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Nortiptyline Class and MOA
Tricyclic (TCA)
Blocks NE reuptake in periphery and CNS.
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Phenelzine Class and MOA
MAOI
Blocks deamination of monoamines.
-
Fluoxetine Class
Is Fluoxetine selective?
SSRI
Little effect on muscarinic, histaminergic, alpha adrenergic or 5-HT receptors
-
Venlafaxine Class and MOA
Seritonin and NE Reuptake Inhibitor (SNRI)
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Trazadone Class and MOAs
Atypical
- -5-HT reuptake inhibitor
- -Partial agonist at 5-HT1A Receptor
- -H1 Receptor agonist
-
Nefazodone Class and MOAs
Atypical
- -5-HT reuptake inhibitor
- -5-HT antagonist (activating effects)
-
Bupropion Class and MAOs
Atypical
DA and NE reuptake inhibitor
-
Mirtazapine Class and MAOs
Atypical
- -Alpha 2 antagonist
- -5-HT2 and 5-HT3 receptor antagonist
-
Lithium Class and MOA
Mood Stabilizer
Probably modifies 5-HT and NE transmission.
-
Nortriptyline Efficacy
- Onset in 2-3 weeks.
- No PRN use.
- DC results in relapse.
-
Nortriptyline Adverse Effects
- 1.
- Orthostatic hypotension
- 2.
- Antihistamine Drowsiness
-
Phenelzine Efficacy
- Not first line.
- Used for atypical depressions.
-
Phenelzine Adverse Effects
Hepatotoxicity.
Low Therapeutic Index.
OD effects are agitation, convulsions.
Beer and Cheese rxn.
-
Fluoxetine Efficacy
More tolerable than MAOIs and TCAs, NOT more efficacious.
Onset 1-3 weeks (same as TCAs)
-
Fluoxetine Adverse Effects
May produce stimulation and suicidal thoughts.
- N/V; Weight LOSS.
- Sexual dysfunction.
-
Venlafaxine Efficacy
Requires 2-3 doses per day.
-
Venlafaxine Adverse Effects
Fewer than TCAs but do increase BP.
SSRI-like SEs.
-
Trazodone Efficacy
Used for depression with anxiety, agitation, and insomnia.
-
Trazodone Adverse Effects.
Marked sedation.
Dizziness.
Hypotension.
Nausea
-
Nefazodone Efficacy
Produces CNS activation.
-
Nafazodone Adverse Effects
NOT sedating.
-
Bupropion Efficacy
Depression with psychomotor retardation (lethargy).
-
Bupropion Adverse Effects
Low incidence of SE.
CNS stimulation can cause nervousness and insomnia.
Seizures at high doses.
-
Mirtazapine Efficacy
Sedative and anxiolytic effects.
-
Mirtazapine Adverse Effects
Similar to TCAs but less pronounced.
-
Lithium Efficacy
DOC for "classic" mania.
Onset in 7-10 days.
-
Lithium Adverse Effects
Marked fatigue, muscle weakness, slurred speech, and tremor.
Thirst and urination (nephrogenic diabetes insipidus)
- tolerance develops to many of the SEs after 4 weeks.
- -no tolerance to tremor (Beta blocker may help)
- -no tolerance to excesive urination and thirst (must regulate water intake to prevent washout)
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