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23 Cards in this Set
- Front
- Back
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Name the 6 SSRI's
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Sertraline
Fluoxetine Fluvoxamine Paroxetine Escitalopram Citalopram |
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Name the 2 SNRI's
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Duloxetine
Venlafaxine |
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Name the TCA's
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Amitriptyline
Clomipramine Doxepin Imipramine Despiramine Nortriptyline |
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Name the MAOI's.
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Selegiline
Phenelzine Tranylcypromine |
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Name the only Tetracyclic Anti-depressant
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Mirtazapine
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Name the 3 other miscellaneous anti-depressants.
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Bupropion
Trazadone Nefazadone |
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Efficacy among different drug classes is fairly similar. Why then, are SSRI's typically chosen as first line therapy?
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Safety in overdose and tolerability
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Why has the use of Trazadone and Nefazadone declined?
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Trazadone causes increased dizziness and sedation and Nefazadone has a black box warning for causing hepatic failure. They are however, effective agents.
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What are the major adverse effects of TCA's?
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Anti-cholinegic side effects (dry mouth, constipation, urinary retention, tachycardia, blurred vision)
Also effects heart conduction and overdose can cause arrhythmia. ***It is important to taper the dose when withdrawing TCA's to avoid cholinergic rebound*** |
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Describe the side effect profile of SSRI's
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Most common side effects include GI upset, headache, sexual dysfunction and insomnia. Paroxetine has anti-cholinergic side effects and causes more sedation. It is also contraindicated in pregnancy.
Fluoxetine causes the greatest degree of insomnia. ***It is important to taper these agents to avoid withdrawal symptoms - longer half-life drugs cause less withdrawal*** |
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What is the only anti-depressant approved in patients under 18 years old?
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Fluoxetine
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What is the particular concern with Bupropion?
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Seizures - You need to start at a low dose and titrate up.
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How would you counsel someone taking an SSRI?
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It take 4-6 weeks to see therapeutic effects
May need to increase dose to get full benefit Side effects (NVD, GI upset, Sexual Dysfunction) - May go away within 1-2 weeks - May need to switch agents May cause drowsiness or agitation (If drowsiness - take before bed, agitation - take in the morning) |
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Mirtazapine is dosed in the PM - Give this drug if the patient wants a sedating effect (Also increases appetite)
You could also give Paroxetine, but Mirtazapine is more sedating |
Fluoxetine is dosed in the AM
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What would you give in a patient who has concomitant DM Neuropathy
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Duloxetine
TCA's are very sedating at therapeutic doses. No optimal. Usually low dosed for insomnia and neuropathic pain. |
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What would you avoid in a patient with uncontrolled hypertension?
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Venlafaxine
Desvenlafaxine |
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What do you want to give a patient who is a current smoker?
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Bupropion - This also causes the least amount of sexual side effects. Give this in younger patients who are sexually active. You want to avoid patient discontinuation.
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What do you want to give a patient who is also anxious?
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An SSRI or an SNRI
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How long are the acute, continuation and maintenance phases?
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Acute is 4-6 weeks
Continuation is 4-9 months Maintenance is 12-36 months |
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If a patient fails a drug within a drug class...
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You want to try at least another drug in that class before considering it a failure.
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It is rare to see therapeutic doses of TCA's prescribed. What is a situation you may see one prescribed at that dose today?
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If the patient is refractory and has responded to a particular agent in the past.
History of Response and familial history of response become important in refractory cases. |
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Do not write "taper" on an exam. How do you want to taper a medication off?
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Go slowly
Half it for a couple weeks Then half it again for a couple weeks Monitor for signs and symptoms of relapse. |
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Initial Doses:
Fluoxetine Paroxetine Sertraline Duloxetine Bupropion Mirtazapine |
20
20 50 30 150 15 |
