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TCAs block which NT(s)?
Serotonin and Norepinephrine
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What class of med is Maprotilin?
TCA (antidepressant)
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This class of drug blocks reuptake of serotonin
SSRI
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Which NTs do MAOIs effect?
Decrease MAO (which removes norepinephrine, serotonin, dopamine)
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What class is Amitriptyline (Elavil)?
TCA antidepressant
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What class is Amoxapine?
TCA antidepressant
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What class is Desipramine (Norpramin)?
TCA antidepressant
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What class is Doxepin (Sinequan)?
TCA antidepressant
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What class is Imipramine (Tofranil)?
TCA antidepressant
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What class is Nortriptyline (Pamelor)?
TCA antidepressant
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What class is Protriptyline (Vivactil)?
TCA antidepressant
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What class is Trimipramine (Surmontil)?
TCA antidepressant
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T or F: It is safe to take TCAs and MAOIs together.
False
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What are cardiac side effects of TCAs?
Tachycardia/irregular heart rate, orthostatic Hypotennsion
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What are sexual side effects of TCAs?
Impotence, delayed orgasm, low libido
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What are GI and urinary side effects of TCAs?
Dry mouth, constipation, urinary retention, increased appetite (increased weight gain)
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What are neurological side effects of TCAs?
Tremors, increased seizures
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Which is less expensive? Which is more effective?
a. TCAs
b. SSRIs
- TCAs less expensive
- SSRIs more effective
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How long does it take for TCAs to work?
2-4 weeks
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What will you assess for early with TCAs?
SI
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What are the therapeutic effects of TCAs? (3)
- 1. Mood elevation
- 2. Increased interest in daily living
- 3. Decreased insomnia
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Which kinds of Rx drugs will you avoid with someone who is taking TCAs.
Hypnotics, sedatives, barbiturates d/t increased CNS depression
MAOIs, PCU d/t increased cardiac dysrhythmias
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What class of drug is Citalopram (Celexa)?
SSRI antidepressant
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What class is Escitalopram (Lexapro)?
SSRI antidepressant
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What class is Fluoxetine (Prozac)?
SSRI antidepressant
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What class is Paroxetine (Paxil, Pexeva)?
SSRI antidepressant
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What class is Sertraline (Zoloft)?
SSRI antidepressant
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Will you take SSRIs with or without food? AM or HS? Why?
With food or at HS if possible d/t neasea
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What mental disorders can SSRIs be used for?
Anxiety, eating disorders, and selected drug use disorders
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This class of antidepressant can be used for PMS
SSRI
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This class of antidepressant can be used to prevent headaches
SSRI
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What are cardia symptoms of Serotonin syndrome?
HTN, tachycardia
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What are observable symptoms of Serotonin syndrome?
sweating, tremors, restlessness, seizures
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What are some behavioral symptoms of Serotonin syndrome?
Anxiety, agitation, confusion, restlessness, lack of coordination
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What class is Bupropion (Wellbutrin)?
Atypical antidepressant
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What class is Mirtazapine (Remeron)?
Atypical antidepressant
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What class is Nefazodone?
Atypical antidepressant
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What class is Trazodone (Oleptro)?
Atypical antidepressant
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What are common side effects of atypical antidepressants? (3)
- 1. dry mouth
- 2. constipation
- 3. dizziness
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This atypical antidepressant has been linked to seizures and might not be good for those with eating disorders
Buproprion
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This atypical antidepressant can ease nicotine cravings and have a loss of appetite.
Buproprion
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Ths atypical antidepressant can increase appetite and cholesterol.
Mirtazapine: the increased cholesterol might need labs
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This atypical antidepressant is linked to liver failure
Nefazodone
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This Atypical antidepressant is linked to priapism and cardiac arrhythmias
Trazodone
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What class is Isocarboxazid (Marplan)?
MAOIs antidepressant
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What class is Phenelzine (Nardil)?
MAOIs antidepressant
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What class is Selegiline (Emsam)?
MAOIs antidepressant
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What class is Tranylcypromine (Parnate)?
MAOIs antidepressant
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What are cardiac s/e of MAOIs?
Hypotension
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What GI and urinary s/e of MAOIs?
- Nausea
- Diarrhea
- constipation
- Difficulty starting urine flow
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What class of antidepressants were first used?
MAOI
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What is a dangerous side effect of MAOIs and what are its triggers?
- Dangerous HTN and HA can occur when taken with specific foods or meds:
- Foods: cheeses, pickled foods, alcohol, chocolate, coffee, bananas, liver, yeast
Drugs: Amphetamines, Methyldopa, Levodopa, Dopamine, Epinephrine
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What is the Tx of MAOI overdose?
Induce vomiting or gastric lavage
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List the things you will monitor during MAOI tx (6)
- 1. SI
- 2. BP/P
- 3. I/O
- 4. daily weight and fasting BG
- 5. Cholesterol (in beginning)
- 6. Liver fxn
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What are mood stabilizers used to treat?
- Bipolar disorder
- Also controls hyperactivity and flight of ideas
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What class is Lithium?
Mood stabilizer
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What values will you monitor during lithium tx?
- 1. Lithium levels
- 2. Fluids
- 3. Sodium
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How often will you monitor Lithium levels? What are ideal levels?
- Every two weeks, then every 2-3 months (drawn in AM prior to next dose)
- 0.6-1.2mmol/L
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Why should you avoid caffeine when taking lithium
Caffeine can decrease serum lithium levels
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T or F: You want to avoid large sodium intake when taking lithium
True
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What class is Valproic acid (Depakote)?
Sedating AED (Mood stabilizer)
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What class is Carbamazepine?
Sedatin AED (Mood stabilizer)
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What are other uses for AEDs?
- Anxiolytic
- Antimannc
- Sleep promoting
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What class is Felbamate?
Activating AED (mood stabilizer)
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What class is Lamotrigine?
Activating AED (mood stabilizer)
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Fill in: Some pts with a seizure disorder might be on ____.
AED
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What class is Phenytoin?
AED
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What class is Zonisamide?
AED
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What class is Topiramate?
AED
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What class is Gabapentin?
AED
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Phenytoin MIGHT help with ____?
Mania
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Zonisamide MIGHT help with ____
Mania
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Toiramate MAY improve ______
mania, might help with eating disorders, PTSD, social phobia
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What are uses for gabapentin?
Great for anxiety and might be effective for mood disorders
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What class is Carbamazepine?
AED
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What is Carbamazepine indicated for?
- Effective for mania and bipolar
- possibly some borderline personality and impulse control
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What are metabolic considerations for Carbamazepine?
Completely absorbed in blood stream, metabolized in liver, crosses BBB
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What labs will you lookf or with Carbamazepine?
- CBC weekly for first two months
- BUN
- liver/thyroid
- Cholesterol
- Electrolytes and possible ECG
- Serum levels (4-12mg/L)
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What symptoms will you watch for with Carbamazepine?
- fever
- sore throat
- mouth ulcers
- bruising
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