Final pharm exam (1).docx

Least side effects third line atypical or tca adhd

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Least side effects Third line Atypical or TCA ADHD Strattera (Atomoxetine) Basics First FDA-approved nonstimulant Noradrenergic reuptake inhibitor Metabolized by cytochrome P450 (drug interactions) Prohibited for use with glaucoma or MAO inhibitor Cannot be used concurrently with albuterol Requires caution with hypertension, tachycardia, cardiovascular or cerebrovascular disease Facts Unique to Strattera Possibility of suicidal ideation calls for screening and close monitoring. Liver damage can occur. Effect is not always immediate. Dose can be BID if needed. Side Effects of Strattera Common GI discomfort Appetite decrease Mood swings Blood pressure increase Rare Liver injury Mania Agitation and/or mood swings Alpha-2 Agonists: Clonidine Good mood stabilizer Effective nonstimulant alternative to Strattera Capable of controlling tics Recently finding more favor in LA form instead of SA Side Effects of Clonidine Hypotension Dry mouth Oversedation Rebound hypertension if abruptly stopped: always taper! ANXIETY Varieties of Benzodiazepines Short acting Ativan (lorazepam) Xanax (alprazolam) Serax (oxazepam) Intermediate acting Valium (diazepam) Long acting Klonopin (clonazepam) Librium (chlordiazepoxide) How Benzodiazepines Work Bind to molecular components of GABAA receptors in central nervous system's neuronal membranes Potentiate GABA-ergic inhibition at all levels of central nervous system Firing rate of critical neurons is decreased in many regions of brain Best used intermittently, in low doses Benzodiazepine Antagonist Romazicon, usually delivered IV Serotonergic Anxiolytics Serotonin has 15 different receptors, so it makes sense that these agents are effective against anxiety Buspirone From azapirone chemical class Chemically similar to Haldol or Clozaril No extrapyramidal syndromes Little risk of dependency Can be used in high doses Approved for treatment of anxiety No effect on GABA system, so do not use for benzodiazepine withdrawal Side Effects of Buspirone Dry mouth Lightheadedness Headache Insomnia Interaction with MAO inhibitors or SSRIs may potentiate serotonin syndrome Typical dosage: Three times per day Classes of Antidepressants Serotonin reuptake inhibitor (SSRI) + Partial antagonist of 5-HT1A receptor Viibryd Serotonin reuptake inhibitors (SSRIs)
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Serotonin-norepinephrine reuptake inhibitors (SNRIs) Effexor (venlafaxine) Also used for hot flashes, menopause in women who cannot take hormones Cymbalta (duloxetine) Savella (milnacipran) Also used for fibromyalgia, neuropathic pain Classes of Antidepressants (cont.) Mixed reuptake and neuroreceptor antagonists Tricyclics- Elavil (amitriptyline) Monoamine oxidase inhibitors (MAOIs) Nardil (phenelzine) Not used so much anymore Decrease metabolic inactivation of catecholamines Multiple side effects and interactions with other drugs and foods Classes of Antidepressants (cont.) Serotonin receptor antagonists Remeron (mirtazapine) Oleptro (trazodone) Antidepressant/antianxiety Alpha-2 antagonist Fewer side effects than tricyclics Aminoketone
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  • Summer '17
  • Selective serotonin reuptake inhibitor, Serotonin Syndrome, cimetidine, griseofulvin

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