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25 Cards in this Set

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  • Back
What are some drugs that may cause depressive symptoms?
• Alcohol
• Amantadine
• Beta blockers
• Clonidine
• Hydralazine
• Levodopa
• Opiates
• Steroids
What is the MOA of tricyclic agents?
• inhibition of presynaptic reuptake mechanisms of norepi and 5-HT
• causes changes in receptor sensitivity
What are the 3 general categories of TCA?
• Primary amines
• Secondary amines
• Tertiary amines
List the names and dosages of primary amines
• Amoxapine (Ascendin): 50-600 mg/d
• Maprotiline (Ludiomil): 50-225 mg/d
List names and dosages for secondary amines
• Desipramine (Norpramin): 25-300 mg/d
• Nortriptylline (Pamelor): 25-200 mg/d
• Protriptyline (Vivactil): 15-60 mg/d
List names and dosages of tertiary amines
• Amitriptylline (Elavil): 25-300 mg/d
• Imipramine (Tofranil): 25-300 mg/d
• Doxepin (Sinequan): 25-300 mg/d
Which class of TCAs are the most activating?
• 2nd generation (secondary amines)
• Protriptylline (Vivactil) is the most activating
Which TCA is the most sedating?
Doxepin (Sinequan)
Which TCA has the most cardiac effects?
• Amiyriptylline (Elavil)
• has more effects on norepinephrine than serotonin
Which TCAs can be used to treat bedwetting?
• Desipramine (Norpramin)
• Imipramine (Tofranil)
What are adverse effects of TCAs?
• Agranulocytosis
• Anticholinergic effects
• Cardiac side effects (CHF, heart block, prolong QT, hypotension, tachycardia)
• CNS stimulation (esp. 2nd amines like Protriptyline)
• Drowsiness and sedation
• Hepatic obstructive jaundice
• Seizures (highest w/ Maprotiline, Amoxapine, Clomipramine)
• Toxic psychosis
• Weight gain
What is the MOA of Monamine Oxidase Inhibitors (MAOI)?
• block the action of an enzyme, monoamine oxidase, which breaks down and removes the monoamines (Serotonin, norepinephrine, and dopamine)

• causes a buildup of these neurotransmitters
There are type A & type B MAOIs. List the 2 type A drugs that are available and their dosages
• Phenelzine (Nardil): 15 mg/d (start); 45 mg/d in divided doses
• Tranylcypromine (Parnate): 10 mg BID; maintenance as low as 10 mg/d
Name a type B MAOI
Selegiline
What are characteristics of Selegiline?
• increases dopamine more
• used in pregnancy
• increasing the dosage of Selegiline reduces selectivity for type B; become more of a type A/B drug
What are adverse effects of MAOIs?
• Hypertensive crisis (#1 side effect): caused by tyramine containing foods and drugs (TCA, SSRI, cocaine, Sudafed)

• anticholinergic (not as much as TCAs)
• postural hypotension
• sedation (with Phenelizine)
• stimulation (with Tranylcypromine)
• sexual dysfunction
How do you start a patient on an MAOI that was on another agent OR start a new agent with a patient on an MAOI?
• need two week wash-out
• can not take anti-depressants for two weeks to avoid drug interactions
What is the MOA of SSRIs?
increases serotonin in the pre-synaptic cleft
What are adverse effects of SSRIs?
• anxiety
• insomnia
• nausea/vomiting
• sexual dysfunction
• sweating
• weight loss/anorexia
What are characteristics of Trazadone (Desyrel)?
• MOA: less potent SSRI; 5HT-2 antagonist
• short half-life (6-10 hrs)
• active metabolite
• ADE: priapism, drowsiness, orthostasis
• Dose: 50-600 mg/d
• can not give higher than 200 mg/d for nursing home patients using it for sleep
What is the MOA, half-life, dosing, and ADE of Buproprion (Wellbutrin)?
• MOA: weak inhibitor of dopamine reuptake and other neurotransmitters
• Half-life: 8-24 hrs
• Dosing: 100 mg PO BID (do not exceed 450 mg/d due to seizure risk)
• ADE: seizures, not for eating disorders (no important drug interactions)
What is the MOA, half-life, dosing, and ADE of Venlafaxine (Effexor)?
• MOA: affects Serotonin, NE, and weak effects on Dopamine
• Half-life: 3-5 hrs
• Starting dose: 75 mg/d
• ADE: similar to SSRIs, high incidence of HTN, EKG changes, weight loss
What is the MOA, dosing, ADE of Mirtazapine (Remeron)?
• MOA: presynaptic alpha-2 agonist, serotonin 2 and 3 receptor antagonist
• Dosing: 15-45 mg/day at bedtime
• ADE: dry mouth, increase LFTs, sedation, weight gain
Generally, what drugs can be used for treatment of OCD?
• SSRIs
• TCA (Clomipramine/Enafranil)
List the drugs and dosings for OCD treatment
• Clomipramine (Enafranil) 50-250 mg QD
• Fluoxetine (Prozax) 60-80 mg QD
• Fluovaxamine (Luvox) 100-300 mg QD
• Paroxetine (Paxil) 40-60 mg QD
• Sertraline (Zoloft) 100-200 mg QD