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43 Cards in this Set
- Front
- Back
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TCAs are first generation anti-depressants. What is their MOA?
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block the reuptake of NE and 5HT
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What are some indications for TCAs?
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Migrain prophylaxis, neuropathic pain, nocturnal enuersis
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What other receptors systems are affected by TCAs?
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Muscuranic, Alpha 1 and Histamin 1
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What are some 3rd Amine TCAs?
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Imipramine- tofranil
Amitriptyline-evail |
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What are some 2nd Amines ?
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Desipramine- Norpramin
Nortriptyline- Pamelor |
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What is the Half Life of TCAS?
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10-90 hours, you should usually give i QHS.
It is highly protein bound It is lipid soluble because it needs to cross teh BBB |
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What are some ADR of TCAs?
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Anti-cholinergic- blurry vision, dry mouth, dry eyes, inc risk of falls
HISTAMINE BLOCKADE- sedation and weight gain ALPHA 1 BLOCKADE- sexual dysfunction and Orthostatic hypotension Seizure risk with TCAs inc because it has a receptor that bind are PTZ binds and that lowers seziure threshold ** WITHDRAWAL SYNDROME- GI, insomina, dizziness, restlessness. |
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If you combino TCAs with MAOs, what can happen?
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severe CNS toxicity if you give these two together
you must d/c one for 2-3 weeks first |
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MAOs have a special DDI with these type of food groups causing HTN, what is it ?
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Tyramine containing foods
Beer, wine, ale Cheese Chicken &beef Dried pickle fish Dired meats MSD Olives Banana peel extract |
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What is the MOA of MAO - Monoamine oxidase inhibitors ?
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rreversible nonselective inhibition of MAO-A: metabolizes norepinephrine & serotonin & MAO-B: metabolizes dopamine
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What is the usual indication for usage of MAO-inhibitors ?
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Atypical depression
refractory depression ( that is not responding to standard treatment) |
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What class of drug is trazadone(Desyrel)?
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Heterocyclic
MOA== SRI- blocks 5HT and Alpha 1 NO CHOLINERGIC, HISTAMINE ADR |
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What are the ADR of Trazadone?
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sedation (alpha 1 ) dizziness( alpha 1) oh(alpha 1) nausea ( 5ht) and
PRIAPSIM!!!!!!!! ****Trazadone is use to counteract the insmoniac effects of SSRI and is often used in the elderly. |
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What are the advantages of using Bupropion ( wellbutryin)
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used for smoking cessation
it inhibits NE and dopamine NO SEXUAL SIDE EFFECTS- might help sexual dysfunction |
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What are some issues with Bupropion
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CNS stimulation, SEIZURE risk ( it is dose dependent)
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What are some indications for SSRIs?
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MDD
GAD OCD PANIC D/O PTSD PMDD SAD |
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What is the usual onset of time for SSRI to be effective?
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4-6 weeks
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What are the NON-FDA indications for SSRIs
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FIBROMYALGIA
MIGRAINES MUTISM ADHD |
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Which of the drugs has the longest 1/2 life?
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Prozac ( fluloxiteint )
30-90 hours give it during the AM bc of insmonia side effects and inc nervousness |
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What is a drug that can be given for Bulemia?
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Fluoxetine ( prozac)
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What a is a gooc SSRI for the elderly with PMDD?
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Zoloft ( Sertaline)
Zoloft also used for panic d.om SAD,PTSD, PMDD |
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What are other FDA indications of SSRIs?
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Fluoxetine(Prozac, Sarafem)(B)- depression, bulimia, OCD, PMDD, panic disorder
Sertraline(Zoloft)(C)- depression, OCD, panic disorder, SAD(seasonal affective d/o), PTSD, PMDD- least SE, good in elderly Fluvoxamine(Luvox)- for OCD only Paroxetine(Paxil)(C)- panic disorder, OCD, GAD, PTSD, SAD, PMDD Citalopram(Celexa)(C)- depression only Escitalopram (Lexapro)(C)- depression, GAD |
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What are the ADRs of SSRIs in general?
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Sexual dysfunction
weakness arthralgia potential to overdose insmonia-- trazadone helps counteract this H/A anxiety |
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How do you manage SSRI induced sexual dysfunction?
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BUPROPION OR NEFAZODONE 2 hours prior to sexual activity
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What is the criteria for Serotonin Syndrome
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3 or more of the following
1- agitation 2- diapohresis 3- diarrhea 4- fever 5- hyper/hypotension 6- incoordination 7- mental status change 8- myoclonus 9- shivering 10-tremor |
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What combined with SSRIs can cause Serotonin Syndrome?
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ALLL anti-depressants
St Johns Wort buspirone meperidine tramadol methadone propoxyphene triptans DM cyclobenzaprine |
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What are some sx of SSRI withdrawal syndrome?
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GI headaches dizziness , flu-like sx anxiety insomnia
It happens m/c with short half life drugs paxil---> zoloft--> prozac |
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What is NEFAZADONE(serzone)?
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It is similar to trazadone , less sedating d/c it does not block alpha 1 receptors
There is no weight gain or sexual dysfunction usually used as adjunct to tx sexual dysfunction S.E adjunct to SSRI usage |
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How are Dual Reuptake inhibitors different from SSRI?
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Broader MOA than SSRIs -- they affect NE and 5-HT.
NE- causing the HTN |
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What are some Dual reuptake inhibitors?
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Venlafaxine- Effexor
Duloxtetine- Cymbalta Pristiq- indications include vasomotor sx for menopausal women Savella- milnacipran- FDA approved for fibromyalgia |
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What are other tx options for depression?
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Psychotherapy
Cognitive behavioral therapy Group therapy Can combine with pharmacotherapy Phototherapy major depression with seasonal variation ECT Controversial Mostly used for refractory or delusional depression EX: TIW for 6 or 8 session Herbal therapies St. John’s wort (hypericin) Anxiolytics |
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What is the First line for GAD?
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SSRIS followed by BDZ then Buspirone
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What is the onset age of ADHD and prevalence ?
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age is uaully 3-7 years old and 3-5% of kids are affects
Females are less liekly impulsive and have problems more with inattention and less hyperactivity |
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What is the pathophysiology behind ADHD?
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1- Smaller volume of certain areas like prefrontal cortex, basal ganglia, caudate nucleus
2- Defect of dopamine4 receptor gene this in turn effects NE and EPI receptors 3- response inhibition - deficits in prefrontal cortex |
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What are the goals of pharmocolgical tx in ADHD?
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modify DA and NE activity in the CNS to inc higher brain fxning and to improve performance works
It works by enhancing DA and NE from presynaptic neurone |
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What are the CONTRAINDICATIONS for ADHD drugs ?
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CVD
Glaucoma Hyperthyroidism Epilepsy H/O of substance abuse |
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What are ADRs of ADHD drugs ?
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Growth suppresion
appetite suppresion weight loss H/A HTN |
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Mixed amphetamine salts
Methylphenidate IR Dexmethylphenidate IR Dextroamphetamine Lisdexamfetamine |
Adderall
Ritalin Focalin Dexedrine Vyvanse --- dec abuse potential. it is a prodrug of dextroamphetamine it is inactive until the GI enzymes cleave |
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Dry mouth
constipation blurry vision difficulty initiating urination S.E of ______ receptor |
Muscurinic blockade
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orthostatic hypotension
sexual dysfunction sedation |
Alpha1 adrenergic blockade
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Histaminic Blockade causes what S.E?
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Weight gain and sedation
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Side Effects related to Norepinephrine activation ?
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tachycardia
insomnia tremor diaphoresis inc anxiety |
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Side Effects of Serotonin?
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insmonia
sexual dysfunction gastrointestional disturbances restlessness (akathsia) H/A appetite loss |
