pharmacotherapy exam 3 pct of depression

• SIG E CAPS
• sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal ideaation

• 5HT2-- sexual side effects, akathisia, agitation, insomnia
• 5HT3-- GI Adverse effects--nausea, diarrhea

• delayed orgasm, decreased libido, erectile dysfunction
• change drugs, skip or reduce dose, sildenafil, tadafil, vardenafil

• phenelzine 15-90 mg
• tranylcypromine 20-60 mg
• isocarboxazid (nonselective) 20-60 mg
• HYPERTENSIVE CRISIS--can occur when combine with high tyramine foods or sympathomimetic drugs

• ACH effects-- dry mouth, constipation, urinary retention, blurred vision
• Antihistamine effects- sedation, weight gain
• Alpha 1 adrenergic blockade orthostatic hypotension
• ADVERSE EFFECTS--sexual dysfunction, mild anticholinergic effects, ortho static hypo, sedaction insomnia

• secondary amines--desipramine, nortriptyline --greater NE relative to 5HT activity
• Tertiary amines--amitriptyline, clomipramine, imipramine, doxepine, trimipramine--greater anticholinergic effects

depression, migraine prophylasxis, neuropathic pain, OCD, enuresis, panic disorder, sleep disorders, ADHD

nest--nortriptyline lease sedation, anticholinergic, orthostatic worse amitrypitline, clomipramine, imipramine

• serotonin reuptake inhibition
• ne reuptake inhibition
• anticholinergic effects
• alpha 1 blockade
• histamine blockade

• start with 50 mg and increase by 25-50 mg q 3 days (not nortiriptilyine)
• most 100-300 mg except nortriptyline 50-150

• anticholinergic effects,
• antihistamine effects
• alpha 1 adrenergic blockade
• sexual side effects
• cardiac conduction delays--arrhythmias in od
• decreased seizure threshold
• toxic in OD--do not use in acutely suicidal pateitns

• fluoxetine 20-60
• paroxetine 20-50
• sertraline 50-100
• fluvoxamine 100-300
• citalopram 20-60
• excitalopram 10-20
• relatively safe in OD, relatively safe in pt with CV dz

• depression
• social phobia'
• panic disorder
• ocd
• bulimia nervosa
• PTSD
• PMDD

• GI--NVD
• sexual side effects
• headache
• insomnia
• fatigue
• agitation
• akathesia and dystonic reactions--5ht can reduce DA levels

• most likely to cause sedation--paroxetine, fluvoxamine
• paroxetine--mild anticholinergic effects
• fluoxetine--higher rates of ax and nervousness
• sertraline-more diarrhea

• onst in 24-72 hours and last up to 7-14 days
• shock-like sensations---parathesias, shockline thinling in figners/toes
• GI compliants
• dizziness,
• flu like symptoms
• sleep disturbances

• several serotnergic drugs combiend
• often involves MAOIs as on the drugs
• other serotonergic drugs implicatied
• SSRIS TCAs serotonin releasing agents, destromethorphan, meperidine
• SYMPTOMS-- altered metnal status--confusion, agitation ; autonomic dysfunction--diaphoresis, tachycardia, BP changes, fever
• neruomuscular abnormalities--clonus
• Allow 2 weeks between MAOI and other antidpressent admin--5 weeks for fluoxetine

• MOA--potent 5ht2 receptr antagonist, relatively weak 5ht reuptake inhibition
• most commonly used as a sedative
• antidepressant dose 200-400mg/day
• one of major metabolites in mcpp--non specific serotonin agonsit, anxiogenic, metabolized by CYP2d6

sedation, cognitive slowing, dizziness, priapism

• potent 5ht2 receptor antagonist
• relatively weak 5ht reuptake inhibition
• alpha 1 receptor blockade
• 300-600 mg/day in 2 divided doses
• preserves sleep architecture
• limited use due to hepatic toxicity warning

• serotonin reuptake inhibition, NE reuptake inhibition, dopamine reuptake inhibition
• usual dose 75-225
• adverse effects --nausea, constipation, headache, dizziness, nervousness, somnolence, ry mouth, sexual dysfunction , increased BP--

• NE and dopamine reuptake inhibtion
• no sexual dysfunction
• no weight gain
• not effective for panic disorder, social phobia,
• effective for smokin cessation and sometimes used for ADD

• insomnia
• anxxiety
• dry mouth
• tremor
• nausea
• skin reactions
• increased blood pressure
• dose related seizure risk--more common with IR formulation

• antagonism of presynaptic alpha 2 receptors
• block 5ht2 and 5ht3 receptors
• blockade histamine receptors
• adverse effects--increased appetite, weight gain, sedation, dry mouth, constipation--dose 15-45 mg

• indicated for MDD, GAD
• NE and Serotonin reuptake inhibitor
• metabolised by CYP 1A2 and CYP 2D6
• Common sE-- nausea, drymouth, fatigue, insomnia, dizziness, constipation, somnolence, increased sweating, decreaed appetite, increased BP--rare--increased LFTs/hepatic failure.
• 40-60 mg

1a2, 2c, 2d6, 3a4

2c, 2d6, 3a4

2c, 2d6, 3a4

2d6

3a4

2d6

2d6

fluvoxamine

• fluovoxamine
• fluoxetine
• sertrailine

• fluoxetine
• sertraline, paroxetine duloxetine
• bupropion
• (NOT ALOT citalopram, escitalopram, venlafaxine)

• fluvoxamine
• fluoxetine
• sertraline
• nefazodone

• weight gain or increased appetite
• hypersomnia
• heavy feeling in arms or legs
• interpersonal rejection sensitivity
• MAOIs greater efficacy than TCAs
• efficacy of SSRIs relative to MAOIs unclear

• subtype of severe depression
• nearly completely absence of capacity for pleausre
• diurnal mood swings--worse in the am
• excessive guilt and eight loss
• unclear if ssris as effectve as TCAs in treatment
• some datea indiate mirtazapine and venlafaxine mroe effective than SSRIs

symptoms return within 4-9 months of recover

symptoms return after 6 to 12 months of recover, increase risk of recurrence after multiple episodes

• acute phase--goal is remission (absense of symptoms) approximately 6-12 weeks
• CONTINUATION PHASE--goal is to prevent relapse and elminate residual symptoms, approximately 4-9 months
• MAINTENANCE PHASE--prevent recurrence, length of treatment varies depending on history of previous episodes