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Which two pathways do anti-depressants target?
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How long does it take to see effects of anti-depressants?
2-4 weeks
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What drugs are used for panic disorder w/ or w/o agoraphobia? (4)
- SSRIs
- MAOIs
- TCAs
- high potency benzodiazepines (alprazolam and clonazepam)
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What drugs are used for OCD?
- Serotonin selective tricyclic clompiramine (Anafranil)
- SSRIs at high doses (Fluoxetine at 60-80 mg)
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Which is more responsive to pharmacotherapy - Obsession or Compulsions?
Obsessions
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How long does it take for S/S to respond to pharmacotherapy in OCD?
12 weeks
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Binging and purging behavior associated with bulimia is responsive to which drugs? (3)
- SSRIs (first line because of low SE profile)
- TCAs
- MAOIs
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What is the MOA for TCAs?
Block presynaptic reuptake of serotonin and norepinephrine.
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List SSRIs (6)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
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List SNRIs (2)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
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List Serotonin receptor agonists and anatagonists (2)
- Trazodone (Desyrel)
- Nefazodone
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List NDRIs (1)
Bupropion (Wellbutrin)
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List TCAs (4)
- Nortriptyline (Pamelor)
- Imipramine (Tofranil)
- Despiramine (Norpramin)
- Clomipramine (Anafranil)
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List MAOIs (3)
- Tranylcypromine (Parnate)
- Phenelzine (Nardil)
- Isocarboxazid (Marplan)
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What kind of drug is Mirtazapine (Remeron)
Anti-depressant
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Which anti-depressants are generally well-tolerated and considered 1st line tx for major depression? (5)
- SSRIs
- Bupropion (Wellbutrin)
- Duloxetine (Cymbalta) SNRI
- Venlafaxine (Effexor) SNRI
- Mirtazapine (Remeron)
- All of the above have low sedative, anticholinergic, and orthostatic hypotensive effects
- Esp useful in pts with cardiac conduction disease, constipation, glaucoma, prostatic hypertrophy
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Which TCAs have the least sedative, anti-cholinergic, and orthostatic effects? (2)
- Nortriptyline (Pamelor)
- Desipramine (Norpramin)
- Esp useful in younger, healthier people
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What is useful for pts on TCA to determine appropriate dosing?
Serum levels
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What should be monitored regularly in children and adolescents started on anti-depressants?
Suicidal thinking
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What are SE of SSRIs? (6)
- Nausea
- Headache
- Neuromuscular restlessness (resembles akathisia)
- Insomnia/sedation
- Delayed ejaculation/anorgasmia
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What can dangerous condition can result when SSRIs are combined with MAOIs?
Fatal serotonin syndrome
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What are the SE of TCAs? (4)
- Orthostatic hypotension (most common)
- Anticholinergic effects
- Cardiac toxicity (sinus tachycardia, v-fib, prolongation of PR, QRS, and QT, heart block, ST and T-wave changes)
- Sexual dysfun
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What are patients who take MAOIs at risk for?
Severe hypertensive crises (tyramine crisis) w/ potential MI or stroke
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What foods should be avoided w/ pts that take MAOIs?
- Meats/fish, beer, red wine, cheese, overripe fruits
- Over-the-counter pain meds
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Which MAOI can cause insomnia and agitation?
Tranylcypromine (Parnate)
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Which MAOI cna cause daytime somnolence?
Phenelzine (Nardil)
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Vagal nerve stimulation is useful for what?
treatment-refractory depression
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