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29 Cards in this Set
- Front
- Back
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what neurotransmitters does CNS use |
ACTH, gamma-aminobutyric acid, dopamine, glutamate, norepinephrine, serotonin
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what neurotransmitters does SNS use
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ACTH, dopamine, epinephrine, norepinephrine
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what neurotransmitters does peripheral nervous system use
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ACTH, norepinephrine
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what neurotransmitters does PSNS use
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ACTH
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how to dx depression
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depressed mood or loss of interest/pleasure in activities for >2wk plus >4 of these factors... -change in sleep pattern -change in appetite/ weight –fatigue -psychomotor agitation or retardation -feelings of worthlessness/guilt -difficulty thinking, concentrating or indecisiveness -recurrent thoughts of death, suicidal ideation, plans, attempts |
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what are the monoamine oxidase inhibitors
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tranylcypromine, isocarboxazid, phenelzine, selegeline
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MAO ADRs
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dizziness, lightheadness, drowsiness, fatigue, weakness, BP effects metabolic effects, hypoglycemia possible |
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what do you have to watch for with MAO drugs
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drug interactions and food interactions
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dose for MAO
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Phenelzine maintenance =15mg qd\ start with 60-90mg |
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who are the tricyclic antidepressants
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secondary amines: nortriptyline, desipramines tertiary amines: amitriptyline, clomipramine, doxepin, imipramine, trimipramine tetracyclic amine: maprotiline |
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ADRs of tricyclic antidepressants
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histamine receptor blockade (sedation) Alpha adrenergic blockade (postural HOTN) Anticholinergic effect (blurred vision, dry mouth, constipation) Cardiac (arrhythmias, sinus tachycardia, prolongation of conduction time |
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Dose for tricyclic antidepressants
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amitriptyline 150mg qhs
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What are the selective serotonin reuptake inhibitors
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citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone, vortioxetine
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What are the differences btwn selective serotonin reuptake inhibitors
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side effect profile |
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What are the kinetics of selective serotonin reuptake inhibitors
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organ dysfunction- renal impairment NOT needed, hepatic impairment may result
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Drug interactions for selective serotonin reuptake inhibitors
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MAO, results in serotonin syndrome
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ADR of selective serotonin reuptake inhibitor
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increased fall risk, lower bone mineral density, sexual dysfunction (Peroxetine), SIADH (Na drops <120), constipation, diarrhea, nausea, dizziness, HA, insomnia
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Dose for selective serotonin reuptake inhibitors
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sertraline 100mg qd
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Who are the serotonin/norepinephrine reuptake inhibitors
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desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine
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Issues with venlafaxine
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higher doses raise BP higher rate of tx- emergent mania than other agents more activating than others dose-dependent weight loss |
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Dose for serotonin/noepinephrine reuptake inhibitors
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Cymbalta 60mg qd
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What is a general caution
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SSRIs and SNRIs are NOT addictive but abrupt cessation causes withdrawl: nausea, HA, dizziness, lethargy, flu-like sx; 2-3d after discontinuation; highest risk: paroxetine and venlafaxine |
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Tell me about norepinephrine/dopamine reuptake inhibitor
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Bupropion ADR = seizure threshold lowering in pts with eating disorders, anaphylactic rxn |
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Tell me about serotonin antagonist
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Mirtazapine (Remeron) multiple blocked receptors accounting for therapeutic effect and side effects onset faster ADR = appetite increase, drowsiness, cholesterol increase do NOT prescribe |
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Tell me about serotonin modulators
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trazodone, vilazodone, and nefazodone ADR = drowsiness, HTN, weight gain, hepatotoxicity (nefazondone) |
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Efficacy of antidepressants
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all are equally effective but ADR are lower in newer agents improvements seen in 1-6wks |
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What is a risk issue with antidepressants
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suicide risk
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What is the preferred agents in elderly
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sertraline, bupropion XL, Citalopram (QT prolongation)
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What do you take into account when selecting drugs
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past tx hx, ADR, pt preference, OD toxicity, cost |
