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25 Cards in this Set

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When choosing an antidepressant, the clinician should consider (5):
Anticipated adverse effects
Comoribid psych or medical problems
History of prior response
Patient preference
Cost
Tricyclic antidepressants (TCAs)
MOA:
A/E:
OD:
MOA: Block reuptake pumps of serotonin and NE
A/E: TCAs bind at other sites which cause many A/E: orthostatic htn, anticholinergic effects, sedation and wt gain. ECG changes
OD can be fatal
List the TCAs.
What is the usual theraputic dose?
Elavil, tofranil, anafranil, sinequan, pamelor, norpramin, surmontil, vivacil, asedin, ludiomil.
Dose is about 50-300mg/day
Desyrel
MOA:
A/E:
OD:
MOA: Desyrel is a weak serotonin reuptake inhibitor and 5HT2 antagonist.
A/E: Sedation, orthosatatic HTN, priapism, GI. No anticholinergic or cardiac a/e.
OD: Safe
List the Monoamine oxidase inhibitors:
Nardil, parnate, emsam.
MAOIs
MOA:
A/E:
MOA: Inhibition of enzyme monoamine oxidase which prevents inactivation of NE, serotonin, and dopamine.
A/E: Tyramine restricted diet reqrd. Sedation insomnia, wt gain, BP changes --> hypertensive crisis. Many Rx interactions
What foods should one avoid on MAOIs?
Avocados, aged cheese, dried meats, soybean products, red wine, tap beers, sauerkraut, raw yest, broad beans, pickled herring, chicken livers.
Limit coffee, tea, chocolate, figs, meat tenderizer, raisins.
Selective serotonin reuptake inhibitors (SSRIs)
MOA:
A/E:
MOA: SSRIs block serotonin reuptake pump.
A/E: Lack side effects of TCAs but may cause GI, headache, sexual dysfxn, insomia/somnolence, discontinuation syndrome, serotonin syndrome.
What is serotonin syndrome and how does it present?
What classes of drugs can cause it?
Results from overactivation of central serotonin receptors, can occurr when MAOIs and SSRIs are used.
Presents with abd px, diarrhea, sweating, fever, tachycardia, delerium, myoclonus, irratability.
List the SSRIs
Celexa, lexapro, prozac, luvox, paxil, zoloft.
Wellbutrin
MOA:
A/E:
OD:
Contraindications?
MOA: Wellbutrin acts as a NE and dopamine reuptake blockade.
A/E: Increased incidence of seizures, nausea, insomnia, agitation, tremor. Contraindicated in pts with eating disorders
OD: Not as saf4e as Desyrel or SSRIs
Effexor:
MOA:
A/E:
OD:
MOA: Inhibits reuptake of serotonine and NE, like TCAs
A/E: Nausea, headache, insomnia, HTN, nervousness, sexual dysfunction
Not as safe as SSRIs in OD
Cymbalta:
MOA:
A/E:
This is often prescribed for:
MOA: Inhibits reuptakeof serotonin and NE, like TCAs and Effexor
A/E: Nausea, drymouth, constipation, sweating, tachycardia
Often given for peripheral neuropathic pain
Serzone:
MOA:
A/E:
OD:
Black box!
MOA: Antagonist of 5HT2 receptor and also blocks reuptake of serotonin.
Fewer A/E: antihistamine activity of deseryl is removed so less somnolence, dry mouth, nausea, dizziness
OD: Safe
BB! Hepatic failure reported, do not give to pts with liver dysfunction
Remeron
MOA:
A/E:
OD:
MOA: Alpha 2 adrenergic auto and heteroreceptor antagonist, 5HT2 and 5HT3 postsynaptic receptor antagonist
A/E: A/E of SSRIs and TCAs have been minimized. Sedation, weight gain and increased apetite are likely.
OD: Safer than TCAs
SSRIs may increased what drug levels if given together?
Tricyclic antidepressats
What drugs may decrease levels of antidepressants due to their induction of CYP450?
Carbamazepine, phenobarbital, phenytoin, rifampin.
If pt has suicide risk, give which class?
SSRI
If pt has Depression with anxiety disorder give...
SSRIs, effexor, TCAs, MAOIs
If pt has chronic pain give...
Elavil (TCA), Cymbalta
If pt has wt gain give...and avoid...
SSRIs, wellbutrin. Avoid TCAs, pirtazapine, MAOIs
If pt has sexual dysfunction give...
Wellbutrin
What is the first line treatment of depression in the elderly?
What class should be avoided?
SSRIs
TCAs are avoided secondary to anticholinergic effects
What is the only drug approved for treatment of pediatric depression?
prozac
What is the best drug to give during lactation?
zoloft