability Scale

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16
Q

mirtazapine

A

NaSSA

(Remeron)

a-2, 5HT2A, 5HT2C, 5HT3, histamine antagonist

useful in anxiety

increases appetite and reduces nausea

very SEDATING, but no sexual side effects

17
Q

trazodone

A

SARIs

(Deseryl)

very SEDATING

must use at higher doses to achieve antidepressant effects

commonly used for treatment of insomnia, but can also be used for anxiety

18
Q

nefazodone

A

SARI

(Serzone)

very SEDATING

useful in anxiety (less sedating than trazodone)

rarely used because of liver toxicity

19
Q

bupropion

A

NDRI

(Wellbutrin)

very stimulating (take dose in the AM) and don’t use in anxiety

synergistic effect of NE and DA–very activating

SE: headache, dizziness, anxiety, tremor

also marketed as Zyban for smoking cessation

20
Q

vortioxetine

A

NDRI

(Brintellix)

synergistic effect of increased NE and DA

SE: nausea, vomiting, diarrhea, headache, dizziness

*low sexual dysfunction

21
Q

Beta-blockers

A

blocks beta receptors, interfering with the binding of EPI and other stress hormones (weakens the peripheral effects of stress)

*these drugs do not block panic attacks

may be helpful for performance anxiety