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20 Cards in this Set
- Front
- Back
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TCAs
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Mechanism:
- block reuptake of norepinephrine and seretonin - block muscarinic cholinergic, H1 histamine and alpha-1 adrendergic receptors Uses: - unipolar depression - anti-panic & anxiolytic - chronic pain - insomnia Toxicity: - dangerous in OD (LD = 3-5x daily dose) - weight gain - cardiac effects - anticholinergic effects Examples: Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine Amoxapine Doxepin |
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Adverse Effects Associated w/ Specific Reuptake Inhibition:
Noradrenergic |
tremors
tachycardia sweating insomnia erectile & ejaculatory problems |
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Adverse Effects Associated w/ Specific Reuptake Inhibition:
Serotonergic |
GI distress
nausea headache nervousness akathisia sexual side effects anorexia |
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Adverse Effects Associated w/ Specific Reuptake Inhibition:
Dopaminergic |
psychomotor activation
aggravation of psychosis |
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Adverse Effects Associated w/ Specific Receptor Antagonism:
Muscarinic Cholinergic |
blurred vision
dry mouth impaired memory constipation urinary retention |
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Adverse Effects Associated w/ Specific Receptor Antagonism:
Histaminergic H1 |
sedation
drowsiness weight gain hypotension |
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Adverse Effects Associated w/ Specific Receptor Antagonism:
Alpha-1 Adrenergic |
postural hypotension
dizziness reflex tachycardia |
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Adverse Effects Associated w/ Specific Receptor Antagonism:
5HT2C |
weight gain
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Adverse Effects Associated w/ Specific Receptor Antagonism:
Dopaminergic D2 |
extrapyramidal movement disorders
endocrine changes sexual dysfunction |
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MAOI
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Mechanism:
inhibit monoamine oxidase from degrading NE in presynaptic terminal once it has been reuptaken Uses: anxiety & depression Toxicity: - poor tolerability - toxic in OD - low tyramine diet necessary to prevent hypertension due to increased NE - drug interactions w/ decongestants, stimulants; narcotics & anethetics lethal in combination Examples: Phenelzine Tranylcypromine Selegiline |
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SSRI
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Uses:
anxiety depression PMDD eating disorders Side Effects: nervousness insomnia GI complaints Sexual dysfunction Headaches Myoclonus Examples: inhibitors of CYP450 - (interactions with other drugs which required CYP450 metabolism) Fluoxetine Paroxetine Fuvoxamine Cleaner drugs to prescribe - Sertraline Citalopram Escitalopram |
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Bupropion
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NDRI
Advantages: - mood stabilizing properties - no sexual dysfunction - no weight gain Disadvantages: - increase seizure risk, esp. in bulemics - no effect in anxiety disorders; may be anxiogenic |
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Venlafaxine
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SNRI
Strengths: - superior efficacy in some populations - rapid onset Weaknesses: - HTN in dose respone manner - increased early side effects - discontinuation syndrome - may be more dangerous in OD than SSRIs |
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Duloxetine
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SNRI
Strengths: - may have efficacy advantages - indicated for pain Weaknesses - BID dosing may be difficult - dual agent side effects - contraindicated in patients with liver problems/history of alcohol abuse toxicity - drug-drug interactions |
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Nefazodone
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SARI
Strengths: - sleep enhancing - anit-emetic - weight gain & sexual dysfunction rare Weaknesses: - BID dosing - drug interactions - alpha effects: sleepy and dizzy - rare liver |
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BZD
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Mechanism: positive allosteric modulator of GABA-A receptor --> net increase of Cl ioni conductance through Cl ion channel --> fast inhibitory NT; full agonist at BZD receptor site (both GABA and BZD must be bound to their sites)
Side Effects: behavioral inhibition psychomotor impairment cognitive/concentration difficulties tolerance (mostly to anti-convulsant effects NOT anxiolytics) dependence withdrawal/seizurs addiction sedation memory problems Examples: Alprazolam Lorazepam Clonazepam Oxazepam Chloridazepoxide |
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Buspirone (anxiolytic)
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- 5HT21A partial agonist
- good for GAD/alcoholic pts/cognitively impaired pts. w/ behavioral dyscontrol - must take at least 30 mg/day for 2 weeks |
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Adrenergic blockers (anxiolytic)
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good for specific social phobia, PTSD
Propranol (beta blocker) Clonidine (alpha receptor agonist) Prazosin (alpha receptor antagonist) |
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Anticonvulsants (anxiolytics)
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Thought to impact "kindling" phenomenon of some anxiety disorders like PTSD
Gabapentin, Tiagabine |
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Neuroleptics, particularly atypicals (anxiolytics)
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Useful for more severe anxiety disorders or anxiety associated w/ depression or biopolar disorder
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