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NURS 572 Pharm 32

Ch 32 Antidepressants

simplified MOA depression lack of monamines Ser, Nor
3 classes of antidepressants TCA, SSRIs, atypicals
MOA of TCAs has structure similar to phenothiazine --> similar SEs of blocking H-1, Alpha-1 and muscarinic. IS A NONSELECTIVE blocker of Nor and 5HT serotonin
MOA SSRI selectively blocks 5HT serotonin
MOA atypical antidepressants mixed 5HT/NE reuptake inhibitor
TCA general properties high ind variability, 1-3 week response, 1-2 month max effect. long half like
TCA SEs cardiotoxic (combo direct cardiac effect, anticholinergic effect) . . . orthostatic, sedation, paradoxical diaphoriesis, seizures, hypomania
name 4 TCAs imipramine, amitriptyline, desipramine, protriptyline
TCA moderately sedating imipramine
TCA VERY sedating, MANY SEs amitriptyline
TCA few SEs desipramine
TCA NOT sedating protriptyline
Major uses SSRI major depressive, OCD, GAD, PMDD, PTSD, bulimia, panic, social phobia
do SSRI's have orthostatic, sedative, anticholinergic, cardiotoxic SEs no - they ONLY selectively inhibit 5HT. Most are highly protein bound, long acting, CYP450 metabolism
common SSRIs SEs compliance limiting sexual dys, N/D, HA, CNS stimulation, sweating
What is important dosing SSRI must taper off to avoid serotonin syndrome
what is serotonin syndrome too much ser --> conf, disorientation, hallucinations, incoordination, sweat, tremore, dysphoria
S/S of serotonin withdrawal syndrome anxiety, dizz, HA, N, tremor, dysphoria
name 6 SSRIs citalopram, escitalopram, fluoxetine, fuvoxamine, poxetine, sertraline
SSRI with fewest interactions (2) citalopram, escitalopram
SSRI with longer half-lives (2) fluoxetine, sertraline
SSRI with relatively short action paroxetine
SSRI specific for OCD, shortest half-life fluvoxamine
atypical, also for smoking cessation bupropion
atypical, hepatotoxic nefazodone
atypical, more effective than SSRIs, dose related HTN significance venlafaxine
atypical, related to loxapine for added neuroleptic action (schizo & depression) amoxapine, which has SEs of EPS, TD, anticholingergic, sedations and seizures all possible SEs
atypical, VERY sedating, reported priapism trazodone
atypical SNRI, CNS and GI SEs duloxetine
Created by: lorrelaws