Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
SSRIs: uses
|
MDD, dysthymia, Generalized Anxiety, Panic, OCD, Social Anxiety, PTSD, Anorexia, Bulimia, others
|
|
|
Side Effects of SSRIs
|
anxiety, restlessness, nausea, sleep disturbances, loose stool, sexual (delayed ejac, anorgasmia, loss libido), headache, tremor, increased perspiration, dry mouth
|
|
|
Serotonin Discontinuation symptoms
|
Stop SSRI abruptly -> nausea, irritability, tearfulness, fatigue, dizziness
|
|
|
Fluoxetine (Prozac)
|
SSRI (block presynaptic SE reuptake)
Half life: 2-3 days (norfluoexine is 2 wks) safe for prego SSRI side effects |
|
|
Sertraline (Zoloft)
|
SSRI (some DE activity too)
Half life: 24 hrs useful in brain injured pts SSRI side effects |
|
|
Paroxetine (Paxil)
|
SSRI (significant) 2D6 inhibition)
half life: 24 hrs sedating -> anxiety disorders Anticholinergic + SSRI side effects |
|
|
Citalopram (Celexa)
|
SSRI
Half life: 24 hr few drug interactions enantiomer -> escitalopram (Lexapro) SSRI side effects |
|
|
Fluvoxamine (Luvox)
|
SSRI
Half life: 24 hrs only approved for OCD (but can also use for depression) SSRI side effects |
|
|
Serotonin Syndrome
|
Char: delirium, fever, hyper/hypotension, neuromusc excitability, autonomic instability -> death
Risk: 2+ SSRI's -> do NOT combine SSRI's |
|
|
Buproprion (Wellbutrin, Zyban)
|
NDRI (No 5HT effects!)
Use for stop smoking, ADHD, NOT for anxiety disorders No sexual side effects (decrease SSRI's neg sex effects) SEIZURE RISK (inc if eating disorder, dialysis) |
|
|
Nefazodone (Serzone)
|
SSRI, SARI (post 5HT 2 receptor antagonist - sleep, not mood), Significant 3A3/4 inhibition, slow titration
Sedating, few sex effects -> good for anxiety Drugs interact, careful w/multiple meds, fulminant hepatic failure |
|
|
Velafaxine (Effexor)
|
SNRI (at high dose, also DE)
Generalized Anxiety Disorder SSRI side effects, inc BP, few drug interactions |
|
|
Duloxetine (Cymbalta)
|
SNRI
Depression with Pain SSRI side effects |
|
|
Mirtazapine (Remeron)
|
alpha-2 adrenergic antagonist (presynaptic) -> no stop releasing nt -> net inc nt
Sedating Give to people who are wasting/need to gain weight Antihistaminic side effects (inc apetite, weight gain), agranulocytosis, expensive |
|
|
Trazodone
|
Used for insomnia, rarely depression
Side effect: PRIAPISM (erectile dysfunction) |
|
|
Amitriptyline (Elavil)
|
TCA
pain management TCA side effects |
|
|
Tricyclic Antidepressants (TCA)
|
Mechanism: block reuptake NE, 5HT, alpha1 adrenergic, histamine, muscarinic Ach
Side Effects: (Ach): dry mouth, urinary retention, constipation, blurred vision (alpha1):orthostatic hypotension (hist): sedation, inc apetite, weight gain prolonged QT interval, VERY LETHAL IN HIGH DOSES |
|
|
Clomipramine (Anafranil)
|
TCA
serotinergic -> OCD TCA side effects |
|
|
Doxepin (Sinequan)
|
TCA
TCA side effects |
|
|
Imipramine (Tofranil)
|
TCA
used for enuresis TCA side effects |
|
|
Nortriptyline (Pamelor)
|
TCA
has useful theraputic levels TCA side effects |
|
|
Desipramine (Norpramin)
|
TCA
TCA side effects |
|
|
Monoamine Oxidase Inhibitors (MAOIs)
|
Mech: inhibits metabolism of NE, 5HT, DE, tyramine -> inc nt -> irreversible inhibition
Used: MDD (atypical), Anxiety disorders, Social phobia, treatment resistant depression Side effect: hypertensive crisis (food w/tyramine, drugs with DE, OTC decongestants, 5HT drugs, Demerol) |
|
|
How does ECT work?
|
bilateral tonic-clonic seizures, 30-90s
EEG slows, returns to normal 1mo-1yr inc cerebral blood flow, gluc, O2, permeability of BBB -> dec in cerebral metabolism inc slow wave activity in prefrontal cx affects every nt system |
|
|
When is ECT indicated?
|
MDD (most common, fastest and most effective treatment, especially psychotic, suicidal, anorexia sx)
Mania (as effective as LI, prego) Schizophrenia (catatonic, mood sx, malignant catatonia, NOT effective for chronic schizo) NOT effective for somatization, personality, OCD, other anxiety |
|
|
Meds to discontinue before ECT
|
Lower threshold: Benzodiazepines, LI, Clozapine, Buproprion
Increase threshold: Lidocaine Increase sz duration: Theophylline, LI |
|
|
Premedication for ECT
|
Muscarinic anti-Ach (dec secretions, bradycardia, asystoles)
Short actingbarbiturate -> methohexital Muscle relaxants -> Succinylcholine Atracurium if lack pseudocholinesterase |
|
|
What are contraindications for ECT?
|
no absolutes
extra monitoring with prego, lesions of CNS, inc intracranial pressure, CNS bleed, recent MI, uncontrolled hypertension |
