anti depressants and mood stabilizers: Segars Flashcards
what antidepressant is indicated in nicotine withdrawal
-bupropion
what antidepressant is indicated in Enuresis (bed wetting)?
-Imipramine
What antidepressant is indicated in Diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain
Duloxetine
what antidepressant is indicated in stress incontinence?
Duloxetine
what are the different categories of antidepressants?
- Tricyclics (TCA’s): tertiary amines and secondary amines
- Heterocyclics or atypicals
- SSRIs
- SNRIs
- MAOIs
what are the Tertiary amine TCAs
- Amitriptyline
- Clomipramine
- Doxepin
- Imipramine
what are the secondary amine TCAs
- Amoxapine
- Desipramine
- Nortriptyline
what are the Heterocyclic or atypicals
- Bupropion
- Mirtazapine
- Nefazodone
- Trazodone
what are the SSRIs
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
- Vilazodone
- Vortioxetine
What are the SNRIs
- Desvenlafaxine
- Duloxetine
- Venlafaxine
- Levomilnacipran
what are the MAOIs
- Isocarboxazid
- Phenelzine
- Selegiline
- Tranycypromine
what receptor do SSRIs block
SERT
Common Side effects of SSRIs
- CNS: sedations or insomnia/agitation/nervousness
- Sexual Dysfunction
- Weight gain or loss
- Acute withdrawal reactions (concern w/ all categories): flu-like symptoms
Rare but serious side effects of SSRIs
- QT prolongations
- Hyponatremia
- Serotonin syndrome: sweating, HYPERREFLEXIA, akathisia/myoclonus, shivering/tremors
- Suicidality
what SSRI has the stongest CYP450 inhibition?
What others are mild inhibitors
Fluoxetine
-Citalopram and Sertraline
what 2 classes of antidepressants inhibit reuptake of serotonin via SERT AND norepinephrine via NET
- TCAs and SNRIs
- Tertiary TCA: equally
- Seconday: NE>5-HT
what drug inhibits reuptake of serotonin, norepi, and Dopamine
Amoxapine
what are the 3 receptor mediated groups of side effects for TCAs
- Cardiovascular (alpha)
- Anticholinergic (muscarinic)
- CNS (histamine)
3 C’s for toxic ingestion of TCAs
- Coma
- Cardiotoxicity
- Convulsions
explain the cardiotoxicity of TCAs
- quinidine like effect
- slows phase 0 by block Na channels
- long QRS
Non TCA SNRIs have similar SEs to SSRI except less risk of what?
- sexual dysfunction
- except higher risk with venlafaxine
what are the 2 agents that act like SSRIs and also selectively block POST-synaptic a1 receptors on NE neurons and post-synaptic 5-HT receptors
- Trazodone
- Nefazodone
What agent selective blocks PRE-synaptic a2 receptors on NE and 5HT neurons
- Mirtazapine
- No SERT/NET activity
What inhibits pre synaptic reuptake of NE via NET and dopamine via DAT (NDRI)
Bupropion
what is the dose dependent side effect of Bupropion
Seizures
all the MAOIs are non selective except which one
Selegiline . . B selective
-become non selective at high doses
how is the antidepressant Selegiline administered
patch
whats the high yield drug interaction with MAOIs
- interact with 5HT and NE affecting drugs
- need a 2 week wash out period (fluoxetine; 5 weeks)
what is the major concern with MAOIs
hypertensive crisis
Describe the 5 R’s to antidepressant efficacy
- Response: >50% reduction in symptoms. not well but better . . Partial Response is >25% but <50%
- Remission: Symptom free (very low to no symptoms0
- Recovery: 2-6 months of ongoing Remission . . not cured
- Relapse: return of symptoms after Remission but before Recovery
- Recurrence: Return of symptoms after Recovery
MOA of Lithium
-inhibits Ca-dependent and depolarization provoked release of NE and DA
Side effects of Lithium
- polyuria (polydipsia)
- clinical picture of nephrogenic diabetes insipidus
Structure of Lithium
- monovalent ion
- handled by kidneys similar to Na/K
- competes with Na for reabsorption
Drug interactions with Lithium and other drugs that impact Na/K
- Diuretics (especially thiazides, hydrochlorothiazide)
- ACEIs: especially Lisinopril
- NSAIDs
why is lithium difficult to monitor
narrow therapeutic agent
-.6-1.0 mEq/mL
what mood stabilizer is a major CYP450 inhibitor
Carbamazepine
