WK 3 - PHARM slides Flashcards
Safest and most effective for depression, anxiety…
SSRIs
Fluoxetine
Selective
Serotonin
Reuptake
Inhibitors
What is the MOA of SSRIs?
Fluoxetine
inhibits serotonin reuptake
not allowing to go into cells so floating around in blood
What are the SSRIs (-tine)
fluoxetine used for?
DEPRESSION
bipolar, OCD, Panic, bulimia, premenstrual dysphoric disorders
Which is safer?
TCA, MAOI, SSRI
SSRI
better tolerated and just as effective as TCA and MAOI
Is the suicide risk higher or lower when taking SSRIs?
Higher - patient starts feeling better but still has suicidal ideas and now hows the energy to follow through with plan
What are the side effects of SSRIs, Fluoxetine?
Suicide Risk
Sexual dysfunction
weight gain
Serotonin syndrome
withdrawal symptom if stopped abruptly
Bruxism
Bruxism - what is it and what should you do about it?
Clenching teeth, headache
See a dentist to get a guard
S/S of serotonin syndrome…
agitation
confusion
anxiety
fever
diaphoresis
tremors
How long before beginning to feel therapeutic effects of fluoxetine (SSRIs)?
2 or more weeks
Fluoxetine drug interactions…
MAOI - 14 day gap stoppage before giving fluoxetine
Stop PROZAC 5 weeks before starting MAOI
Do NOT combine with TCA or Lithium
Monitor response to warfarin
SSRIs & SNRIs
What is the difference?
They have the same effect
But…
SSRI = safer
SNRI - added norepinephrine
SNRI -Serotonin Norepinephrine reuptake inhibitors. MOA-
(-ine)
Venlafaxine
Duloxetine
inhibits serotonin and norepinephrine reuptake
Venlafaxine adverse effects:
neonatal withdrawal syndrome with late pregnancy use
withdrawal syndrome of stopped abruptly
do NOT take with MAOIs
Duloxetine adverse effects
Liver toxicity -
no ETOH
no Liver disease patients
TCA = Tricyclic Antidepressants
MOA
Imipramine
amitriptyline
increase effects of serotonin and norepinephrine in the CNS
Side effects of SNRIs
duloxetine
venlafaxine.
Serotonin Syndrome (St. John’s wort)
fatigue,
insomnia
constipation
nausea
decreased libido
suicide risk
Indications of SNRIs
duloxetine
venlafaxine. (-ine)
Depression, anxiety, neuropathic pain
TCA = Tricyclic Antidepressants
Adverse effects
Imipramine
amitriptyline
Dangerous - (SSRI more safe)
- Cardiac toxicity and risk of overdose
- MOST COMMON - orthostatic hypotension
- Anticholinergic effects (can’t see, pee, spit, poop - BUT you do sweat)
- Tachycardia
- arrhythmias
- seizures
- hypomania
- suicide risk
How many doses is lethal for TCAs?
Imipramine?
8 times the daily dose
only give one week supply to patients
Dosing is best once daily at bedtime due to sedation effects
MAOIs - when in the treatment of depression would you bring in, how effective are they, and how safe are they?
Later choice
effective
Dangerous
What should you avoid if on MAOIs that cause hypertensive crisis?
foods rich in TYRAMINE
fermented
aged cheese
cured meats
avocado
bananas
red wine
caffeine
pepperoni
Hypertensive crisis - s/s =
SEVERE HEADACHE
extremely high BP
Stroke - bleed
Confusion
Lethargy
What is the drug of choice for Atypical depression?
depression with a temporary mood boost
MAOIs
When taking MAOIs you should avoid…
ALL meds that have not been approved by DR
Atypical Antidepressants -
Bupropion (wellbutrin)
what is in contrast with SSRIs?
Atypical antidepressants do not cause weight gain or sexual dysfunction
appears to increase sexual desire and pleasure
what are the two reasons for using Buproprion?
Atypical Depression
Smoking Cessation
BE APPROPriate and don’t smoke
Bupropion MOA =
decreased reuptake of dopamine and norepinephrine
Adverse side effects of Bupropion =
Seizures
Suicide risk
small risk of hallucination and delusions so do not take if you have a psychotic disorder
Most common side effects of Buproprion =
agitation, headache, dry mouth, constipation, weight loss, blurred vision, dizziness, tachycardia
What are the 5 most common anxiety disorders?
GAD
Panic Disorder
OCD
PTSD
Social anxiety disorder
Difference between general anxiety and panic attacks
general = doom, guilty
panic = no self worth
What drugs are used for anxiety disorders?
SSRIs
SNRIs
Benzodiazepines
Respond well to both psychotherapy and drug therapy.
Or just psychotherapy
For Anxiety disorders -
which drugs are for short term and long term?
Short Term = Benzodiazepines
Long Term = SSRIs & SNRIs
what types of disorders for SSRI?
All anxiety disorders
Do not have to have depression to use
No potential for abuse
What types of disorders for benzodiazepines?
GAD
Panic Disorder
potential for abuse
Benzodiazepines -
suffixes
-pam
-lam
What are the side effects for Benzodiazepines?
Everything lower…
- sedation
- amnesia
- muscle relaxant
- respiratory depression
create worsening hypoxemia (COPD pt ex) and hypoventilation, exacerbates sleep apnea
Knocks out respiratory drive
What route has effects on heart when giving benzodiazepines?
PO = no effect on heart
IV = profound hypotension and cardiac arrest
Benzodiazepines MOA =
diazepam
lorazepam
alprazolam
enhances GABA effects on CNS
Safer than Barbiturates
Benzodiazepines - what to know about their half-lifes?
Very long half-lifes
What happens with onset and duration of benzodiazepines?
Inset and duration of action accumulate
When to use benzodiazepines?
for Anxiety
insomnia
seizures
muscle spasms
alcohol withdrawals
Adverse effects of Benzodiazepines?
CNS depression
Low BP
Respiratory Depression
Sedation
amnesia
PAM takes lorazePAM for her anxiety. She does not drive her BENZ anymore because BENZos cause sedation
What is the antidote for Benzos for sedation effects?
flumazenil
will not reverse respiratory depression
dependance is low
Buspirone does not have CNS effect
uses:
GAD
Compare Benzodiazepines and Buspirone?
Buspirone has the same effect as Benzodiazepines but…
NO abuse potential
NO effects on the CNS
Adverse effects of Buspirone
dizziness
nausea
headache
lightheadedness
excitiement
Drug/Food interactions for Buspirone
Grapefruit Juice
Erythromycin
ketoconazole
Drugs of choice for panic disorders
SSRI. (preferred)
SNRI
TCA MAOI
Benzos = 2nd line
OCD = drugs and definition
compulsions that consume at least one hour per fay and interfere with daily activities
Drugs – SSRIs. with behavioral therapy
Social anxiety disorders -
defintion and therapy
intense irrational fear of being scrutinized, embarrassed, humiliated.
Psychotherapy and/or
SSRI
Benzos
for performance anxiety = benzos. (one before public speaking, for example)
PTSD - Psychotherapy and drugs
Trauma focused therapy
Stress inoculation training
SSRI
TCA or MAOI
