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20 Cards in this Set
- Front
- Back
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80. Side effect categories of TCAs?
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a. Anti-histamine
b. Antiadrenergic c. Antimuscarinic d. Wt. gain e. Lethal in overdose f. Seizures g. Serotonergic effects |
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81. Antihistamine effects of TCAs?
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a. Sedation
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82. Antiadrenergic (Cardiovascular) properties of TCAs?
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1. Orthostatic hypotension
2. Dizziness 3. Reflex tachycardia 4. Arrhythmias 5. ECG changes |
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83. What ECG changes occur w/TCAs?
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a. Widening of the QRS, QT, and PR intervals.
b. Avoid in pts w/pre-existing conduction abnormalities or recent MI. |
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84. Antimuscarinic effects of TCAs (aka Anticholinergic)?
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a. Dry mouth
b. Constipation c. Urinary retention d. Blurred vision e. Tachycardia f. Exacerbation or narrow angle glaucoma! |
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85. Effects of Overdose on TCAs?
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a. Lethal in overdose- must assess suicide risk!
1. Agitation 2. Tremors 3. Ataxia 4. Delirium 5. Hypoventilation from CNS depression 6. Myoclonus 7. Hyperreflexia 8. Seizures 9. Coma. |
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86. Seizures w/TCAs?
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a. At a rate of about 0.3%.
b. More common at higher plasma levels and with Clomipramine and Tetracyclics. |
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87. MOA of MAOIs?
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a. MAOIs prevent the inactivation of biogenic amines such as NE, 5-HT, dopamine, and tyramine (an intermediate in the conversion of tyrosine to NE).
b. By irreversibly inhibiting the enzymes MAO-A and –B, MAOIs ↑ the number of neurotransmitters available in synapses. |
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88. MAO-A vs. MAO-B?
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a. Preferentially deactivates serotonin, and MAO-B preferentially deactivates NE/EPI.
b. Both types also act on dopamine and tyramine. |
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89. Use of MAOIs?
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a. MAOIs are not used as first-line agents bc of the ↑ safety and tolerance of newer agents.
b. However, MAOIs are considered very effective for certain types of refractory depression and in refractory panic/anxiety disorder. |
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90. 3 MAOI drugs?
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1. Phenelzine (Nardil)
2. Tranylcypromine (Parnate) 3. Isocarboxazid (Marplan). |
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91. SE of MAOIs?
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a. Serotonin syndrome: Serotonin syndrome occurs when SSRIs and MAOIs are taken together or if other drugs cause ↑ serotonin levels.
b. Hypertensive crisis c. Orthostatic hypotension (most common) d. Drowsiness e. Wt. gain f. Sexual dysfunction g. Dry mouth h. Sleep dysfunction i. Rarely, there is liver toxicity, seizures, and oedema |
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92. Titration rule for MAOIs?
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a. Start low and go slow (low doses that are ↑’d slowly).
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93. With what vitamin deficiency can MAOIs cause paresthesias?
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a. Pyridoxine deficiency.
b. Tx w/B6. |
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94. Presentation of Serotonin syndrome?
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a. Initially characterized by lethargy, restlessness, confusion, flushing, diaphoresis, tremor, and myoclonic jerks.
b. May progress to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, and death |
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95. How to avoid Serotonin syndrome?
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a. Wait at least 2 wks before switching from SSRI to MAOI, and at least 5-6 wks w/fluoxetine.
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96. Presentation of Hypertensive crisis?
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a. In addition to markedly elevated BP, it is also characterized by:
1. HA 2. Sweating 3. N/V 4. Photophobia 5. Autonomic instability 6. Chest pain 7. Arrhythmias 8. Death |
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97. For what type of depression are MAOIs considered more effective?
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a. Atypical depression characterized by:
1. Hypersomnia 2. ↑ appetite 3. ↑sensitivity to interpersonal rejection. |
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98. Selegiline (EMSAM patch)?
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a. An MAOI used to treat depression that does not require following the dietary restrictions when used in low dosages.
b. However, decongestants, opiates (Demerol), and serotonergic drugs must still be avoided. |
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99. Tx of Serotonin syndrome?
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a. Discontinue med.
b. Can also try calcium channel blockers (oral nifedipine). c. If carefully monitored, you can try chlorpromazine or phentolamine. |
