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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)
Half life: 24 hr
few drug interactions
enantiomer -> escitalopram (Lexapro)
SSRI side effects
Fluvoxamine (Luvox)
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)
Depression with Pain
SSRI side effects
Mirtazapine (Remeron)
alpha-2 adrenergic antagonist (presynaptic) -> no stop releasing nt -> net inc nt
Give to people who are wasting/need to gain weight
Antihistaminic side effects (inc apetite, weight gain), agranulocytosis, expensive
Used for insomnia, rarely depression
Side effect: PRIAPISM (erectile dysfunction)
Amitriptyline (Elavil)
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)
serotinergic -> OCD
TCA side effects
Doxepin (Sinequan)
TCA side effects
Imipramine (Tofranil)
used for enuresis
TCA side effects
Nortriptyline (Pamelor)
has useful theraputic levels
TCA side effects
Desipramine (Norpramin)
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