SSRIs, SNRIs, TCAs, MAOIs, antipsychotics, mood stabilizers and benzodiazepines: mechanisms, side effects and monitoring.
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- What is the primary mechanism of action of SSRIs?
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They block reuptake of serotonin (5-HT) at the presynaptic neuron, increasing synaptic serotonin levels.- Name a commonly used SSRI.
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Fluoxetine (also sertraline, escitalopram, paroxetine).- What sexual side effect is commonly associated with SSRIs?
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Sexual dysfunction (decreased libido, delayed orgasm).- What GI side effects are common when starting an SSRI?
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Nausea and other GI upset.- What is the FDA black box warning for SSRIs in young patients?
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Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.- What triad of symptoms characterizes serotonin syndrome?
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Mental status changes, autonomic instability, and neuromuscular abnormalities (e.g., clonus, hyperreflexia).- What is the mechanism of action of SNRIs?
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They block reuptake of both serotonin and norepinephrine.- Name a commonly used SNRI.
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Venlafaxine (also duloxetine).- What cardiovascular effect should be monitored with SNRIs?
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Increased blood pressure.- What is the mechanism of action of tricyclic antidepressants (TCAs)?
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They inhibit reuptake of serotonin and norepinephrine, with additional anticholinergic, antihistaminic, and alpha-adrenergic blocking effects.- Name a commonly used TCA.
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Amitriptyline (also nortriptyline, imipramine).- What class of side effects is characteristic of TCAs due to receptor blockade?
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Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention).- Why are TCAs particularly dangerous in overdose?
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They can cause fatal cardiac arrhythmias due to sodium channel blockade.- What test should be monitored in patients on TCAs, especially with cardiac history?
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ECG (to monitor for QT prolongation and conduction abnormalities).- What is the mechanism of action of MAOIs?
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They inhibit monoamine oxidase, preventing breakdown of serotonin, norepinephrine, and dopamine.
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