Pathophysiology
MDD, GAD, SAD, AND PD are all considered this type of disorder.
What is anxiety disorder?
Pathophysiology slide 4
This class of antidepressants is very lipophilic. Plasma protein binding and distribution in tissues is high. They have a 6-7-6 ring arrangement with an a side chain containing a terminal amine.
What are tricyclic antidepressants?
This SSRI has the longest half-life among the class and must be discontinued for 4 weeks or longer before starting an MAOI.
What is Fluoxetine?
Acute, Continuation, Maintenance
What are the three phases of Depression treatment?
Fluoxetine
What is Prozac?
Opioids, benzodiazepines, alcohol, isotretinoin, anticonvulsants, CCBS, barbiturates', interferon alpha, and levonorgesterone implants.
What are medications causing depressive symptoms?
Slide 7
Unlike other SSRIs, Citalopram and Escitalopram have a higher bioavailability because they don't go though this phase.
What is first-pass metabolism?
Fluvoxamine is an inhibitor of this CYP enzyme, which may cause an elevation of the plasma concentration enzyme substrates such as Diltiazem.
What is CYP3A4?
SSRI, SNRI, Mirtazapine, Bupropion +/-, and psychotherapy.
What is the First line treatment for moderate to severe depression?
Effexor
What is Venlafaxine?
Serotonin, Norepinephrine, and Dopamine are not functioning properly. Thus alters receptors on the pre- and post-synapse causing depressed symptoms.
What is Dysregulation?
Slide 11
DAILY DOUBLE!!
Isoniazid is considered to be hepatotoxic because of this attached reactive group.
What are hydrazines?
Drug classes such as TCAs, SNRIs, and Tetracyclic/Unicyclic Antidepressants combined with MAOIs can cause these two adverse reactions.
What are Serotonin Syndrome and Hypertensive crisis?
Starting dose CR:25mg/ Max Dose: 62.5mg
Most anticholinergic and has a pregnancy category D
What is Paroxetine (Paxil)?
Bupropion
What is Wellbutrin?
Cleaning, symmetry, forbidden thoughts, harm, and discarding (hoarding).
What are common OCD themes/dimensions?
This BDZ is metabolized to the same active metabolite as Diazepam, but the difference is that it's a prodrug.
What is Clorazepate?
This particular antidepressant drug can INDIRECTLY inhibit CYP2D6 and raise plasma concentration levels of certain substrates such as; Effexor, desipramine, and haloperidol and risperidone.
What is Bupropion?
For 3rd line treatment in Social Anxiety Disorder (SAD) patient will continue an SSRI plus this drug if partial response to SSRI.
What is Buspirone?
Remeron
What is Mirtazepine?
dysregulated, low cortisol release - prevents feedback inhibition. HPA and SNS disassociated, uncontrolled NE and epi release.
What is PTSD response?
This drug is considered a Short Acting BDZ with a half-life of 2hrs, because of this OH group this drug skips Phase I and goes straight to Phase II metabolism. It also has no active metabolite.
What is Temazepam?
All antidepressants have this black box warning.
What is Suicidal Ideation?
This drug is a NE and DA Reuptake inhibitor and has an increased risk of seizures after 300-350mg.
What is bupropion (Wellbutrin)?
Desvenlafaxine
What is Pristiq?
DAILY DOUBLE!!
PD occurs due to decrease volume in parts of the brain, decrease in BDZ-receptors, and serotonin. The decrease in serotonin leads to anxiety and alters this.
What is GABA?
5-HT1A partial agonist and reuptake inhibitor. Not hepatotoxic and has a one week onset effect. Very potent inhibitor of CYP2C8.
What is Vilazodone?
This drugs MOA is an A2 receptor antagonist and a 5HT2/3 receptor antagonist. Increasing serotonin reuptake in the 5HT1A.
What is Mirtazapine?
Buspirone, Lithium (therapeutic levels=0.6-1 mEq/L), Liothyronine (T3) regardless of thyroid status, SGAs for treatment resistance (only when psychotic features are present), or St. Johns Wort.
What is 3rd line option: Augmentation of Therapy?
Trintellix
What is Vortioxetine?