3. Segars Antidepressants and Mood Stabilizers Flashcards by Sarah Mahonski | Brainscape

Q

What drug is indicated for nicotine withdrawl?

A

Buproprion (zyban)

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Q

What drug is indicated for enuresis (involuntary urination)?

A

Imipramine - Tertiary amine TCA

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Q

What drug is indicated for:

diabetic peripheral neuropathy
fibromyalgia
stress incontinence
chronic MSK pain?

A

Duloxetine -SNRI

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Q

What are the 5 R’s of Antidepressant Efficacy?

A

Response–> more than 50% reduction in sx (not well, just better)
Remission –> sx free (well functioning state) less than 6 months
Recovery –>not cured, 6-12 months of remisssion
Relapse –> return of sx after remission but before recovery
Recurrence –> return of sx after recovery

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Q

What do you do if a patient doesn’t respond fro an antidepressant after ~ 8 week trial?

A

Switch to another antidepressant with a different MOA

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Q

What are signs of an antidepressant withdrawal syndrome?

A

FINISH

Flu like sx
Insomnia
Nausea
Imbalance
Sensory Disturbances
Hyperarousal

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Q

Citalopram
Escitalopram
Fluoxetine
Paroxeitine 
Sertraline
Vilazodone
Vortioxetine

are what type of drugs?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Citalopram is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Escitalopram is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Fluoxetine is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Paroxetine is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Setraline is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT

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Q

Vilazodone is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT
partial agonist on 5-HT 1A

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Q

Vortioxetine is what?

A

SSRI -selectivly inhibit the pre-synaptic reuptake of Serotonin via presynaptic transporter SERT
Partial agonist off 5-HT1B and full agonist on 5-HT-1D

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Q

Do SSRIs or TCAs have more side effects?

A

TCA- SSRIs have less impact on histamine, muscarinic, and adrenergic receptors

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Q

CNS (sedation or insomnia/agitation/nervousness)
Sexual dysfunction (change in libido/impotence)
Weight gain (adults) / Weight loss (mild; adolescents)
Acute withdrawal reactions (concern w/ all categories)

Are primary side effects of what drug class?

A

SSRI

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Q

What is serotonin syndrome? What can cause it?

A

Sx: sweating, hyperreflexia, Akathisia/myoclonus, shivering/tremors
Serious dose dependent side effect of SSRI

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Q

What are rare dose dependent toxicities of SSRI?

A

QT prolongation
Hyponatremia (SIADH)
Serotonin syndrome
suicidality ( high risk in children, adolescents, and young adults

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Q

What SSRI has the most interactions with CYP450?

A

Fluoxetine - strong and broad CYP450 inhibitor

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Q

Which SSRI has the least amount of Reactions with CYP450? (2)

A

Vortioxetine and Escitalopram

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Q

What SSRIs are mild CYP 450 inhibitors? (3)

A

Citalopram
sertraline
vilazodone

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Q

What are SNRIs (including TCA)?

A

Selectivly inhibit the pre-synaptic reuptake of serotonin via SERT and Norepinephrine via NET

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Q

How do tertiary amines TCAs clomipramine, amitriptyline, Doxepin, and Imipramine TCAs work?

A

inhibit both NE/5-HT relatively equally

(Clomiprmaine/ Amitriptyline impact 5HT more)

more anticholinergic effects than secondary TCAs

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Q

How do secondary amine TCAs work?

Amoxapine, Desipramine, Nortriptyline

A

Inhibit NE>5HT

Q

Do SNRIs generally affect 5HT or NE reuptake more?

A

5HT>NE

Q

What is tertiary TCA Amine is metabolized to secondary amine TCA Nortriptyline?

A

Amitriptyline

Q

What tertiary amine TCA is metabolized to Despiramine?

A

Imipramine

Q

What receptors do TCAs impact in addition to NET and SERT?

A

Histamine (H1)
Muscarinic (cholinergic)
alpha 1 (adrenergic)

Q

What are TCA side effects?

A

Cardiovascular (a1)–> tachycardia, orthostatic hypotension, dysrhytmias
Anticholinergic (muscarinic)–> Dry mouth, Urinary retention/Constipation, Blurred vision/ increased intraoccular pressure
CNS (histamine) – >Sedation/fatigue, dizziness/seizures

Q

What can result from toxic ingestion of TCAs?

A

3 C’s:

Coma
Cardiotoxicity (conduction abnormalities)
Convulsions

Q

What type of drugs are Nefazodone, and Trazodone?

A

SARA

two agents that that act like SSRIs
selectively block at post synaptic a1 receptors on norAdrenergic neurons
block post synaptic 5-HT2 receptors
Also bloc H1 and cause sedation

Q

What type of drug is Mirtazapine?

A

SARA
- blocks presynaptic a2 receptors on norAdrenergic and Serotonergic 5HT neurons

blocks post synaptic 5-HT(2/3) receptors
Blocks H1
No SERT/NET activity

Q

What are the SARA side effects (H1/a1)?

A

CNS: sedation (most with Trazodone/Mirtazapine)
Orthostatic HTN (most with Trazodone)
weight gain (most with mirtazapine)

Q

What are NDRIs?

A

antidepressants that selectively inhibit presynaptic Reuptake of NE (via NET) and Dopamine (via DAT)

enhanced, prolonged NE and DA neurotransmission to post-synaptic receptors
enhances presynaptic release of NE and DA via VMAT2

Q

What type of drug is buproprion?

A

NDRI

Q

Agitation/Insomnia (stimulating)–> HTN/Tachycardia/tremors
Weightloss
Seizures (dose-dependent or those at risk)

are side effects of what drugs?

A

NDRI’s

Q

What do MAO inhibitors do?

A

Increase levels of monoamines in neuronal vesicles

2. increase the amount of NE, 5-HT and DA released

Q

Isocarboazid, Phenelzine, Selegiline, and Tranylcypromine are what type of drugs?

A

MAOI’s

Q

What type of MAOI’s are irreversible?

A

Oral agents

Q

All MAOIs are nonselective against MAO A/B except what?

A

Selegiline is B selective–> nonselective at high doses

Q

What MAOI is a patch?

A

Selegiline

Q

Isocarboxazid
Phenelzine
Selegiline (patch)
Tranylcypromine

are what types of drugs?

A

MAOIs

Q

MAOI’s can interact with what drugs?

A

5-HT/NE affecting drugs
-there is a 2 week wash out period for fluoxetine, can take 5 weeks for it to leave the system making interactions possible

Q

A major concern of MAOI’s is what?

A

Hypertensive Crisis

Signs:

severe headache
sweating/severe anxiety
nosebleeds
tachycardia
chest pain

Q

What miscellaneous antidepressant is an NMDA receptor (glutamate) antagonist) that is indicated for treatment-resistant depression in conjunction with ongoing antidepressant therapy?

A

Esketamine- S isomer of ketamine

nasal administration by an REMs authorized physician and must be monitored 2 hrs post dose for blood person, and cognitive impairtment

Q

What miscellaneous antidepressant is a GABA (A) receptor positive allosteric modulator that is identical to endogenous alloprenanolone and used to treat post partum depression?

A

Brexanolone

sounds like pregnenolone

Q

How long does GABA(A) receptor positive allosteric modulatorBrexanolone last?

A

efficacy lasts up to 30 days post does

Q

Anti-seizure agents carbamazepine, Lamotrigine, and valproic acid; and lithium are used to treat what aspect of mood disorders?

A

Mood stabalizers

Q

What are the targets of lithium as a mood stabilizer?

A

Brain Structure
Neurotransmitter modulation
Intracellular changes

Q

What neurotransmitter transmission is inhibited by lithium?

A

dopamine

-Li+ interferes with Gs anGi activity keeping them in the inactive state

Q

What receptor is down regulated by lithium?

A

NMDA receptor in chronic use

Q

Lithium increase the neuronstransmission of what?

A

GABA

Q

What drug is a monovalent ion that compete with Na+ for kidney reabsorption?

A

Lithium

-

Q

Accumulation of Lithium in the principle cells of the collecting duct can lead to what?

A

resistance to ADH
Polyuria/Polydipsia

**Nephrogenic Diabetes insidious is a big side effect

Q

What drugs interact with lithium?

A

Diuretics
ACEIs
NSAIDs

Q

What are the indications of Lithium?

A

acute maintenance and treatment of mania/ bipolar I disorder
Augmentation for patients in unipolar depressive patients with inadequate response to antidepressant therapy
Off label reduces risk of suicide and mortality in patients with mood disorders

Q

What is the use of Valproic acid/Divalproex as a mood stabilizer?

A

acute bipolar I (with or without psychotic features)

Q

What is the use of Lamotrigine as an mood stabilizer?

A

lamotrigine is used for maintenance of Bipolar I and II

Q

What is the use of carbamazepine as a mood stabilizer?

A

acute maintenance treatment of acute mania and mixed episodes of bipolar I

carbamazepine is a major CYP450 inducer