Amitriptyline

^^ lipophilicity (can deseat warfarin in blood)

^^ first pass metabolism

MOA: inhibit storage + reuptake of serotinin + NE (theraputic)

inhibits α₁, histamine and cholinergic receptors (adverse)

ADRs: hypotension, drowsiness, lower seizure threshold, conduction disturbance 

anti SLUD: salivate, lacrimate, urinate, defecate

Heterocyclic

less sexual dysfunction

venlafaxine

desvenlafavine

heterocyclic

Seritonergic norepinephrine reuptake inhibitor

SNRI

heterocyclic

Seritonergic norepinephrine reuptake inhibitor

SNRI

2nd gen: trazodone, bupropion

3rd gen: venlafaxine, mirtazapine, nefazodone, duloxetine

ADRs: nauseau, vomit, antihistamine

alpha 1 block:trazodone worst

HTN: venlafaxine worst

CNS stim: bupropion, venlafaxine

Liver failure: nefazodone

^ suicide : ALL

SSRIs

drug list

fluoxetine

paroxetine

citalopram

escitalopram

sertraline

Selective serotonin reuptake inhibitors

SSRIs

general

MOA: inhibit 5 ht reuptake

ADRs: nausea, vomiting, dry mouth, insomnia/drowsiness

sexual dysfunction (decreased libido not sympathetics)

increased suicide (adolescents)

Must wean off drug

cannot stop immediatly

combining SSRI with other agent causes ^^^5HT release in CNS

SSRI + MAOI, 2nd gen neuroleptic, sumatriptan

symptoms: similar to ecstasy intox

niaphoresis, hyperthermia, tachycardia, htn, myoclonus

Treatment: cyproheptadine(antihistamine and anti 5ht)

propranolol (for CV)

basically a SNRI

use- ADHD, not as good as stimulants

tranylcypromine

phenelzine

MAOIs

MOA: inhibit monoamine oxidase (which breaks NE and 5HT)

ADRs: very common, reason not more used

persistant mao inhibition for 2-3 weeks after discontinue