Therapeutics - Depression 2
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What are the SE for Serzone?
sedation, orthostasis, dry mouth, nausea, liver failure
Of the SSRIs ___________ has the most potential to cause anticholinergic side effects such as dry mouth constipation and sedation
Of the SSRIs Paxil has the most potential to cause ___________________such as ___________________________.
- Anticholinergic side effects
- Dry mouth constipation and sedation
______________ may cause more GI distress than other SSRIS, such as diarrhea or loose stools along with insomnia or activation.
Zoloft may cause more _________________such as ________________________________________________.
- GI distress
- diarrhea or loose stools along with insomnia or activation
Serotonin syndrome is a combination of adverse effects that occurs due to excessive serotonin, what are the symptoms?
GI symptoms, tremors, hyperreflexia, restlessness, tachycardia, hypertension, manic-like symptoms, confusion and hyperpyrexia
Serotonin syndrome occurs mainly in what group of patients?
Patient is on more than one medication that increases serotonin levels
Once agent is discontinued, serotonin syndrome symptoms normally resolve within ____________.
Abrupt discontinuation is not recommended for what SSRIs?
- Short-acting agents such as Paxil, Celexa and Zoloft
What are the symptoms of SSRI discontinuation syndrome associated with short-acting agents such as Paxil, Celexa and Zoloft?
Vivid dreams, nightmares, tremor, dizziness, crying spells, nausea and poor concentration
How does Wellbutrin produce an antidepressant effect?
- Primarily through inhibition of NE and DA reuptake
- No direct effect on serotonin
________________ is less likely to cause sexual side effects than other agents.
____________ is less likely to induce mania, though the risk still exist.
The seizure potential is higher with ______________ and is dose-dependent.
Wellbutrin seizure potential is higher than other agents, this property is dependent on what?
How can Wellbutrin be used to decrease the risk of seizure induction?
SR and XL formulations
Wellbutrin should be avoided in patients with:
- Alcohol withdrawal
- Existing seizure condition
- Bulimia or anorexia nervosa
- (Avoid wEllButrin)
Effexor has what unique SE and what is it dependent on?
- Increase in Diastolic BP
- Dose-Dependant, seen in doses over 300 mg/day
Is Effexor contraindicated in controlled hypertension?
Can you stop Effexor abruptly?
No, discontinuation syndrome has been reported, thus tapering is suggested
How does Remeron impose its antidepressant effect?
Through the increase of NE and serotonin activity
Increased sedation caused by Remeron is found at _________ doses.
Low doses (<15 mg)
Patients with ____________________________________ may benefit from Remeron use.
a decreased appetite or body weight
Patients with a decreased appetite or body weight may benefit from __________ use.
___________________has the potential to increase total cholesterol and triglycerides along with glucose dysregulation.
- ________________ fewer GI side effects compared to the SSRI’s
Nefazadone elicits it antidepressant effect through what?
Increasing serotonin and possibly NE
__________________ is an SSRI that is less likely to cause sexual dysfunction, agitation or weight changes
Nefazadone is is less likely to cause _____________, _____________ and ________________.
sexual dysfunction, agitation or weight changes
Nefazadone contains a black box warning due:
Is Nefazadone a first line agent?
What monitoring should occur if Nefazadone is used?
- Liver enzymes should be monitored
- Signs and symptoms of liver failure
What should you educate patients on Nefazadone about?
S/S of Liver failure
Cymbalta elicits its antidepressant effect by:
Increasing both serotonin and NE
What can Cymbalta also be used to treat?
Pain due to diabetic neuropathy
What are the most common adverse effects of Cymbalta?
CNS (sedation, dizziness, headache, insomnia) and GI (nausea, vomiting, diarrhea) and xerostomia
Tricyclic Antidepressants elicit a response by:
blocking reuptake of NE and serotonin
Typical side effects of TCAs include:
- Weight gain
- Hypotensive effects
- Sexual dysfunction
- Decrease in the seizure threshold
- (What’s sad)
TCAs have a high______________________, so doses are normally given at bedtime.
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