Pharmacology - Antidepressants

Front 1

When choosing an antidepressant, the clinician should consider (5):

Back 1

Anticipated adverse effects
Comoribid psych or medical problems
History of prior response
Patient preference
Cost

Front 2

Tricyclic antidepressants (TCAs)
MOA:
A/E:
OD:

Back 2

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

Front 3

List the TCAs.
What is the usual theraputic dose?

Back 3

Elavil, tofranil, anafranil, sinequan, pamelor, norpramin, surmontil, vivacil, asedin, ludiomil.
Dose is about 50-300mg/day

Front 4

Desyrel
MOA:
A/E:
OD:

Back 4

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

Front 5

List the Monoamine oxidase inhibitors:

Back 5

Nardil, parnate, emsam.

Front 6

MAOIs
MOA:
A/E:

Back 6

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

Front 7

What foods should one avoid on MAOIs?

Back 7

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.

Front 8

Selective serotonin reuptake inhibitors (SSRIs)
MOA:
A/E:

Back 8

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.

Front 9

What is serotonin syndrome and how does it present?
What classes of drugs can cause it?

Back 9

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.

Front 10

List the SSRIs

Back 10

Celexa, lexapro, prozac, luvox, paxil, zoloft.

Front 11

Wellbutrin
MOA:
A/E:
OD:
Contraindications?

Back 11

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

Front 12

Effexor:
MOA:
A/E:
OD:

Back 12

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

Front 13

Cymbalta:
MOA:
A/E:
This is often prescribed for:

Back 13

MOA: Inhibits reuptakeof serotonin and NE, like TCAs and Effexor
A/E: Nausea, drymouth, constipation, sweating, tachycardia
Often given for peripheral neuropathic pain

Front 14

Serzone:
MOA:
A/E:
OD:
Black box!

Back 14

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

Front 15

Remeron
MOA:
A/E:
OD:

Back 15

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

Front 16

SSRIs may increased what drug levels if given together?

Back 16

Tricyclic antidepressats

Front 17

What drugs may decrease levels of antidepressants due to their induction of CYP450?

Back 17

Carbamazepine, phenobarbital, phenytoin, rifampin.

Front 18

If pt has suicide risk, give which class?

Back 18

SSRI

Front 19

If pt has Depression with anxiety disorder give...

Back 19

SSRIs, effexor, TCAs, MAOIs

Front 20

If pt has chronic pain give...

Back 20

Elavil (TCA), Cymbalta

Front 21

If pt has wt gain give...and avoid...

Back 21

SSRIs, wellbutrin. Avoid TCAs, pirtazapine, MAOIs

Front 22

If pt has sexual dysfunction give...

Back 22

Wellbutrin

Front 23

What is the first line treatment of depression in the elderly?
What class should be avoided?

Back 23

SSRIs
TCAs are avoided secondary to anticholinergic effects

Front 24

What is the only drug approved for treatment of pediatric depression?

Back 24

prozac

Front 25

What is the best drug to give during lactation?

Back 25

zoloft