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34 Cards in this Set
- Front
- Back
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What are most adverse effects of TCAs due to
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blockade of receptors
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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 |
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Are TCA side effects really a problem?
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yes, often lead to serious problems w/ patient acceptance and compliance
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Which has fewer serious adverse effects, SSRIs or TCAs?
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SSRIs
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How do SSRIs differ from TCAs
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no sedation
no arrhythmias no vascular effects few autonomic side effects |
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Name some of SSRIs unique adverse effects
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stimulant- insomnia, agitation, anxiety
akathisia (esp w/ fluoxetine) HEADACHE GI UPSET- nausea, wt loss SEXUAL DYSFUNCTION- dec libido inc BP (w/ venlafaxine) |
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How do MAOIs differ from TCAs
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no cardiac toxicity
little sedation low antimuscarinic activity |
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MAOIs adverse effects
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orthostatic hyptension
CNS STIMULATION GI distress, wt gain some sexual dysfunction |
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trazodone and nefazodone adverse effects
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SEDATION
dizzines, orthostatic hypotension agitation priapism (w/ trazodone) |
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bupropion adverse effects
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agitation
insomnia wt. loss headache nausea seizures |
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mirtazapine
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sedation
wt gain dizziness dry mouth constipation |
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amoxapine side effects
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like TCA but also
extrapyramidal effects tardive dyskinesia |
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maprotiline side effects
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like TCA but also
inc seizures |
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What is the only drug that has received approval for use in children w/ major depressive disorder
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fluoxetine
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TCA overdose
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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 |
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SSRIs overdose
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higher therapeutic index
discontinuation reax- agitation, headache, sleep problems esp w/ venlafaxine |
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MAOIs overdose
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uncommon
supportive therapy recommended |
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Maprotiline and amoxapine overdose
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like TCAs
maprotiline also has higher incidence of seizures |
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bupropion overdose
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agitation
delirium seizures |
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What happens when ADs are taken with other drugs that have high protein binding?
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They compete for binding --> increased free blood levels --> enhanced drug effects
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Give three examples of drugs with increased protein binding.
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Phenytoin, aspirin, phenothiazines
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Name four things that increase TCA effects by altered liver metabolism
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neuroleptics
methyphenidate oral contraceptives some SSRIs |
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Name three things that inc TCA effects by altered liver metabolism
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barbituates
carbamazepine rifampin |
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Do fluoxetine and paroxetine induce or inhibit CYP enzymes?
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inhibit
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Do TCAs potentiate or block the effects of cholinergics?
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potentiate
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Do TCAs potentiate or block the effects of sympathomimetics (cold meds)
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potentiate
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Do TCAs potentiate or block the effects of alcohol and other sedatives?
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potentiate
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Do TCAs potentiate or block the effects of guanethidine?
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block
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Do TCAs potentiate or block the effects of clonidine?
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block
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What happens when you mix SSRIs with fenfluramine and MAOIs?
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serotonin syndrome
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What happens when you mix MAOIs with sympathomimetics?
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acute hypertensive reax (often with severe headache)
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What happens when you mix MAOIs with foods containing tyramine (cheeses, red wine, chocolate, etc)
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acute hypertensive reaz
(often with severe headache) "cheese effect" |
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What is described by hyperthermia, muscle rigidity, hyperreflexia, myoclonus, diaphoreses, rapid fluctuations in vital signs and mental status?
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serotonin syndrome
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What happens when you mix MAOIs with meperidine and destropethorphan?
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hyperpyrexia
delirium convulsions coma death |
