Name the category.
CNS Agents
Name the 2 main drugs.
Duloxetine
Pregabalin
What kind of drug is duloxetine?
Serotonin-norepinephrine reuptake inhibitor
What is the mechanism of action?
inhibition of serotonin and norepinephrine reuptake in synaptic cleft → ↑ serotonin and norepinephrine levels
List indications for duloxetine.
Major depressive disorder (second-line therapy)
Generalized anxiety disorder
Neuropathic pain (e.g. diabetic neuropathy)
Duloxetine and milnacipran specifically: fibromyalgia
Stress incontinence in women: duloxetine
Venlafaxine specifically: social anxiety disorder, OCD, panic disorder, and PTSD
List side effects of duloxetine.
Similar profile to SSRIs
Stimulant effect
Increased blood pressure
Insomnia, strange dreams, nightmares
Can increase cholesterol and triglycerides
Nausea
What is the risk of duloxetine?
risk of serotonin syndrome if used concomitantly with other serotonergic drugs
What should be remembered in terms of blood pressure and duloxetine?
Blood pressure should be well-controlled before and after initiating SNRI therapy.
What kind of agent is pregabalin?
Second-generation anticonvulsant —> Gapapentinoids
List indications for pregabalin.
Drug combination for long-term treatment of focal seizures
Neuropathic pain
Neuralgia after herpes infection
What is the mechanism of action of pregabalin?
Inhibition of presynaptic P/Q-type Ca2+ channels via action on the α2δ-subunit → ↓ Ca2+ intracellular flow → ↓ glutamate release [1]
Does not bind to GABA receptors despite being a GABA analog
List adverse effects of pregabalin.
Somnolence
Ataxia
Impaired vision
Name a contraindication of pregabalin.
Hypersensitivity
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