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Drugs for Depressive Disorders

Terms in this set (11)

SSRI's
-selective serotonin reuptake inhibitors
-1st line tx for major depressive disorder
-discontinuation syndrome (taper slowly)
-can either sedate or activate
-contraindicated with MAOI's
-adverse effects: fatigue, N&D, dry mouth, dizziness, tremor, lack of sex drive/ sex dysfunction

-citalopram
-fluoxetine
-paroxetine
-sertraline
-escitalopram
SNRI's
-venlafaxine
-duloxetine

-venlafaxine popular next step strategy after SSRIs
-dul can decrease pain
-monitor blood pressure
-discontinuation syndome
NRI's
contraindicated in ppl taking MAOI's
NDRI's
-bupropion
-not indicated for pts <18
-may increase sexual desire
-aid to quit smoking
-contraindicated for MAOI's
SNDI's
-serotonin NE disinhibitors
-mirtazepine
-contraindicated with MAOI's
TCA's
-inhibits reuptake of serotonin and NE
-similar effects to SSRI's but more adverse effects
-can worsen heart or other medical conditions
-lethal in OD
-contraindicated with MAOI's

-amitryptyline
-clomipramine
-nortriptyline
MAOI's
-phenelzine
-tranylcypromine
-moclobemide

-inhibits enzyme monoamine oxidase which normally breaks down neurotransmitters, including seritonin and NE
-TYRAMINE CONTRAINDICATION-> can lead to hypertensive crisis
Hypertensive crisis
...
serotonin syndrome symptoms
-hyperactivity or restlessess
-tachycardia -> CVS shock
-fever-> hyperpyrexia
-high blood pressure
-delerium
-irrational, mood swings, hostility
-seizures
-myoclonis, incoordination, tonic rigidity
-abdo pain, diarreah, bloating
-apnea->death

Slide:
-hyperreflexia, agitation, mydryasis, tachycadia, hypertensive, clonus, tremor, increased bowel sounds, diaphoresis
serotonin syndrome interventions
-remove offending agents
-initiate symptomatic tx (seritonin recpetor blockade with cyproheptadine, methysergide, propanolol)
-cooling blankets, chlorpromazine for hyperthermia,
-dantrolene, diazepam for muscle rigidity or rigours
-anticonvulsants
-artificial ventilation
-paralysis?
toxic effects of MAOI's
-HYPERTENSIVE CRISIS
-severe headache
-tachycardia, palpitations
-hypertension
-nausea and vomiting
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