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25 Cards in this Set

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55. What class of drugs are Trazodone (Desyrel) and Nefazodone (Serzone)?
a. Serotonin Receptor Antagonists and agonists
56. Use of Trazodone (Desyrel) and Nefazodone (Serzone)
a. Refractory major depression
b. Major depression w/anxiety
c. Insomnia (secondary to its sedative effects).
57. Side effects of Trazodone (Desyrel) and Nefazodone (Serzone)?
a. They do not have the sexual side effects of SSRIs and do not affect rapid eye movement (REM) sleep.
b. Sedation!
c. Priapism!!! (esp. w/Trazodone).
d. Nausea
e. Dizziness
f. Orthostatic hypotension
g. Cardiac arrhythmias.
58. Black box warning for nefazodone?
a. Rare but serious Liver failure 1/250,000-300,000.
59. α2-Adrenergic Receptor antagonist?
a. Mirtazapine (Remeron)
60. Use of Mirtazapine (Remeron)?
a. Refractory major depression, especially in pts who need to gain weight.
61. Side effects of Mirtazapine (Remeron)?
a. Sedation
b. Weight gain!!!!
c. Dizziness
d. Somnolence
e. Tremor
f. Dry mouth
g. Constipation
h. Rare agranulocytosis
62. Side effect benefits of Mirtazapine (Remeron)?
a. No sexual side effects and few drug interactions.
63. Use of Remeron for depression in elderly?
a. Helps w/sleep and appetite.
64. MOA of Heterocyclic antidepressants: TCAs?
a. TCAs inhibit the reuptake of NE and 5-HT.
b. ↑ availability of monoamines in the synapse.
c. Bc of the long half-lives, most are dosed once daily.
d. They are rarely used first-line bc they have a higher incidence of side effects, require greater monitoring of dosing, and can be LETHAL in Overdose.
65. What are the 4 tertiary amine TCAs and what general side effects do they have?
1. Amitriptyline (Elavil)
2. Imipramine (Tofranil)
3. Clomipramine (Anafranil)
4. Doxepin (Sinequan)
b. The tertiary amines are highly anticholinergic, more sedating, and have greater lethality in overdose.
66. Use of Amitriptyline (Elavil) [A tertiary amine TCA]?
a. Chronic Pain
b. Migraines
c. Insomnia
67. Use of Imipramine (Tofranil) [A tertiary amine TCA]?
a. Has intramuscular form
b. Useful in enuresis and panic disorder.
68. Use of Clomipramine (Anafranil) [A tertiary amine TCA]?
a. Most serotonin specific
b. Useful in tx of OCD!
69. Use of Doxepin (Sinequan) [A tertiary amine TCA]?
a. Chronic Pain
b. Emerging use as a sleep aid in low doses.
70. 2 Secondary amine TCAs and their general side effect profile?
1. Nortriptyline (Pamelor, Aventyl)
2. Desipramine (Norpramin)
b. Metabolites of tertiary amines (less anticholinergic and less sedating).
71. Use of Nortriptyline (Pamelor, Aventyl) [A secondary amine TCA]?
a. Least likely to cause orthostatic hypotension.
b. Useful in therapeutic blood levels
c. Useful in treating chronic pain.
72. Effects/SE of Desipramine (Norpramin) [A secondary amine TCA]?
a. More activating; least sedating
b. Least cholinergic.
73. Mainstay of tx for TCA overdose?
a. IV Sodium bicarbonate.
74. 2 Tetracyclic antidepressants?
a. Amoxapine (Asendin)
b. Maprotiline (Ludiomil)
75. Amoxapine (Asendin) SE?
a. Metabolite of antipsychotic loxapine
b. May cause EPS and has similar SE profile to typical antipsychotics.
76. Maprotiline (Ludiomil) SE?
a. Higher rates of seizure, arrhythmia, and fatality in overdose.
77. What dose of TCAs can be lethal in overdose?
a. A 1-week supply (as little as 1-2g).
78. TCA binding in blood?
a. TCAs are highly protein bound and lipid soluble.
b. They therefore interact w/other meds that have high protein binding.
79. What are the SE of TCAs mostly due to?
a. Their lack of specificity and interaction w/other receptors.