pharm psych titus info.txt

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tallone4830
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pharm psych titus info.txt
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2012-10-26 23:26:46
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pharm psych titus info.txt
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  1. SSRI
    Selective Serotonin Reuptake Inhibitor
  2. SSRI MOA
    inhibit the reuptake of serotonin in the synaptic cleft
  3. SSRI kinetics
    long T1/2 (24+ hrs)
  4. SSRI indications
    depression, OCD, GAD/panic disorder, bulemia. fluoxetine carries the only indication for children.
  5. SSRI contraindications
    citalopram QT prolongation risk.
  6. SSRI interactions
    SSRI + MAOI (serotonin syndrome), prevent c 2 wk washout. SSRI + thioridazine (inhibit metabolism of thioridazine, which is a QT prolonger).
  7. SSRI side effects
    serotonin syndrome, sexual dysfunction, GI upset, agitation, insomnia.
  8. fluoxitine misc
    fluoxitine has the longest T1/2 longest, with active metabolite norfluoxetine >100h **so has increased potential for interactions, long washout period (5+ wks)**. but also is least likely to have discontinuation symptoms c abrupt withdrawal (dizziness, nausea, headache).
  9. SSRI hepatic/renal impairment
    paroxetine and sertraline do not require dosing adjustments with hepatic/renal impairment.
  10. TCA MOA
    Inhibit the reuptake of serotonin AND norepinephrine in the synaptic cleft. clomipramine (and amitriptyline) is most selective for 5HT, desipramine (and nortriptyline) is most selective for NE.
  11. TCA kinetics
    nortriptyline is a metabolite of amitriptyline, desipramine is a metabolite of imipramine.
  12. TCA indications
    depression, chronic pain (adjunct). many others (amitriptyline has the most).
  13. TCA contraindications
    caution in conditions where antimuscarinic effects would be undesirable (urinary retention/BPH, glaucoma/incr IOP).
  14. TCA interactions
    TCA + MAOI (serotonin syndrome), prevent c a 2 wk washout. others on bonus slides.
  15. TCA side effects
    side effects due to the antagonization of muscarinic (dry mouth, confusion, urinary retention, constipation, blurred vision, incr IOP), histamine (sedation), and adrinergic (a1 - orthostatic hypotension) receptors. amitriptyline has the greatest degree of antagonism at these receptors, so it usually has the largest side-effect profile.
  16. amitriptyline dosing
    depression starting 25-50mg/d, maintenance 100-300mg/d
  17. TCA OD
    not good -- slow absorption so time passes before full effect occurs, death d/t cardiac arrhythmia (QRS widening and heart block), hypotension, or CNS sedation.
  18. TCA
    TriCyclic Antidepressant
  19. SNRI
    Serotonin-Norepinephrine Reuptake Inhibitor
  20. SNRI MOA
    Inhibit the reuptake of serotonin AND norepinephrine in the synaptic cleft. Venlafexine is more selective for 5HT, milnacipran blocks both equally, others fall somewhere between the two.
  21. SNRI kinetics
    shorter T1/2 than the SSRIs. venlafaxine is extensively metabolized by 2D6, which is subject to genetic polymorphisms.
  22. SNRI indications
    depression, GAD/panic disorder, social anxiety. also useful in chronic pain.
  23. SNRI contraindications
    duloxetine hepatic impairment
  24. SNRI interactions
    SNRI + MAOI (serotonin syndrome), prevent c 2 wk washout. SNRI + antithrombotic drugs (platelet serotonin depletion inhibiting aggregation capabilities).
  25. SNRI side effects
    dose-related sustained HTN. GI distress (especially c venlafaxine). removal: venlafaxine has the most SE if you don't properly taper.
  26. desvenlafaxine dosing
    depression 50mg/d, only SNRI drug that does not require titration
  27. NaSSA
    Noradrinergic and Specific Serotonergic Antidepressant
  28. NaSSA MOA
    Inhibit a2 autoreceptors/heteroreceptors, resulting in enhanced serotonin and norepinephrine release. Also antagonize serotonin 5HT2 and 5HT3 postsynaptic receptors, resulting in enhanced 5HT1 neurotransmission.
  29. NaSSA indications
    depression, PTSD. good for elderly patients, as it also helps treat insomnia and helps them gain weight at the same time.
  30. NaSSA side effects
    Has high high affinity for histamine receptors (sedation). Also increased appetite/weight gain, and rarely severe neutropenia. Less GI SE (blocks 5HT3) and less sexual dysfunction.
  31. Atypical Antidepressants MOA
    Not clearly understood. trazadone is a serotonin antagonist at low doses, but a serotonin agonist (though less potent than fluoxetine) at higher doses. vilazodone is both an SSRI and a 5-HT1A partial agonist. nefazodone is primarily an antagonist at 5HT2, shows slight reuptake inhibition, antagonizes a1 adrenergic receptors.
  32. Atypical Antidepressants kinetics
    trazadone and vilazodone are highly protein bound -- trazadone you don't take with food, vilazodone you do. nefazodone is a potent CYP3A4 inhibitor.
  33. Atypical Antidepressants indications
    depression, several off-label uses.
  34. Atypical Antidepressants contraindications
    nefazodone with ANY liver issues (black box warning)
  35. Atypical Antidepressants interactions
    serotonin modulators + MOAI (serotonin storm), prevent c 2 wk washout. nefazodone + simvastatin (mypopathy).
  36. Atypical Antidepressants SE
    trazadone priaprism
  37. MAOI
    MonoAmine Oxidase Inhibitor
  38. MAOI MOA
    Inhibit the monoamine oxidase enzyme. MAO-A breaks down E, NE, 5HT, and DA. MAO-B breaks down phenylethylamine and DA (used more for parkinson's, but at high doses they begin to lose selectivity).
  39. MAOI kinetics
    selegiline is available TD (bypasses gut/first-pass metabolism, so can use lower doses).
  40. MAOI indications
    depression (atypical)
  41. MAOI contraindications
    avoid tyramine-containing foods (catacholamine-releasing agent typically broken down by MAO-A in gut) (cheese, wine, beer, yogurt, yeast).
  42. MAOI interactions
    MAOI + sympathomimetics (hypertensive crisis). MAOI + COMTI (tachycardia, HTN, arrhythmias), prevent c 2 wk washout.
  43. MAOI side effects
    sleep (insomnia, less REM), weight gain, hypotension, sexual disturbances (worst class for this), HTN crisis (monitor BP).
  44. NDRI
    Norepinephrine and Dopamine Reuptake Inhibitor
  45. NDRI MOA
    inhibits the reuptake of both dopamine and norepinephrine
  46. NDRI indications
    depression, smoking cessation
  47. NDRI contraindications
    seizures (bupropion lowers threshold).
  48. NDRI interactions
    NDRI + MAOI (HTN). NRDI + thioridazide (ventricular arrhythmias, seizures)
  49. NDRI side effects
    seizures. also dry mouth, nausea, insomnia. lacks serotonergic effects, so less sexual SE.

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