Exam (elaborations)
Antidepressants and Antipsychotics
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Antidepressants and Antipsychotics Antidepressants and Antipsychotics Antidepressants and Antipsychotics
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Antidepressants and AntipsychoticsWhat is the criteria for major depressive disorder? - ANS A. 5+ in 2 week period
-depressed mood or dec interest/pleasure in all activities
-wt/appetitie change
-sleep diosrder
-psychomotor agitation
-fatigue
-loss of energy
-feelings of worthlessness/inappropriate guilt
-dec concentration
-suicidal ideation
B. associated with impairment in functioning
C. not attributable to substance abuse
D. not better explained by psychotic illness
E. no history of manic episodes
What are the proposed biological mech for depression? - ANS monoamine deficiency hypothesis
(depletion of serotonin, NE and dopamine)
What are all of the pharm options for depression? - ANS SSRI +
SNRI
bupropion
mirtazapine
trazodone
TCAs
,MOAIs
NMDA antagonist
What are the different SSRIs? - ANS fluoxetine
sertraline
paroxetine
fluvoxamine OCD**
citalopram
escitalopram
What is the MOA for SSRIs? - ANS inhibitis 5HT reuptake to inc serotonin in synapse
receptor downregulation
What are other things that are regulated by serotonin receptors? - ANS anti anxiety/antidepressant
effect
insomnia/anxiety/hallucinations/sexual dysfunction
wt regulation
vasoconstriction
emesis
What are SE of SSRIs? - ANS GI (n/v/d)
sex dysfunction (dec libido/ejaculation)******
inc anxiety/agitation
ha
diaphoresis
insomnia/sedation
, RARE but hyponatremia from SIADH
Which SSRI is more likely to cause sedation, constipation and dry mouth? - ANS paroxetine
Which SSRI is more likely to cause insomnia/activation (wake u up)? - ANS fluoxetine
sertraline
What does citalopram have the potential toxicity? - ANS cardiac
must be in doses less than 40
max 20mg a day if hepatic impairment
ECG in pts with CHF, Brady, concomitant meds that prolong QT interval
What are the drug to drug interactions (pharmcodynamic) effects of SSRi - ANS serotonin
syndrome!!!!!!!!!!!!
inc bleeding w NSAIDs, anticoag, anti platelet!!!!!!!!!!!!!!!
SSRIs drug to drug interaction (pharmacokinetic) - ANS CYP450 inhibition
fluoxetine/paroxetine (inhibit 2D6)
fluvoxamine (inhibit 1A2 and 2C19)
What are some SSRIs plus? - ANS new antidepressants
vilazodone(TAKE W FOOD)
vortioxetine (improve cognitive progssing speed)
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