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Pharmacology > Anti-Depressants and Mood Stabilizers > Flashcards

Anti-Depressants and Mood Stabilizers Flashcards

1
Q

what are the safest depression drugs for pregnant patients?

A

setraline, citalopram, fluoxetine

all SSRIs

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2
Q

MAO Inhibitors

A

two types - MAO-A and MAO-B

MOA-A is used for refractory depression

increases NE, Epi, 5-HT and DA
Tyramine - interaction

Phenelzine, tranylcypromine, isocarboxazid

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3
Q

what are the toxicities and interactions of MAOIs?

A

hypertensive crisis

because of tyramine - foods are aged cheese and cured meats, red wine, chocolate, avocado, soy sauce and sauerkraut

alpha1 agonist increase NE

serotonin syndrome

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4
Q

what are the symptoms of hypertensive crisis?

A 
occipital headache 
stiff neck 
nausea/vomiting 
photophobia
palpitations
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5
Q

name the drugs that can cause serotonin syndrome?

A 
SSRIs
TCAs
Meperidine
dextromethorphan
tramadol
triptans
linezolid
St Johns Wort
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6
Q

TCA’s

A

Block NE and 5-HT reuptake - NET and SERT

Block alpha1, M and H1 receptors

CYP2D6 - slow metabolizers

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7
Q

TCA Toxicities

A

serotonin syndrome

coma, convulsions and cardiotoxicity - give sodium bicarbonate

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8
Q

symptoms of serotonin syndrome

A

rigidity, hyperthermia, hypertension, tachycardia, myclonus, delirium, confusion and GI symptoms

happens within 24 hours

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9
Q

treatment of serotonin syndrome

A

benzodiazepines, cyproheptadine and ventilation

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10
Q

Imipramine

A

TCA

enuresis

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11
Q

desipramine

A

TCA

least anticholinergic effects

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12
Q

clomipramine

A

TCA

for depression but also useful for OCD

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13
Q

amytriptyline

A

TCA

also, used for neuropathic pain, migraine

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14
Q

Nortriptyline

A

TCA

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15
Q

Doxepin

A

TCA

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16
Q

Amoxapine

A

TCA that has some D2 blockade - parkinsonian like symptoms

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17
Q

Fluoxetine

A

SSRI

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18
Q

Fluvoxamine

A

SSRI

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19
Q

Paroxetine

20
Q

Sertraline

A

SSRI

safer for pregnant patients

21
Q

Citalopram

A

SSRI

safer for pregnant patients

22
Q

Escitalopram

23
Q

uses for SSRI’s

A 
depression 
OCD 
panic disorder 
bulimia 
anorexia
PTSD
prementrual dysphoric disorder
24
Q

characteristics of SSRI’s

A

5-HT specific

fewer ANS symptoms than TCAs
-less serious overdose symptoms

25
SSRI toxicity
insomnia, headache, nausea and vomiting bleeding abnormalities - platelets impotence - use phosphodiesterase inhibitors serotonin syndrome weight gain - from block of 5-HT-2c drug interactions - CYP 2D6 (most with fluoxetine)
26
What are the SNRI's
Duloxetine Venlafaxine Desvenlafaxine Milnacipran
27
SNRI's characteristics
serotonin and norepinephrine reuptake inhibitors no effect on H1, alpha1 or M receptors used for depression, fibromyalgia and neuropathic pain
28
bupropion - mechanism
inhibit DAT, NET and inhibits dopamine and norepinephrine little M and H1 effects
29
bupropion effects
no sexual effects inhibits cyp 2D6 reduces seizure threshold - anorexia noncompetitive antagonist of nicotinic receptor - smoking cessation
30
mirtazapine
tetracyclic antidepressant blocks alpha2 which increases NE and 5-HT release weight gain - H1, 5-HT block (good for eating disorders) - sedation no sexual dysfunction - blockade of 5-HT-2A No nausea - blockade of 5-HT3 anxiolytic - stimulates 5-HT-1A
31
trazodone
serotonin reuptake inhibitor and blocker H1 blockade - sedation alpha1 blockade - priapism increased levels of trazodone with inhibitors CYP3A4 other drug is nefazodone - hepatotoxic
32
drugs for treating acute mania
lithium valproate carbamazepine lamotrifine atypical antipsychotics
33
lithium - mechanism and uses
blocks inosine 5-monophosphatase lithium has a narrow TI
34
lithium - interactions
Na+ loss promotes Li+ reabsorption meaning there is toxicities with diuretics NSAIDs and ACE inhibitors facilitate Li+ reabsorption in proximal convoluted tubule amiloride enhances Li+ excretion
35
lithium - effects and toxicities
tremors - beta blocker leukocytosis - not related to infection polyuria and polydipsia because theres a loss of ADH response (amiloride) hypothyroidism - main thing, reason to stop use, decreases T3/4 and increases TSH ebstein anomaly - not for use in pregnancy
36
valproate acid - MOA and uses
broad spectrum mechanism - Na+ and T-type calcium channel block, decrease glutamate NMDA receptors, increases GABA receptor action and increases GABA synthesis, block degradation of GABA used for TC seizure, absonce and partial seizures, migraine prophalxis, alternative to lithium in bipolar disorder
37
valproate acid toxicity and effect
valproate syndrome - includes spina bifida, neural tube defects, autism weight gain hepatitis - check liver enzymes ALT inhibitor of CYP2D6 and CYP3A4
38
carbamazepine
blocks sodium channels and NE reuptake used for TC and partial seizures, trigeminal neuralgia and bipolar disorder effects - water intox, aplastic anemia, tertaogen, stevenjohnson syndrome (HLA variant) inducer of CYP3A4
39
inducers of CYP3A4
carbemazepine phenytoin phenobarbital rifampin griseofulvin
40
lamotrigine
potentiates GABA, blocks voltage-gated Na+ channels and glutamate blockade
41
what are atypical antipsychotics used for in mood disorders?
they are approved for mania - aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone
42
How do atypical antipsychotics work?
specific to 5-HT2 increase DA release which helps relieve the negative symptoms and some of the positive symptoms of psychosis All prolong QT interval
43
aripiprazole
partial D2 agonist 5-HT2A antagonist Partial 5-HT1a agonist
44
olanzapine
less ANS effects and fewer extrapyramidal effects causes weight gain and sedation approved for mania in combination with fluoxetine binds 5-HT2A most strongly
45
quetiapine
D2 blocker, binds for short period minimal muscarinic, H1 and Alpha1
46
risperidone
hypotension from alpha1 blockade increase prolactin, hyperlipidemia and hyperglycemia
47
ziprasidone
blocks 5-HT and NE uptake skin reaction and eosinophilia

Pharmacology (23 decks)

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