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43 Cards in this Set

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TCAs are first generation anti-depressants. What is their MOA?
block the reuptake of NE and 5HT
What are some indications for TCAs?
Migrain prophylaxis, neuropathic pain, nocturnal enuersis
What other receptors systems are affected by TCAs?
Muscuranic, Alpha 1 and Histamin 1
What are some 3rd Amine TCAs?
Imipramine- tofranil
Amitriptyline-evail
What are some 2nd Amines ?
Desipramine- Norpramin
Nortriptyline- Pamelor
What is the Half Life of TCAS?
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
What are some ADR of TCAs?
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.
If you combino TCAs with MAOs, what can happen?
severe CNS toxicity if you give these two together
you must d/c one for 2-3 weeks first
MAOs have a special DDI with these type of food groups causing HTN, what is it ?
Tyramine containing foods
Beer, wine, ale
Cheese
Chicken &beef
Dried pickle fish
Dired meats
MSD
Olives
Banana peel extract
What is the MOA of MAO - Monoamine oxidase inhibitors ?
rreversible nonselective inhibition of MAO-A: metabolizes norepinephrine & serotonin & MAO-B: metabolizes dopamine
What is the usual indication for usage of MAO-inhibitors ?
Atypical depression
refractory depression ( that is not responding to standard treatment)
What class of drug is trazadone(Desyrel)?
Heterocyclic
MOA== SRI- blocks 5HT and Alpha 1
NO CHOLINERGIC, HISTAMINE ADR
What are the ADR of Trazadone?
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.
What are the advantages of using Bupropion ( wellbutryin)
used for smoking cessation
it inhibits NE and dopamine
NO SEXUAL SIDE EFFECTS- might help sexual dysfunction
What are some issues with Bupropion
CNS stimulation, SEIZURE risk ( it is dose dependent)
What are some indications for SSRIs?
MDD
GAD
OCD
PANIC D/O
PTSD
PMDD
SAD
What is the usual onset of time for SSRI to be effective?
4-6 weeks
What are the NON-FDA indications for SSRIs
FIBROMYALGIA
MIGRAINES
MUTISM
ADHD
Which of the drugs has the longest 1/2 life?
Prozac ( fluloxiteint )
30-90 hours
give it during the AM bc of insmonia side effects and inc nervousness
What is a drug that can be given for Bulemia?
Fluoxetine ( prozac)
What a is a gooc SSRI for the elderly with PMDD?
Zoloft ( Sertaline)
Zoloft also used for panic d.om SAD,PTSD, PMDD
What are other FDA indications of SSRIs?
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
What are the ADRs of SSRIs in general?
Sexual dysfunction
weakness
arthralgia
potential to overdose
insmonia-- trazadone helps counteract this
H/A
anxiety
How do you manage SSRI induced sexual dysfunction?
BUPROPION OR NEFAZODONE 2 hours prior to sexual activity
What is the criteria for Serotonin Syndrome
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
What combined with SSRIs can cause Serotonin Syndrome?
ALLL anti-depressants
St Johns Wort
buspirone
meperidine
tramadol
methadone
propoxyphene
triptans
DM
cyclobenzaprine
What are some sx of SSRI withdrawal syndrome?
GI headaches dizziness , flu-like sx anxiety insomnia


It happens m/c with short half life drugs
paxil---> zoloft--> prozac
What is NEFAZADONE(serzone)?
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
How are Dual Reuptake inhibitors different from SSRI?
Broader MOA than SSRIs -- they affect NE and 5-HT.

NE- causing the HTN
What are some Dual reuptake inhibitors?
Venlafaxine- Effexor
Duloxtetine- Cymbalta
Pristiq- indications include vasomotor sx for menopausal women
Savella- milnacipran- FDA approved for fibromyalgia
What are other tx options for depression?
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
What is the First line for GAD?
SSRIS followed by BDZ then Buspirone
What is the onset age of ADHD and prevalence ?
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
What is the pathophysiology behind ADHD?
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
What are the goals of pharmocolgical tx in ADHD?
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
What are the CONTRAINDICATIONS for ADHD drugs ?
CVD
Glaucoma
Hyperthyroidism
Epilepsy
H/O of substance abuse
What are ADRs of ADHD drugs ?
Growth suppresion
appetite suppresion
weight loss
H/A
HTN
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
Dry mouth
constipation
blurry vision
difficulty initiating urination
S.E of ______ receptor
Muscurinic blockade
orthostatic hypotension
sexual dysfunction
sedation
Alpha1 adrenergic blockade
Histaminic Blockade causes what S.E?
Weight gain and sedation
Side Effects related to Norepinephrine activation ?
tachycardia
insomnia
tremor
diaphoresis
inc anxiety
Side Effects of Serotonin?
insmonia
sexual dysfunction
gastrointestional disturbances
restlessness (akathsia)
H/A
appetite loss