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47 Cards in this Set

  • Front
  • Back
Cause and symptoms of serotonin syndrome
Caused by combination of SSRI and MAOIs

Early: Lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks

Late: hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death
Cause of a hypertensive crisis
MAOIs taken with tyramine-rich foods (Chianti, cheese, chicken liver, fava beans, cured meats) or sympathomimetics; buildup of catecholamines
Venlafaxine
-Trade name
-MOA
-Use
-SE
Effexor
Serotonin/norepi reuptake inhibitor
Refractory depression
Same as SSRIs, increase BP (don't use in untreated BP problems), withdrawl with missed doses (zaps, flu sx)
Names of TCAs and specific indications/S
Imipramine - Tofranil
Amitriptyline - Elavil
Trimipramine - Surmontil
Nortriptyline - Pamelor (least orthostatic hypotension)
Desipramine - Norpramin (least sedating, least anticholinergic SE)
Clomipramine - Anafranil (most 5-HT specific, use in OCD)
Doxepin - Sinequan
Side effects of TCAs
Anti-HAM:
Anti-histamine (sedation)
Anti-adrenergic (orthostatic hypotension, tachy, arrhythmias, QRS>100ms)
Anit-muscarinic
Weight gain, lethal overdose
Names of MAOIs (3)
Phenelzine - Nardil
Tranylcypromine - Parnate
Isocarboxazid - Marplan
MAOI mechanism of action
Prevent inactivation of norepi, 5-HA, dopamine, tyramine (A=5-HT, B=norepi/epi)
Bupropion
-Trade name
-MOA
-Use
-SE
-CI
Wellbutrin
Norepi/dopamine reuptake inhibitor
Smoking cessation, seasonal affective disorder, adult ADHD
SE similar to SSRI (less sexual SE), exacerbate psychosis and seizures

Not for psychosis, anxiety, seizure disorder, eatin disorders, not with MAOIs
Indications of MAOIs
Refractory depression
Side effects of MAOIs
Orthostatic hypotension, drowsiness, weight gain, sexual dysfunction, dry mouth, sleep dysfunction
Serotonin syndrome w/ SSRI, hypertensive crisis w/ tyramine
SSRI Names and specific indications/SE
Fluoxetine - Prozac (longest half life, no need to taper)
Sertraline - Zoloft (GI disturb)
Paroxetine - Paxil (most 5-HT specific, most activating)
Fluvoxamine - Luvox (only for OCD)
Citalopram - Celexa
Escitalopram - Lexapro (fewer SE)
SSRI Mechanism of action
Inhibit presynaptic 5-HT pumps
SSRI indications
Most common antidepressants, OCD, anxiety, premenstrual dysphoric disorder
Side effects of SSRIs
Sexual dysfunction, GI disturbance, insomnia, headache, anorexia, serotonin syndrome
Nefazodone/Trazodone
-Trade name
-MOA
-Use
-SE
Serzone, Desyrel
Serotonin antagonist and reuptake inhibitor
Refractory depression, depression with anxiety, insomnia
Nausea, dizziness, orthostatic hypotension, cardiac arrhythmias, sedation, priapism
Mirtazapine
-Trade name
-MOA
-Use
-SE
Remeron
Norepi/5-HT antagonist
Refractory depression, weight gain
Sedation (at low doses), weight gain, dizziness, somnolence, tremor, agranulocytosis
What percent of patients with MDD will respond to medication?
70%
Which antidepressants are used for OCD?
SSRI, TCA
Which antidepressants are used for panic disorder?
SSRIs, TCAs, MAOIs
Which antidepressants are used for eating disorders?
SSRIs, TCAs, MAOIs
Which antidepressants are used for dysthymia?
SSRIs
Which antidepressants are used for social phobias?
MAOIs, SSRIs
Which antidepressants are used for PTSD?
SSRIs, TCAs
Which antidepressants are used for IBS?
SSRIs, TCAs
Which antidepressants are used for enuresis?
TCAs
Which antidepressants are used for neuropathic pain?
TCAs
Which antidepressants are used for migraines?
TCAs, SSRIs, bupropion
Which antidepressants are used for smoking cessation?
Bupropion
Which antidepressants are used for Autism?
SSRIs
Which antidepressants are used for premenstrual dysphoric disorder?
SSRIs
Which antidepressants are used for depression in bipolar disorder?
SSRIs, bupropion
Which antidepressants are used for insomnia?
Mirtazapine, TCAs
Which TCA is least likely to cause orthostatic hypotension?
Nortriptyline (Pamelor)
Which TCA is least sedating?
Desipramine (Norpramin)
Which TCA has the least anticholinergic side effects?
Desipramine (Norpramin)
Which TCA is most serotonin specific?
Clomipramine (Anafranil)
Which TCA is useful for OCD?
Clomipramine (Anafranil)
How is TCA overdose treated?
IV sodium bicarbonate
What receptors do TCAs act on?
Inhibit uptake of: Norepi, Serotonin

Block: histamine, adrenergic and muscarinic
What are symptoms of blocking histamine receptors?
Sedation
What are symptoms of blocking adrenergic receptors?
orthostatic hypotension, tachycardia, arrhythmias
What are symptoms of blocking muscarinic receptors?
dry mouth, constipation, urinary retention, blurred vision, tachycardia
What receptors do MAOIs act on?
norepi (MAO-B), serotonin (MAO-A), dopamine, tyramine
Which SSRI causes the most GI symptoms?
Sertraline (Zoloft)
Which SSRI is the most serotonin specific?
Paroxetine (Paxil)
Which SSRI is the most activating?
Paroxetine (Paxil)
Which SSRI is only approved for OCD?
Fluvoxamine (Luvox)