Anti-Depressants and Mood Stabilizers Flashcards
what are the safest depression drugs for pregnant patients?
setraline, citalopram, fluoxetine
all SSRIs
MAO Inhibitors
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
what are the toxicities and interactions of MAOIs?
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
what are the symptoms of hypertensive crisis?
occipital headache stiff neck nausea/vomiting photophobia palpitations
name the drugs that can cause serotonin syndrome?
SSRIs TCAs Meperidine dextromethorphan tramadol triptans linezolid St Johns Wort
TCA’s
Block NE and 5-HT reuptake - NET and SERT
Block alpha1, M and H1 receptors
CYP2D6 - slow metabolizers
TCA Toxicities
serotonin syndrome
coma, convulsions and cardiotoxicity - give sodium bicarbonate
symptoms of serotonin syndrome
rigidity, hyperthermia, hypertension, tachycardia, myclonus, delirium, confusion and GI symptoms
happens within 24 hours
treatment of serotonin syndrome
benzodiazepines, cyproheptadine and ventilation
Imipramine
TCA
enuresis
desipramine
TCA
least anticholinergic effects
clomipramine
TCA
for depression but also useful for OCD
amytriptyline
TCA
also, used for neuropathic pain, migraine
Nortriptyline
TCA
Doxepin
TCA
Amoxapine
TCA that has some D2 blockade - parkinsonian like symptoms
Fluoxetine
SSRI
Fluvoxamine
SSRI
Paroxetine
SSRI
Sertraline
SSRI
safer for pregnant patients
Citalopram
SSRI
safer for pregnant patients
Escitalopram
SSRI
uses for SSRI’s
depression OCD panic disorder bulimia anorexia PTSD prementrual dysphoric disorder
characteristics of SSRI’s
5-HT specific
fewer ANS symptoms than TCAs
-less serious overdose symptoms
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)
What are the SNRI’s
Duloxetine
Venlafaxine
Desvenlafaxine
Milnacipran
SNRI’s characteristics
serotonin and norepinephrine reuptake inhibitors
no effect on H1, alpha1 or M receptors
used for depression, fibromyalgia and neuropathic pain
bupropion - mechanism
inhibit DAT, NET and inhibits dopamine and norepinephrine
little M and H1 effects
bupropion effects
no sexual effects
inhibits cyp 2D6
reduces seizure threshold - anorexia
noncompetitive antagonist of nicotinic receptor - smoking cessation
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
trazodone
serotonin reuptake inhibitor and blocker
H1 blockade - sedation
alpha1 blockade - priapism
increased levels of trazodone with inhibitors CYP3A4
other drug is nefazodone - hepatotoxic
drugs for treating acute mania
lithium
valproate
carbamazepine
lamotrifine
atypical antipsychotics
lithium - mechanism and uses
blocks inosine 5-monophosphatase
lithium has a narrow TI
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
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
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
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
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
inducers of CYP3A4
carbemazepine
phenytoin
phenobarbital
rifampin
griseofulvin
lamotrigine
potentiates GABA, blocks voltage-gated Na+ channels and glutamate blockade
what are atypical antipsychotics used for in mood disorders?
they are approved for mania - aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone
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
aripiprazole
partial D2 agonist
5-HT2A antagonist
Partial 5-HT1a agonist
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
quetiapine
D2 blocker, binds for short period
minimal muscarinic, H1 and Alpha1
risperidone
hypotension from alpha1 blockade
increase prolactin, hyperlipidemia and hyperglycemia
ziprasidone
blocks 5-HT and NE uptake
skin reaction and eosinophilia
