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What are the 5 Different types of Anti-Depressents?
-Monoamine Oxidase Inhibitors (MAOI)
-Tricyclic Antidepressants (TCA)
-Selective Serotonin Reuptake Inhibitors (SSRI)
-Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
-Others (sometimes referred to as atypical)
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What is the Mech of action of the MAO inhibitors?
MAO metabolizes NE,5-HT, and DA
If you inhibit MAO enzyme, you increase the prevent this degradation--> increasing the availablity of NE,5-HT and DA
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What are MAO inhibitors used for?
-Major depressive disorders
(also, Panic, social anxiety disorders) but not approved.
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What are the different types of MAOIs?
Isocarboxazid
Phenelzine
Tranycypromine
Selegiline
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What are the adverse effects of MAOIs
- Dizziness, Headache, Dry mouth, Insomnia, Constipation, Weight gain
- Edema, Sexual dysfunction, Manina/hypomania, Lower seizure threshold
Hypertension, occipital headache, palpitations, N/V, Chills, restlessness
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What causes the hypertensive crisis in MAOIs?
How do you treat this?
Caused by interaction of MAOI with dietary tyramine
- Treat with a MAOI diet (low tyramine)
- (cheese, wine, beer, pickled fish, fava beans, beer, chicken liver)
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What are the Tricyclic antidepressants Mech of action?
- They inhibit the reuptake of neurotransmiters by presynaptic neuon
- Esspecially NE and 5-HT
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What are TCA's indications?
Major depressive disorders (all)
OCD (clomiprame only)
Panic disorder (Imipramine)
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Name the TCA agents
Indicate the parent drugs (P)
Imipramine (P)
Clomipramine (P)
Amitriptyline (P)
Desipramine
Nortriptyline
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What are some drug interactions of:
SSRI's
MAOI's
- SSRIs (except Fluvoxamine) inhibit CYP450 --> increased TCA levels
- -MAOI:
- Dont use these 14 days prior to TCA drugs.
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What is the SSRI mech of action?
What are they selective for??
- They inhibit the reuptake of 5-HT
- this results in increased synaptic 5-HT
Selective for 5-HT
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What are some of the indications for SSRIs??
- -Major Depressive Disorder (MDD)
- -Obsessive Compulsive Disorder (OCD) -Panic Disorder (PD)
- -Social Anxiety Disorder (Social Phobia) -Post Traumatic Stress Disorder (PTSD) -Generalized Anxiety Disorder (GAD)
- -Bulimia Nervosa
- -Premenstrual Dysphoric Disorder (PMDD)
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What are the SSRI adverse effects?
indicate which are included in activation effects.
- -Agitation
- -Anxiety
- -Sleep disturbance
- -Tremor
- -Sexual dysfunction
- -GI distress
- -Weight changes
- -⋙ Induction of mania/hypomania
- -⋙ Lowers seizure threshold (<TCA)
- -Serotonin syndrome
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What are some drug interactions of the SSRIs?
*What can the elevation of 5-HT cause??
- -All inhibit CYP450 (except fluvoxamine)
- (thus other drug levels will increase)
-Dont used MAOI's for 14 days prior to SSRI), and 5 weeks for Fluoxetine.
* Can cause Serotonin syndrome
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Name the 6 SSRIs
- Fluoxetine
- Sertaline
- Paroxetine
- Fluvoxamine
- Citalopram
- Escitalopram
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What is seen in serotonin syndrome?
- -Restlessness, tremor
- -⇧ Muscle tone, myoclonus
- -Agitation/confusion
- -Hyperreflexia
- -⇧ Temperature
- -Cardiac arrhythmia
- -Death
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