N: Antidepressants

Front 1

Amitryptyline
- class
- mech
- indication
- contraindications
- SE
- interactions?
- how long till therapeutic effect appears?

Back 1

- trycyclic antiD
- block reuptake of NE and 5HT @ nerve endings; Na channel blocker; antimuscarinic; antihistamine; a-receptor blocker
- relief of depression. Endogenous depression is more likely to be alleviated than are the other depressive states.
- MAOI use w/i 15 day; Recent MI; hyperS
- prolonged QRS @ toxic doses / fatal cardiac arrhythmias; other SEs corresponding to other mechs.
- decongestants & local anesthetics w/ sympahtomimetics; antiHTN drugs, anything inhib P450-2d6 may require lowered dose of tricyclic antiD
- weeks, as with the other trycyclics

Front 2

Concomitant use of MAOI and tricyclic amines can cause what?

What can toxicity of tricylic amines cause?

Back 2

potentially fatal hyperpyretic (high fever) crisis & seizures.... this is termed "sterotonergic syndrome"

fatal toxicity via disturbances of QRS and arrhythmias.

Front 3

Imipramine
- class
- mech
- indication
- contraindications
- SE
- concurrent use with MAOI can cause...
- toxicity of just imipramine?

Back 3

- tricyclic amine
- blocks reuptake of NE and serotonin, etc... just like amitryptyline.
- depression, chronic pain, nocturnal enuresis (bedwetting)
- MAOI use w/i 15 days; recent MI, drug hyperS
- things with sympathomimetics, inhib of P450 2d6 will require larger dose
- serotonergic syndrome.
- conduction abnormalities/arrhythmias

Front 4

Fluoxetine
- trade name
- class
- mech
- indication
- contraindications
+ can EtOH cause problems?
- how long does active drug persist after dosing is stopped?
- SE

Back 4

- prozac
- antiD
- selective serotonin reuptake inhib
- depression, OCD, bulimia nervosa, panic disorder
- MAOI w/i 15 days, drugs also metabolized by P450-2d6; caution w/ liver dz or impaired renal fx
+ it can interfere with therapeutic effects
- chillis, hemorrhage, ^appetite, N&V, WG, agitation, amnesia, confusion, sleep disorder
- a good long while. The active metabolite is norfluoxetine is around w/ an 8d halflife... so it'll persist for weeks post-stop. CONSIDER THIS IF SWITCHING TO MAOI

Front 5

Citalopram
- class
- mech
- indication
- contraindications
- SE

Back 5

- antiD
- SSRI
- depression
- MAOI w/i 15 days, EtOH can interfere w/therapy
- tachycardia, postural hypotension, migraine, increased salivation, flatulance, weight change, impaired concentration, decreased libido, *delayed orgasms!*
- MAOI, P450 CYP 3a4 and 2c10.

Front 6

Sertraline
- trade name
- class
- anything special about it wrt the rest of it's class?

Back 6

Zoloft
- SSRI
- nope.

Front 7

Of the trycyclic amines, which are better at inhibiting 5HT reuptake - tertiary amines or secondary amines?

Back 7

tertiary amines like amytriptilene and Imipramine.

Secondaries are better at inhib NE reuptake. (Norpramine, Pamelor)

Front 8

Name some SSRI's.
- what is the mechanism of these medications?
- common side effects?
- what is their primary difference from tricyclic amines?

Back 8

Sertraline, Citalopram, Fluoxetine, Paroxetine
- selectively inhibit reuptake of 5HT
- anorgasma, impotence, N&V, agitation, anxiety, sleep disturbance, tremor,
and headache.
- little affinity for muscarinic receptors (and histamine receptors, it seems)

Front 9

Bupropion
- trade name
- mech
- indications
- contraindications
- SE
- notes on withdrawal?

Back 9

- wellbutrin
- weak reuptake inhib of serotonin, NE, and DA
- MAOI w/i 14 days, pts w/ seizue dz
- dry mouth, insomnia, agitation
- avoid abrupt withD; serotonin syndrome can develop w/ concurrent use with MAOI

Front 10

What is the primary MAOI antidepressant still used clinically?
- mech?
- indications
- contraindications?
- SE?
- how fast of an onset?
- drugs to avoid coadmin? foods?

Back 10

Phenelzine (Nardil)
- prevents MAO from met biogenic amines... since this is all over the body, diverse effects / SE are pretty common.
- depression characterized as atypical.
- other sympathomimetic drugs because HTN crisis may result; CHF, liv dz (abnormal LFTs), pheochromocytoma (tumor that ^NE and E)
- dizziness, headache, dry mouth, insomnia, constipation, blurred vision, nausea, peripheral edema, forgetfulness, fainting spells, hesitancy of urination, myoclonic jerks, elevation of liver enzymes.
- serotoninergic agents may induce serotonin syndrome; tyramine-rich foods should be avoided.

Front 11

Venlafaxine
- trade name?
- mech
- indications
- contra
- SE
- major drug interactions?
- may cause what at unusually high doses?
- Bonus: what other drug of this class is thought to avoid this high dose effect?

Back 11

- effexor
- multiple: potent 5HT and NE reuptake inhibitor, weak DA uptake inhib.
- depression, or genearllyed anxiety dz.
- impaired hepatic/renal fx, people w/ hx of mania, alcohol, lactation.
- NO anticholinergic, sedative, or orthostatic hypotensive effects; anxiety, nervousness, insomnia, mania, hypomania, seizures, suicide, dizziness, somnolence, tremors, abnormal dreams
- MAOIs... can cause serotonin syndrome
- idiopathic HTN
- duloxitine (Cymbalta)

Front 12

What is a MAOI that is only used for major depression without melancholia, and is definitely not a 1st line drug?
- should this drug ever be given to those with a cerebrovascular defect?
- should pts eat chess on this drug?

Back 12

Tranylcypromine
- no
- no, they are high in tyramine.

Front 13

Lithium
- class
- mech
- indications
- contraindications
- SE
- what is interesting to note re: distribution of this drug in the body?
- what are three classes of commonly used drugs w/ known interactions w/ lithium?
- does lithium have a wide therapeutic index?

Back 13

- anti-manic, mood stabilizer
- alters Na transport in nerve and muscle cells and inhibits the recycling of neuronal membrane phosphoinositides involved in generation of 2nd messengers
- treat manic stage of bipolar dz
- pts with renal or CV dz; severe debilitation or dehydration, sodium depleted pt (this raises risk of toxicity)
- distribution approximates that of total body water.
- diuretic (via reducing renal clearance of Li), NSAID, ACE inhib.
- no, very narrow.