Week 3 - Drugs for Depression & Anxiety Flashcards
SSRI’s SNRI’s TCA’s MAOI’s Atypical Antidepressants Benzodiazepines
What are the common assessments for depression severity?
Grief, loss, life events, childbirth
Use tools to help determine severity.
How long does it typically take to determine the initial response to antidepressants?
1-4 weeks
Max effect can take up to 12 weeks.
What steps should be taken if an antidepressant is not working?
- Increase dose
- Switch to same class drug
- Switch to another class drug
- Add a second drug
What is a significant risk associated with antidepressant drugs?
Suicide risk
Prescriptions should be written for the smallest number of doses consistent with good management.
What is the action of Fluoxetine (Prozac)?
Selectively block neuronal reuptake of serotonin
List some adverse effects of Fluoxetine (Prozac).
- Sexual dysfunction
- Weight gain
- Serotonin syndrome
- Withdrawal syndrome
- Bruxism
- Suicide Risk
What should be monitored when combining Fluoxetine with other drugs?
Responses to warfarin
Fluoxetine can elevate plasma levels of TCA’s and Lithium.
What are the two main classes of drugs used for anxiety disorders?
- SSRIs
- Benzodiazepines
What is the action of Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)?
Block neuronal reuptake of serotonin and norepinephrine
Works like SSRIs but less tolerated than SSRIs
What is a common adverse effect of SNRIs?
*Withdrawal syndrome (with abrupt withdrawal)
*Contraindicated with MAOI
*No late pregnancy - can result in neonatal withdrawal syndrome
*Liver toxicity - no alcoholics or liver disease
What are the common adverse effects of Tricyclic Antidepressants (TCAs)?
- Orthostatic hypotension
- Anticholinergic effects (can’t pee, spit, or poop)
- Suicide Risk
- Sedation
- Cardiac toxicity
- overdose (lethal)
What is the main risk associated with MAOIs?
Hypertensive crisis triggered by food rich in tyramine
What is a unique feature of Bupropion (Wellbutrin) compared to SSRIs?
Does not cause weight gain or sexual dysfunction
What is the action of Buspirone (Buspar)?
Binds to serotonin receptors with high affinity and to dopamine receptors with lower affinity
What are the first-line drugs for panic disorders?
- SSRIs (preferred)
- SNRIs
- TCAs
- MAOIs
What types of therapy are recommended for PTSD?
- Psychotherapy
- Trauma-focused therapy
- Stress inoculation training
Fill in the blank:
endogenous GABA
What are some common adverse effects of benzodiazepines?
- CNS depression
- Respiratory Depression
- Anterograde amnesia
- Confusion
- Paradoxical effects
What is a significant risk when discontinuing benzodiazepines after long-term use?
Withdrawal symptoms such as panic and convulsions
True or False: Benzodiazepines have a high potential for abuse.
False
Benzodiazepines have a lower potential for abuse compared to barbiturates.
What is the main use of beta blockers in anxiety disorders?
Performance anxiety
What questions should we ask a depressed person?
Do you have thoughts of suicide?
Do you have a plan?
Do you have access to items needed?
what drug class is fluoxetine?
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs used to treat depression and other mental health conditions.
What is the action of SSRIs?
Blocks serotonin and keeps it in the system.
SSRIs work by preventing the reabsorption of serotonin, a neurotransmitter that helps regulate mood, appetite, and other bodily functions.
when was fluoxetine introduced?
1987
What is the most commonly prescribed antidepressant class?
SSRIs
and are safer and more tolerated and equally effective when compared to TCAs and MAOIs.
OFF label uses for SSRIs
Bipolar disorder
OCD
Panic Disorder
Bulimia
Premenstrual dysphorbic disorder
What is a serious adverse effect of fluoxetine?
Serotonin SyndromeSuicide risk
Bruxism
Extrapyramidal symptoms
more serotonin in system = increased risk of serotonin syndrome.
s/s = agitation, confusion, anxiety
BRUXISM = clenching teeth, headache.
See a dentist for a mouth guard
Can you stop Fluoxetine?
No, it needs to be tapered slowly ~6 months;
otherwise risk for withdrawal syndrome:
s/s Lethal, tremors, muscle rigidity
Bruxism =
clenching teeth and headaches
See a dentist to geet a mouth guard
How long of a gap needed between MAOI and SSRI?
(stopping MAOI to take a SSRI)
14 days
How long is needed between stopping prozac and starting an MAOI?
5 weeks
Do not combine what two drugs with Fluoxetine?
TCAs, & Lithium
Can you combine MAOIs with other drugs?
NO
TCAs lethal dose is how many times the daily dose?
8 times
only one week supply is given to patients
When is the safest time to take TCAs?
Bedtime due to sedation effects
What is the drug of choice for atypical depression?
MAIOs
Are MAOIs mild or big guns?
Big Guns
When would you get a MAOI
When other stuff did not work
S/S of hypertensive crisis
- Severe Headache
- very high BP
- Stroke
- Bleed
- Confusion
- lethargy
When can you take other drugs while taking MAOIs?
Never unless approved by DR
What is a drug from the ATYPICAL ANTIDEPRESSANTS?
Bupropion
What is the difference between Bupropion (atypical antidepressants) and SSRIs?
Bupropion does not cause weight gain or sexual dysfunction
What type of patients would you not prescribe Bupropion?
Pts with psychotic disorders
due to small risk of psychotic symptoms (hallucinations & delusions)
Most common Atypical Depressants?
Bupropion
Mirtazapine
Trazodone
What are the 5 most common anxiety disorders?
GAD
Panic disorder
OCD
Social anxiety disorder
PTSD
Medications for anxiety disorders are:
SSRIs
SNRIs
Benzodiazepines
also psychotherapy
SSRI, SNRI, Benzos
which are long term?
SSRI
SNRI
What med can be used for GAD & Panic disorder?
Benzos
What route is no effect on heart for benzo?
PO
What route of benzos gives a profound hypotension and cardiac arrest?
IV
What happens to patients with respiratory depressants and COPD that take BENZOS?
create worsening hypoxemia, hypoventilation and make sleep apnea worse
knocks out respiratory drive
-lam & -pam
what drug class?
Benzodiazepines
What are some actions of BENZOs?
- Reduces anxiety
- Sedation
- Muscle Relaxer
- Amnesia (sx)
Antidote (reversal) for Benzos?
Flumazenil
Buspirone have an effect on CNS?
no
Buspirone adverse effects?
dizziness, lightheadedness
Buspirone food interaction?
Grapefruit juice
Drugs for OCD?
SSRIs
Compulsions that consume one hour per day and interfere with daily living?
OCD
Intense irrational fear of situation in which one might be scrutinized by others…
Social Anxiety Disorder
Tx for Social Anxiety disorder
Psychotherapy
SSRI
Benzo
Beta Blockers (performance only)
How to treat PTSD
Psychotherapy
trauma focused & Stress inoculation training
SSRI (first choice)
TCA
MAOI
