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Psych > Anti-Depressants and Mood Stabilizers -- Segars > Flashcards

Anti-Depressants and Mood Stabilizers -- Segars Flashcards

1
Q

TCAs - drugs (2 classes) - 6 total

A

Despiramine, Nortriptyline, Imipramine, Amitriptyline, Doxepin

Amoxapine

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2
Q

TCAs - MoA

Like what other class?

A

Block reuptake of NE and 5-HT from synaptic cleft

SNRI’s

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3
Q

***TCAs - side effects

A

Anti-alpha: tachy, ortho hypotension, dysrhythmias

Anti-muscarinic: dry mouth, urinary retention, blurred vision

Anti-histamine: sedation

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4
Q

TCAs - overdose

A

3 Cs – coma, cardiotoxicity, convulsions

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5
Q

How does TCA overdose cause cardiotoxicity?

Like what?

A

Sodium channel blockade (like Quinidine or Class 1A antiarrhythmics) –> slows conduction –> sloped phase 0, prolonged repolarization

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6
Q

SSRIs - drugs (7)

A 
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodone
Vortioxetine

FLashbacks PARalyze SEnior CITizens

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7
Q

SSRIs - MoA

A

Selective inhibition of SEROTONIN reuptake by SERT –> enhanced, prolonged serotonin neurotransmission

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8
Q

Why are SSRIs better than TCAs?

A

MUCH less side effects

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9
Q

Mental status changes, muscle stiffness and hyperreflexia, autonomic instability (sweating, shivering, tremors), hyperthermia

What can cause it?

How to remember?

A

Serotonin syndrome

ANYTHING that increases serotonin (SSRIs, TCAs, MAOIs)

3 A’s

  • Activity of neuromuscular (clonus, hyperreflexia, hypertonia, tremor, seizure)
  • Autonomic instability (hyperthermia, diaphoresis, diarrhea)
  • Agitation (mental)
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10
Q

CYP450 inhibitor (SSRI)

LEAST inhibition of CYP450 (SSRI)

A

Fluoxetine

Citalopram/Sertraline

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11
Q

SSRIs - side effects

SNRIs (non-TCAs) - side effects

SARAs - side effects

A 
Serotonin syndrome
Sedation
Insomnia
Weight gain
GI distress

SAME

SAME

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12
Q

SNRIs (non-TCAs) - drugs (4)

A

Venlafaxine/Desvenlafaxine
Duloxetine
Levomilnacipran

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13
Q

SARAs - drugs (3)

MoAs of each

A

Mirtazapine - block pre-synaptic alpha-2 receptors, 5-HT2 receptors, 5-HT3 receptors, and H1 receptors

Nefazodone, Trazodone - block receptors: 5-HT (SSRI), 5-HT2a, and alpha-1 (post-synaptic)

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14
Q

Specific SARA side effect that may be used purposefully?

A

Sedation (Mirtazapine) - for insomnia + depression

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15
Q

Bupropion - MoA

Use?

Major side effect?

A

NDRI – inhibits re-uptake of NE (NET) and dopamine (DAT)

Smoking cessation

Agitation/insomnia (stimulation)

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16
Q

MAOs - MoA

Drugs? (4)

A

IRREVERSIBLY inhibit MOA, increasing NE, 5-HT, and DA

MAO Takes Pride In Shanghai

  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline
17
Q

MAOs - side effects

Major one? Explain.

A

Tranylcypromine = stimulation/insomnia
- Amphetamine derivative

Expected SEs (ortho hypo, sexual dysfunction, weight gain)

  • **Hypertensive crisis – ingest TYRAMINE (cheese, wine) and get significant catecholamine release
    • MAO-A in GI is required for tyramine metabolism
18
Q

MAOs - caution in who?

A

Anyone on another 5-HT/NE affecting drug…

- Sympathomimetics, anti-HTNs, SSRIs, TCAs, SNRIs, etc.

19
Q

Which MAO is good for avoiding hypertensive crisis?

A

Selegiline - low dose

20
Q

Enuresis - treatment

A

Imipramine (TCA)

21
Q

Neuromuscular pain, fibromyalgia, diabetic peripheral neuropathy…treatment?

A

Duloxetine

22
Q

Stress incontinence…treatment?

A

Duloxetine

23
Q

Mood Stabilizer drugs (4)

What are the first 3?

A

Carbamazepine
Lamotrigine
Valproic acid
Lithium

Anti-seizure meds

24
Q

Lithium - MoAs (2?)

A

Inhibits calcium-dependent and depolarization-provoked release of NE and DA

Inhibits inositol monophosphate, causing decreased cerebral inositol
- Valproate and Carbamazepine do a similar thing

25
Q

Lithium - used for what? (4)

A
  • Mania
  • Bipolar disorder
  • Suicide risk reduction in bipolar disorder
  • AUGMENTATION in UNIPOLAR depression
26
Q

***Lithium - drug interactions

A

Other agents that affect Na/K in the kidney…

  • Thiazides (Na loss, Li+ reabsorption)
  • Lisinopril
  • NSAIDs (altered renal perfusion)
27
Q

Issue w/ using Lithium

A

VERY narrow therapeutic window

28
Q

***Lithium - major side effects (2)

Others?

A

Nephrogenic diabetes insipidus, teratogen

Tremor, hypothyroidism (inhibits iodination), polyuria

LMNOP

29
Q

Differentiate uses of the anti-seizure meds in mood stabilization

A

Divalproex/Valproate = ACUTE bipolar

Carbamazepine = acute AND maintenance bipolar

Lamotrigine = maintenance bipolar TYPE 2 (no crazy mania)

30
Q

***Side effects of 3 anti-seizure meds used here

A

Carb = 3A4 INDUCER

Valproate = 2D6 INHIBITOR

Lam = 2C9 INHIBITOR

Psych (15 decks)

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