Celexa, bc of increased risk of Qtc prolongation and torsades, should NOT be concurrently prescribed in what six situations?
- PImozide (neuroleptic, used for treatment resistant Tourettes)
- QT >500
- Cardiac problems (recent MI, uncompensated HF, Congenital long QT, hypoK or hypoMg, bradycardia.)
- Class 1A drugs: (Quinidine, Procainamide)
- Class 3 drugs: (Amiodarone, Sotalol )
- Medications that prolong QT
Celexa, bc of increased risk of Qtc prolongation and torsades, should be avoided in what (5) cardiac problems?
- recent MI
- uncompensated HF
- Congenital long QT
- hypoK or hypoMg
- bradycardia
What is the triad Serotonin Syndrome?
- Mental status change
- Neuromuscular change: hyperreflexia, myoclonus, ocular clonus shivering, rigidity
- Autonomic instability: Mydriasis, tachycardia, diaphoresis, diarrhea, vomit, fever.
Other than antidepressants, what (6) medication classes can cause serotonin syndrome?
- Antimigraine: Triptans
- Opioids
- Antiemetics: Odansatron, metoclopramide.
- Abx: Linezolid
- Supplements: St Johns wart, tryptophan
- drugs of abuse: MDMA, LSD, cocaine, amphetamines.
Serotonin Syndrome is similar in presentation with NMS….what are the key differences?
SS more likely to have:
- Shivering
- Hyperreflexia
- Myoclonus
- V/D
NMS more likely to have:
- Fever
- Muscle rigidity.
What is the mnemonic for anticholinergic toxicity?
Red as a beet Dry as a bone Hot as a hare Full as a flask mad as a hatter Blind as a bat
What are the common symptoms of Serotonergic Antidepressant Discontinuation Syndrome?
- Dizziness
- Flu-like
- Insomnia
4 Nausea - “shock like” sensation
- Reemergence of anxiety and mood symptoms.
What is the MOA of Bupropion?
NE and DA reuptake inhibitor.
What is the MOA of Mirtazapine?
alpha-2 presynaptic antagonist (causing increased release of Monoamines from presynaptic neuron)
5-HT2 and 5-HT3 antagonist (so little GI or sexual SE)
What are the SE of Mirtazapine to be aware of?
- Neutropenia (1:1000)
- Sedation at low dose, activation at higher dose.
- HTN (increase adrenergic drive)
- Hypotension (alpha 1 antagonism)
- Weight gain, increased appetite, dizziness, constipation.
