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47 Cards in this Set

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Nefazodone: MOA
Heterocyclic class.
Mild 5-HT and NE reuptake inhibitor that also antagonizes f-HT2 receptor --> lead to enhanced 5-HT1-mediated neurotransmission.
Mirtazapine: MOA
Heterocyclic class.
Minimal effects on amine reuptake. But antagonizes 5-HT2 and 5-HT3 receptors--> lead to enhanced 5-HT1 mediated neurotransmission.
Venlafaxine: MOA
Heterocyclic class.
5-HT reuptake inhibitor at low dose (like SSRI), but NE reuptake inhibitor at high doses.
Which heterocyclic antidepressant cause increased appetite and weight gain?
Mirtazapine.
Which heterocyclic antidepressant cause anorexia and weight loss?
Venlafaxine.
Name heterocyclic antidepressants.
Nefazadone, mirtazapine, venlafaxine.
MOA of heterocyclic antidepressants.
Inhibit reuptake of NE, 5-HT. (similar to TCA)
Difference between MAO-A and MAO-B.
MAO-A = selective for 5-HT, NE, andtyramine.

MAO-B = selective for dopamine.

(Use MAO-B in antiparkinsonism--to build up dopamine)
Side effect of MAO inhibitors.
Orthostatic hypotension.
Impotence.
Hypertensive rxn w/ tyramine intake. (In the absence of MAO activity, tyramine acts as indirect sympathomimetic--> cause NE release from sympathetic nerve terminal--> hypertensive crisis.)
Hyperreflexia, agitation, hallucination, seizure, hyperthermia, hyperpyrexia.
Hepatotoxicity.
Reversible MOA inhibitor.
Tranycypromine
Irreversible MOA inhibitor.
Phenelzine and isocarboxazid.
Selective for MAO-B and also an antiparkinsonism agent.
Selegiline.
TCA antidepressant MOA.
Inhibits reuptake of NE and 5-HT
Antidepressants whose effects no seen for weeks.
TCA and SSRI.
Imipramine
TCA.
Inhibit reuptake of NE, 5-HT. Also block muscarinic, histamine receptors, alpha1 and alpha2-adrenoceptors.
Rx enuresis, chronic pain states, acute panic attacks, and phobias.
Imipramine (TCA)
Side effect of Imipramine (and most TCA).
Excessive sedation; 2ndary amines cause less sedation than tertiary amines.
Antichoinergic: blurred vision, dry mouth, urinary retention, constipation, agigation, tachycardia, sweating (amitriptyline produces the most severe anticholinergic effects).
Alpha1 blockade: Postural hypotension, tachycardia.
Additive depression of CNS w/ ethanol, barbiturates.
OD:resp depression, convulsion, arrhythmias, coma.
Advantage of SSRI over other antidepressants.
Minimal antimuscarinic, antihistamine, and alpha1-adrenoceptor blockade effects.
BUT, clinical effects not seen for several weeks.
Paroxetine
SSRI
Sertaline
SSRI
Citalopram
SSRI
Fluvoxamine
SSRI
Fluoxetine
SSRI
Which class of antidepressants has high side effect profile.
TCA. B/c of anti-M1, anti-H1, and anti-alpha1 effects.
Amoxapine
Heterocyclics.
2nd generation typicals.
Maprotiline
Heterocyclics.
2nd generation typicals.
Trazodone
Heterocyclics.
2nd generation atypicals
Bupropion
Heterocyclics.
2nd generation atypicals.
Nefazodone
Heterocyclics.
3rd generation.
Mirtazapine
Heterocyclics.
3rd generation.
Venlafaxine
Heterocyclics.
3rd generation.
Tranylcypromine
MAO
Phenelzine
MAO
Isocarboxazid
MAO
Selegiline
MAO
Imipramine
TCA.
Tertiary amines.
Amitriptyline
TCA.
Tertiary amines.
Doxepin
TCA.
Tertiary amines.
Desipramine
TCA.
2ndary amines.
Nortiptyline
TCA.
2ndary amines.
Protriptyline
TCA.
2ndary amines.
SE: sexual problem (loss of desire, impaired arousal, delayed/impaired ejaculation or orgasm)
All SSRI. Venlafaxine.
Paroxetine has highest rate.

Can be minimized by "drug holidays" (skip one day dose and resume in 2 days. Could reduce efficacy or lead to serotonin withdrawal symptoms (dizziness, depressed, nausea, confusion).
Antidepressant without sexual side effects?
First line: bupropion, nefazodone, mirtazapine (if weight gain is not an important consideration).

Second choise: try different SSRI.

Third: Nortriptyline (TCA), if not high overdose or seizure risk.
Alternative to sedation/tiredness of SSRI?
Adjust day time doses. If tiredness remain, switch to less sedating bupropion.

(Usualy don't develop tolerance to sedation/tiredness)
Restlessness or stimulation side effect of antidepressant.
Most common w/ bupropion.
Fluoxetine is worse among SSRI.

Citalopram has the least profile.
Switch to trazodone (occasional arrhythmias, but is safe for the majority) or lorazepam.
Consider nefazodone, mirtazapine, or less activating TCA like nortriptyline (if not high overdose or seizure risk).
Weight gain problem.
What are the alternative AD?
Among SSRI, paroxetine cause wt gain. Tricyclics cause wt gain, too.

Switch to bupropion, nefazodone.
Which AD cause GI side effects (nausea, and rarely diarrhea or vomiting)
More common w/ SSRI and venlafaxine.
Less common w/ bupropion (gives constipation) and tricyclics.
But tolerance often develops w/in few weeks.
Don't use cisapride, but instead H2 blockers.