Pharm Day 1 (Antidepressants)

TCAS, monoamine oxidase and MAO inhibitors are examples of _____ antidepressants?

older

SSRIs and SNRIs are examples of ______ antidepressants?

newer

What are antidepressants effective in?

relieving depression

How long does it take for antidepressants to kick in?

2-4 weeks, educate patient on this!

What route is antidepressants given and where is it metabolized?

given PO, metabolized in the liver

What type of patients do we need to be careful with when giving antidepressants?

substance abuse patients

Do all patients have the same reactions to antidepressants?

no, they differ

Mechanism of action for antidepressants?

normalize abnormal neurotransmission systems in the brain

When should antidepressants be used? (2 things)

when depressive symptoms persists at least 2 weeks, to treat anxiety disorders

What are 3 contradictions for antidepressant use?

suicidal tendencies, acute schizophrenia, mixed mania/depression

How are antidepressant medications administered?

initiated with small doses that gradually increases until therapeutic effect is achieved

How long will depression treatment occur for?

9 months after symptoms subside 

What is the prototype of tricyclic antidepressants?

imipramine (Tofranil)

Are tricyclic antidepressants first line drugs?

no- can be dangerous due to narrow therapeutic range

What is the black box warning of Imipramine (Tofranil)?

increased risk of suicidal ideations→ watch 18-24 year olds who are taking antidepressants 

What is Imipramine (Tofranil) indicated for?

treatment of depression and sometimes enuresis

What is the prototype of SSRI’s?

Fluoxetine HCI

What do SSRI’s affect?

serotonin levels

Are SSRI’s first choice treatment?

yes

What is Fluoxetine (Prozac) used for?

depression, anxiety, panic disorder, OCD, bulimia nervosa, anorexia, aggression

What is the black box warning in Fluoxetine (Prozac)?

increased suicidal ideation in 18-24 years old

Caution for Fluoxetine (Prozac)?

severe liver impairment

2 major adverse effects of Fluoxetine (Prozac)?

Serotonin syndrome risk, anti depression discontinuation syndrome risk 

Can Fluoxetine (Prozac) be given to children?

yes

What are 5 signs and symptoms of serotonin syndrome?

tremor, hyperactive bowel sounds, excessive sweating, tachycardia, hypertension

How do we avoid serotonin syndrome?

do not take SSNI’s with MAO inhibitor or within 2 weeks of each other

What are 5 ways to treat serotonin syndrome? (MBSOM)

muscle relaxants, benzodiazepines, serotonin production blocking agents, oxygen and iv fluids, monitoring ABC’s

What symptoms occur if a patient forgets to take their antidepressants?

flu-like symptoms, dizziness, GI upset, lethargy, sleep problems

More serious problems of not taking antidepressants?

suicidal tendencies

Should antidepressants be tapered?

yes

How long should antidepressants typically be tapered for?

6-8 weeks

What is the prototype of SNRI’s?

Venlafaxine (Effexor)

What is Venlafaxine (Effexor) used for?

first line treatment for depression and anxiety disorders

What are 2 cautions for Venlafaxine (Effexor)?

renal and hepatic impairment

What is the prototype for MAO inhibitors?

Pheneizine (Nardil)

What are 3 warning signs of a hypertensive crisis?

headache, tachycardia, vision changes

Why do patients taking Pheneizine (Nardil) need to avoid foods containing tyramine?

increases the risk for hypertensive crisis

3 examples of foods containing tyramine?

aged cheese, beer, aged beef/ chicken

What should never be mixed with antidepressants because it increases the risk of serotonin syndrome? 

herbal remedies 

What does Trazodone do besides treat insomnia?

lowers seizure threshold