Week 11 Flashcards
SSRI plus partial antagonist of 5-HT1A receptor:
Viibryd
Examples of SNRIs:
Effexor (venlafaxine)
Cymbalta (duloxetine)
Savella (milnacipran)
What SNRI is also used for hot flashes, menopause in women who cannot take hormones?
Effexor(venlafaxine)
Example of tricyclics:
Elavil (amitriptyline)
Example if MAOI:
Nardil (phenelzine)
Examples of serotonin receptors antagonists:
Remeron (mirtazapine)
Oleptro (trazadone)
Wellbutrin is an:
Aminoketone
Abilify (aripiprazole) is an:
Atypical antipsychotic that can be used for refractory depression or bipolar depression.
SSRIs MOA:
Potently and selectively inhibit serotonin uptake on presynaptic neuron which increases concentration of 5HT in synapse by inhibiting reuptake.
SSRIs are indicated for:
Frequently 1st choice for depression
Used with anxiety
Very useful in OCD
Examples of SSRIs:
Zoloft (sertraline) Paxil (paroxetine) Celexa (citalopram) Lexapro (escitalopram) Luvox (fluvoxamine) Prozac (fluoxetine)-oldest with longest half-life
What SSRI do you not need to taper off?
Prozac due to long half-life
SSRI with shortest half-life?
Luvox (fluvoxamine)
How long for SSRI to reach full therapeutic strength?
2 weeks
Side effects of SSRIs:
Nausea, loose stools
Sexual dysfunction
Weight gain
Black box: suicidal ideation
Symptoms of serotonin syndrome:
Rigidity Hyperthermia Autonomic instability Tremors Confusion Delirium Coma
Causes of serotonin syndrome:
Interaction of SSRI with cardiac meds
Dosage too high
Interaction with MAOIs
Interaction with St. John’s Wart
SSRI withdrawal syndrome symptoms:
Flu-like Lightheadedness Uneasiness or restlessness Sleepiness or sensory disturbances Headaches
Short acting benzodiazepines:
Ativan, Xanax, Serax
Long acting benzodiazepines:
Klonopin
Librium
Longest half life of the benzodiazepines:
Valium
MOA of benzodiazepines:
Bind to molecular components of GABA receptors in the CNS’s neuronal membranes. Potential GABA-ergic inhibition at all levels of CNS which decreases the firing rate of critical neurons
Benzodiazepines metabolized in:
Liver
Side effects of benzodiazepines:
Sedation
Respiratory depression
Increased tolerance/physiologic dependence
Benzodiazepine antagonist:
Romazicon delivered IV
Serotonergic Agonist:
Buspirone (Buspar)
Buspirone is used in treatment of:
Anxiety (no effect of GABA system so do not use in benzodiazepine withdrawal)
Side effects of buspirone:
Dry mouth Lightheadedness Headache Insomnia Interaction with maois or SSRIs May potentiate serotonin syndrome
ADHD diagnostic criteria:
Consistent through time More than one setting Existed before 12 Clear impairment of functioning No longer disqualified by comorbid diagnosis
First line treatment of adhd:
Stimulants: adderral(amphetamine/dexamphetamine) or Ritalin (methylphenidate)
Contraindications of stimulants:
History of schizophrenia or other psychosis
Symptoms of anxiety, tension, and agitation
Side effects of stimulants:
Decreased appetite Delayed onset of sleep Rare: Growth deceleration Blood dyscrasias (CBC once/twice a year) Mood changes Hallucinations
First line nonstimulant medication for adhd:
Strattera (atomoxetine)
Strattera is a:
Noradrenergic reuptake inhibitor- increases norepinephrine
Strattera is not to be used:
With glaucoma or MAOIs or concurrently with albuterol
Side effects of strattera:
Suicidal ideation Liver damage Effect not always immediate GI upset Decreased appetite Mood swings BP increase
Clonidine is an:
Alpha-2 agonist- good mood stabilizer, capable of controlling tics and hyperactivity
Side effects of clonidine:
Hypotension
Dry mouth
Oversedation
Rebound hypertension is stopped abruptly
Guanfacine is an:
Alpha-2 agonist that is less sedation than clonidine and the only antihypertensive agent approved for ADHD
What antidepressants are food for patients with somnolence?
Fluoxetine (Prozac) and sertraline (Zoloft)
What antidepressant is good for patients with insomnia:
Paroxetine(Paxil)
Second line therapy in depression:
TCA- nortriptyline or desipramine
First line therapy for GAD:
SSRI or SNRI
Second line for GAD:
Buspirone or imipramine