| What are SSRIs? | Better for cardiac pt, selective block of serotonin reuptake.
litlle blocking effect on muscarinic, a adrenergic and histaminic
Include (Fluexetine (prozac- long half life for weeks, stimulate suicidal thoughts lowest risk for discontinuation)
Citalopram, Paroxetiene, Sertraline (affected by food absorption) Fluvoxetine (only for OCD) |
| What are therapeutic indications of SSRIs? pharmacokinetcs and adverse effects? | Depression, OCD, panic disorder, GAD, SAD
PO, substrates for CYP metabolism and inhibitors of enzyme
Effects (less severe than TCA, no arrhythmias, sexual dysfunction, change in weight, suicidal thoughts, serotonin syndrome (hyperthermia, tachcardia, sweating, myoclonic (if with MAOI), changed mental status)
Disconitnuation syndrome (occurs w/abrupt withdrawal |
| What are SNRIs? | Block serotonin and NE reuptake like TCA, effective in pain relief (diabetic neuropathy, fibromyalgia and low back pain)
Discontinuation syndrome
Include (Venlafaxine (long acting, potent blocker, high dose blocks NE reuptake, increase BP and HR)
Duloxetine (block both NE and SA at all doses, for Depression, GAD, SAD, diabetic neuropathy)
Side effects (sexual dysfct) |
| What are TCAs? | Block a1 Rs (othrostatic hypotension and dizziness)
Histaminic Rs (sedation and weight gain) and Muscarinic Rs (blurred vision, xerostomia, constipation, urinary retention)
Include (3ary amines (Imipramine [controls bed wetting children], amitryptiline, Clomipramine.
2ary Amines (Desipramine [block NE reputake], Maprotiline, Amoxapine [block DA Rs]) |
| What are actions, indications pharmacokinetcs and precautions for TCAs? | Actions (secondary for mood improvement, we should have slow withdrawal to minimize discontinuation syndrome)
Indications (2nd line tx for chronic pain syndrome, and moderate to severe depression)
Oral Admin
CV effects (Block Na+ channels delay AV conduction, avoid in cardiac disease)
Precautions (Narrow Therapeutic window, in bipolar use carefully during depressive episodes, don't associate with MAO I due to risk of HTA) |
| What are MAO I? | Stable molecules w/MAO, inactivates it in brain, liver and gut
Antidepressant action is delayed several weeks, include Phenelzine, Tranylypromine, Selegiline
Indications (unresponsive/ allergic to TCAs)
Adverse effects (drug-food interaction like tyramine lead to HTA and arrythmia
Drug-drug intreraction (not w/SSRIs since life threat serotonin syndrome |
| What are atypical antidepressants? | Mirtazapine (blocks presynaptic a2 and serotonin receptors, antihistaminic also sedative, no antimuscarininc activity like TCA and no sexual dysfunction like SSRIs)
Bupropion (block DA, NE, decrease nicotin craving, no sexual dysfct or weight gain, high dose induce seizures) |
| What are tx for mania and bipolar? | Lithium salts (bipolar, downregulates NMDA Rs, oral admin, low therapeutic index)
Antiepileptics (mood stabilizers)
Antipsychotics (improve manic sx)
Atypical antipsychotics (mania management) |
