Pharm Antidepressants

What are the two older-generation antidepressants?

Tricyclic antidepressants and monoamine oxidase (MAO) inhibitors

What are the two newer-generation antidepressants?

SSRI and SNRIs (selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors)

When do you need to take antidepressants before depressive symptoms improve?

2 to 4 weeks

How are antidepressants given?

Orally only

Where are antidepressants metabolized?

The liver

What is the action of antidepressants?

They increase the concentration of serotonin, norepinephrine, and dopamine in the body

What is the major indication for antidepressants?

Depressive symptoms that persist for at least 2 weeks OR anxiety disorders.

What are some alternative uses of antidepressants?

Enuresis

Neuropathic pain

What is the main contraindication for antidepressants?

Suicidal tendencies!

List some contraindications to taking antidepressants?

-Acute schizophrenia

-Renal disease, hepatic disease, cardiovascular disease

-Glaucoma

-Seizures

How is antidepressant dosage started?

Gradually increase according to clinical response.

How long should you take antidepressants after first depressive episode?

9 months

How long should you take antidepressants after a second episode of depression?

5 years

How long should you take antidepressants after a third episode of depression?

long-term therapy

What is the prototype tricyclic antidepressant?

imipramine (Tofranil)

What is the method of action of imipramine?

blocks reuptake of norepinephrine and serotonin

Why isn't imipramine used very often?

has a very narrow therapeutic range --> easily becomes toxic

What is the Black Box Warning for imipramine?

Increased risk of suicidal ideations.

What are the four cautions for imipramine (not the suicidal one)?

Cardiac conduction abnormalities

Urinary retention

Glaucoma

Hepatic impairment

What is the prototype SSRI?

Fluoxetine HCl

What is another SSRI?

Sertraline

Why are SSRIs preferred to tricyclic antidepressants?

Produce fewer serious effects

Seem to primarily affect serotonin and not other neurotransmitters

What is the other name for fluoxetine HCl?

Prozac

What do you take fluoxetine/prozac for?

Depression/anxiety

Panic disorder

OCD

Anorexia

Aggression

What is the Black Box Warning for fluoxetine/prozac?

Increased risk of suicidal ideation?

What are the two non-suicide adverse effects for fluoxetine?

Serotonin syndrome risk

Antidepressant discontinuation syndrome risk

List the signs and symptoms of serotonin syndrome (THIS SOUNDS LIKE A SELECT ALL THAT APPLY. KNOW THESE.)

Hypertension

Tachycardia

Diaphoresis

Agitation/seizures

Uneven pupils

Tremor

Hyperactive bowel sounds

How do you avoid serotonin syndrome?

Don't take prozac with a MAO inhibitor. Stop it 5 weeks in advance if starting a MAO inhibitor.

How do you treat serotonin syndrome? (KNOW THESE TOO!!!)

Muscle relaxants

Benzodiazepines (ex. valium, ativan)

Serotonin-blocking agents

Oxygen/fluids

Monitoring ABCs

What are the symptoms of antidepression discontinuation syndrome?

flu-like symptoms, GI upset, anxiety or lethargy, mood disturbances, suicidal tendencies

How long should you taper dosage of antidepressants to prevent discontinuation syndrome?

6 to 8 weeks

What is the prototype S/NRI?

Venlafaxine

What's the action of SNRIs?

Same as SSRIs, except block reuptake of norepinephrine instead of serotonin.

What is the black box warning for venlafaxine?

Suicidal ideation

What are the two cautions for venlafaxine?

Renal impairment

Hepatic impairment

What are MAO-I's?

3rd line treatments for depression (rarely used in clinical practice today)

What do you NOT take with MAO-I's?

SSRIs

What is the prototype MAOI?

Pheneizine

What is the mechanism of action of pheneizine?

Binds to MAO and increases epinephrine, norepinephrine, serotonin, dopamine

What foods should you AVOID when taking MAOI's (pheneizine?)

Any food containing TYRAMINE

List the foods that include tyramine. All of them.

Aged stuff - cheese, wine, beer, yeast.

Meat - beef, chicken, liver

Other - yogurt, soy sauce, chocolate, bananas

Bupropion

atypical antidepressant. Also used for smoking cessation.

Trazodone

atypical antidepressant. Also used for sleep med.

Mirtazapine

atypical antidepressant. increases seizure risk.