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34 Cards in this Set

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  • Back
What are most adverse effects of TCAs due to
blockade of receptors
TCA effects:
1. CNS
2. vascular
3. heart
4. anticholinergic
5. vegetative
6. sexual dysfunction
1. SEDATION, seizures (esp w/ maprotiline)
2. ORTHOSTATIC HYPOTENSION (alpha 1 block)
3. tachycardia, conduction block, arrhythmias, ectopic ventricular contraction
4. PERIPHERAL- DRY MOUTH; CNS- CONFUSION
5. INC APPETITE, WT GAIN
5. impotence, delayed orgasm, dec libido
Are TCA side effects really a problem?
yes, often lead to serious problems w/ patient acceptance and compliance
Which has fewer serious adverse effects, SSRIs or TCAs?
SSRIs
How do SSRIs differ from TCAs
no sedation
no arrhythmias
no vascular effects
few autonomic side effects
Name some of SSRIs unique adverse effects
stimulant- insomnia, agitation, anxiety
akathisia (esp w/ fluoxetine)
HEADACHE
GI UPSET- nausea, wt loss
SEXUAL DYSFUNCTION- dec libido
inc BP (w/ venlafaxine)
How do MAOIs differ from TCAs
no cardiac toxicity
little sedation
low antimuscarinic activity
MAOIs adverse effects
orthostatic hyptension
CNS STIMULATION
GI distress, wt gain
some sexual dysfunction
trazodone and nefazodone adverse effects
SEDATION
dizzines, orthostatic hypotension
agitation
priapism (w/ trazodone)
bupropion adverse effects
agitation
insomnia
wt. loss
headache
nausea
seizures
mirtazapine
sedation
wt gain
dizziness
dry mouth
constipation
amoxapine side effects
like TCA but also
extrapyramidal effects
tardive dyskinesia
maprotiline side effects
like TCA but also
inc seizures
What is the only drug that has received approval for use in children w/ major depressive disorder
fluoxetine
TCA overdose
low therapeutic index!
tx = gastric lavage and/or dialysis, physostigmine; phenytoin or diazepam for seizures; NaBicarb, phenytoin and lidocaine for arrhythmias

withdrawal sx w/ abrupt stopping
SSRIs overdose
higher therapeutic index

discontinuation reax- agitation, headache, sleep problems
esp w/ venlafaxine
MAOIs overdose
uncommon
supportive therapy recommended
Maprotiline and amoxapine overdose
like TCAs
maprotiline also has higher incidence of seizures
bupropion overdose
agitation
delirium
seizures
What happens when ADs are taken with other drugs that have high protein binding?
They compete for binding --> increased free blood levels --> enhanced drug effects
Give three examples of drugs with increased protein binding.
Phenytoin, aspirin, phenothiazines
Name four things that increase TCA effects by altered liver metabolism
neuroleptics
methyphenidate
oral contraceptives
some SSRIs
Name three things that inc TCA effects by altered liver metabolism
barbituates
carbamazepine
rifampin
Do fluoxetine and paroxetine induce or inhibit CYP enzymes?
inhibit
Do TCAs potentiate or block the effects of cholinergics?
potentiate
Do TCAs potentiate or block the effects of sympathomimetics (cold meds)
potentiate
Do TCAs potentiate or block the effects of alcohol and other sedatives?
potentiate
Do TCAs potentiate or block the effects of guanethidine?
block
Do TCAs potentiate or block the effects of clonidine?
block
What happens when you mix SSRIs with fenfluramine and MAOIs?
serotonin syndrome
What happens when you mix MAOIs with sympathomimetics?
acute hypertensive reax (often with severe headache)
What happens when you mix MAOIs with foods containing tyramine (cheeses, red wine, chocolate, etc)
acute hypertensive reaz
(often with severe headache)
"cheese effect"
What is described by hyperthermia, muscle rigidity, hyperreflexia, myoclonus, diaphoreses, rapid fluctuations in vital signs and mental status?
serotonin syndrome
What happens when you mix MAOIs with meperidine and destropethorphan?
hyperpyrexia
delirium
convulsions
coma
death