Pharmacology - Antidepressants 2
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- When choosing an antidepressant, the clinician should consider (5):
-
Anticipated adverse effects
Comoribid psych or medical problems
History of prior response
Patient preference
Cost -
Tricyclic antidepressants (TCAs)
MOA:
A/E:
OD: -
MOA: Block reuptake pumps of serotonin and NE
A/E: TCAs bind at other sites which cause many A/E: orthostatic htn, anticholinergic effects, sedation and wt gain. ECG changes
OD can be fatal -
List the TCAs.
What is the usual theraputic dose? -
Elavil, tofranil, anafranil, sinequan, pamelor, norpramin, surmontil, vivacil, asedin, ludiomil.
Dose is about 50-300mg/day -
Desyrel
MOA:
A/E:
OD: -
MOA: Desyrel is a weak serotonin reuptake inhibitor and 5HT2 antagonist.
A/E: Sedation, orthosatatic HTN, priapism, GI. No anticholinergic or cardiac a/e.
OD: Safe - List the Monoamine oxidase inhibitors:
- Nardil, parnate, emsam.
-
MAOIs
MOA:
A/E: -
MOA: Inhibition of enzyme monoamine oxidase which prevents inactivation of NE, serotonin, and dopamine.
A/E: Tyramine restricted diet reqrd. Sedation insomnia, wt gain, BP changes --> hypertensive crisis. Many Rx interactions - What foods should one avoid on MAOIs?
-
Avocados, aged cheese, dried meats, soybean products, red wine, tap beers, sauerkraut, raw yest, broad beans, pickled herring, chicken livers.
Limit coffee, tea, chocolate, figs, meat tenderizer, raisins. -
Selective serotonin reuptake inhibitors (SSRIs)
MOA:
A/E: -
MOA: SSRIs block serotonin reuptake pump.
A/E: Lack side effects of TCAs but may cause GI, headache, sexual dysfxn, insomia/somnolence, discontinuation syndrome, serotonin syndrome. -
What is serotonin syndrome and how does it present?
What classes of drugs can cause it? -
Results from overactivation of central serotonin receptors, can occurr when MAOIs and SSRIs are used.
Presents with abd px, diarrhea, sweating, fever, tachycardia, delerium, myoclonus, irratability. - List the SSRIs
- Celexa, lexapro, prozac, luvox, paxil, zoloft.
-
Wellbutrin
MOA:
A/E:
OD:
Contraindications? -
MOA: Wellbutrin acts as a NE and dopamine reuptake blockade.
A/E: Increased incidence of seizures, nausea, insomnia, agitation, tremor. Contraindicated in pts with eating disorders
OD: Not as saf4e as Desyrel or SSRIs -
Effexor:
MOA:
A/E:
OD: -
MOA: Inhibits reuptake of serotonine and NE, like TCAs
A/E: Nausea, headache, insomnia, HTN, nervousness, sexual dysfunction
Not as safe as SSRIs in OD -
Cymbalta:
MOA:
A/E:
This is often prescribed for: -
MOA: Inhibits reuptakeof serotonin and NE, like TCAs and Effexor
A/E: Nausea, drymouth, constipation, sweating, tachycardia
Often given for peripheral neuropathic pain -
Serzone:
MOA:
A/E:
OD:
Black box! -
MOA: Antagonist of 5HT2 receptor and also blocks reuptake of serotonin.
Fewer A/E: antihistamine activity of deseryl is removed so less somnolence, dry mouth, nausea, dizziness
OD: Safe
BB! Hepatic failure reported, do not give to pts with liver dysfunction -
Remeron
MOA:
A/E:
OD: -
MOA: Alpha 2 adrenergic auto and heteroreceptor antagonist, 5HT2 and 5HT3 postsynaptic receptor antagonist
A/E: A/E of SSRIs and TCAs have been minimized. Sedation, weight gain and increased apetite are likely.
OD: Safer than TCAs - SSRIs may increased what drug levels if given together?
- Tricyclic antidepressats
- What drugs may decrease levels of antidepressants due to their induction of CYP450?
- Carbamazepine, phenobarbital, phenytoin, rifampin.
- If pt has suicide risk, give which class?
- SSRI
- If pt has Depression with anxiety disorder give...
- SSRIs, effexor, TCAs, MAOIs
- If pt has chronic pain give...
- Elavil (TCA), Cymbalta
- If pt has wt gain give...and avoid...
- SSRIs, wellbutrin. Avoid TCAs, pirtazapine, MAOIs
- If pt has sexual dysfunction give...
- Wellbutrin
-
What is the first line treatment of depression in the elderly?
What class should be avoided? -
SSRIs
TCAs are avoided secondary to anticholinergic effects - What is the only drug approved for treatment of pediatric depression?
- prozac
- What is the best drug to give during lactation?
- zoloft