Antidepressants
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| Depression | is a mood disorder in which feeling of sadness, loss, anger, or frustration interfere with everyday life for several weeks or longer. MAO inhibitors are contraindicated for all antidepressant drugs.
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| Tricyclic Antidepressants | are 2nd line drugs, blocks the reuptake norepineprine and serotoniin,which increases the actin of both hormones (treats depression) Also blocks acetycholoine (treats enuresis). Are more toxic in overdose than other antidepressants.
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| Contraindications for TCAs | MAO inhibitor drugs
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| Black Box Warning for TCAs | risk for suicide, children to 24 years old
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| Administration for Imipramine | Bedtime to aid sleep and decrease daytime sedation.
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| Adverse affects of Imipramine a TCA | Sedation, orthostatic hypotension, cardiac dysrhythmias, anticholinergic symptoms, and weight gain
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| Selective Serotonin Reuptake Inhibitors (SSRIs) | first choice drugs, best taken in the AM; not approved in children younger than 18; also enzyme inducers; overdose produces symptoms like nausea, vomiting, agitation, hypomania, and restlessness.
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| Fluoxeline (Prozac) SSRI prototype | blocks serotonin which elevates the mood. Use for depression, anxiety, obessive-compulsive disorder, bulimia nervosa and premenstrual dysphoric disorder.
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| Adverse Effects of SSRIs | affects the CNS, sexual dysfunction, GI, increase GI bleeding and serotonin syndrome. For DM patients hypoglycemic effect.
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| Administration for SSRIs | one daily in the morning or evening (may interfer with sleep). May take with food.
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| Citalopram (Celexa) | Have active metabolites.
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| Excitalopram (Lexapro) | Reach steady concentrations in 1-2 weeks.
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| Sertraline (Zoloft) | Have active metabolite. Reach steady concentrations in 1-2 weeks.
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| Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) | Block uptake of serotonin and norepinephrine, which increases the level of serotonin and norepineprine. Use for depression and anxiety. First line treatment
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| Adverse Effects of SNRIs | CNS and cardiovascular, GI, sexual dysfunciton, dermatology effects, weight loss in old age.
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| Administation of SNRIs | PO with food.
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| Black Box Warning for SNRIs | rick for suicide, children to 24 years old. Cross placenta and may enter breast milk.
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| Venlafaxine (Effexor) | Serotonin Norepinephrine Reuptke Inhibitor
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| Desvenlafaxine (Pristiq) | Serotonin Norepinephrine Reuptke Inhibitor
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| Duloxetine (Cymbalta) | SNRI. Treats neuropathic pain and relieves painful physical symptoms r/t depression. Hepatic toxicity, ( do not drink alcohol with this drug).
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| Paroxetine (Paxil) | SSRI
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| Monoamine Oxidase Inhibitors | Third line treatment. Treats depression. Binds to MAO increasing epinephrine, norepinephrine, serotonin, and dopamine in the CNS.
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| Phenelzine (Nardil) | MAO
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| MAO adverse effects | Hypertensive crisis due to food containing tyramine and dysrhythmias, drowsiness, dizziness, sexual dysfunction, and orthostatic hypotension.
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| Administation of MAOs | Three times daily.
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| Contraindications of MAOs | Other MAO inhibitors, anesthesia, OTC cold and hay fever meds.
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| Buproprion (Wellbrutrin) | Prescribed for depression and smoking. Inhibits the reuptake of dopamine, norepinephrine, and serotonin. Treats depression take it with SSRI and for smoking. AE: seizures. No ae on cardiac system.
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