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Behavioral science > anti depressants and mood stabilizers: Segars > Flashcards

anti depressants and mood stabilizers: Segars Flashcards

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1
Q

what antidepressant is indicated in nicotine withdrawal

A

-bupropion

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2
Q

what antidepressant is indicated in Enuresis (bed wetting)?

A

-Imipramine

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3
Q

What antidepressant is indicated in Diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain

A

Duloxetine

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4
Q

what antidepressant is indicated in stress incontinence?

A

Duloxetine

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5
Q

what are the different categories of antidepressants?

A
  • Tricyclics (TCA’s): tertiary amines and secondary amines
  • Heterocyclics or atypicals
  • SSRIs
  • SNRIs
  • MAOIs
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6
Q

what are the Tertiary amine TCAs

A
  • Amitriptyline
  • Clomipramine
  • Doxepin
  • Imipramine
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7
Q

what are the secondary amine TCAs

A
  • Amoxapine
  • Desipramine
  • Nortriptyline
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8
Q

what are the Heterocyclic or atypicals

A
  • Bupropion
  • Mirtazapine
  • Nefazodone
  • Trazodone
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9
Q

what are the SSRIs

A
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Vilazodone
  • Vortioxetine
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10
Q

What are the SNRIs

A
  • Desvenlafaxine
  • Duloxetine
  • Venlafaxine
  • Levomilnacipran
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11
Q

what are the MAOIs

A
  • Isocarboxazid
  • Phenelzine
  • Selegiline
  • Tranycypromine
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12
Q

what receptor do SSRIs block

A

SERT

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13
Q

Common Side effects of SSRIs

A
  • CNS: sedations or insomnia/agitation/nervousness
  • Sexual Dysfunction
  • Weight gain or loss
  • Acute withdrawal reactions (concern w/ all categories): flu-like symptoms
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14
Q

Rare but serious side effects of SSRIs

A
  • QT prolongations
  • Hyponatremia
  • Serotonin syndrome: sweating, HYPERREFLEXIA, akathisia/myoclonus, shivering/tremors
  • Suicidality
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15
Q

what SSRI has the stongest CYP450 inhibition?

What others are mild inhibitors

A

Fluoxetine

-Citalopram and Sertraline

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16
Q

what 2 classes of antidepressants inhibit reuptake of serotonin via SERT AND norepinephrine via NET

A
  • TCAs and SNRIs
  • Tertiary TCA: equally
  • Seconday: NE>5-HT
17
Q

what drug inhibits reuptake of serotonin, norepi, and Dopamine

A

Amoxapine

18
Q

what are the 3 receptor mediated groups of side effects for TCAs

A
  • Cardiovascular (alpha)
  • Anticholinergic (muscarinic)
  • CNS (histamine)
19
Q

3 C’s for toxic ingestion of TCAs

A
  • Coma
  • Cardiotoxicity
  • Convulsions
20
Q

explain the cardiotoxicity of TCAs

A
  • quinidine like effect
  • slows phase 0 by block Na channels
  • long QRS
21
Q

Non TCA SNRIs have similar SEs to SSRI except less risk of what?

A
  • sexual dysfunction

- except higher risk with venlafaxine

22
Q

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

A
  • Trazodone

- Nefazodone

23
Q

What agent selective blocks PRE-synaptic a2 receptors on NE and 5HT neurons

A
  • Mirtazapine

- No SERT/NET activity

24
Q

What inhibits pre synaptic reuptake of NE via NET and dopamine via DAT (NDRI)

A

Bupropion

25
Q

what is the dose dependent side effect of Bupropion

A

Seizures

26
Q

all the MAOIs are non selective except which one

A

Selegiline . . B selective

-become non selective at high doses

27
Q

how is the antidepressant Selegiline administered

A

patch

28
Q

whats the high yield drug interaction with MAOIs

A
  • interact with 5HT and NE affecting drugs

- need a 2 week wash out period (fluoxetine; 5 weeks)

29
Q

what is the major concern with MAOIs

A

hypertensive crisis

30
Q

Describe the 5 R’s to antidepressant efficacy

A
  • 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
31
Q

MOA of Lithium

A

-inhibits Ca-dependent and depolarization provoked release of NE and DA

32
Q

Side effects of Lithium

A
  • polyuria (polydipsia)

- clinical picture of nephrogenic diabetes insipidus

33
Q

Structure of Lithium

A
  • monovalent ion
  • handled by kidneys similar to Na/K
  • competes with Na for reabsorption
34
Q

Drug interactions with Lithium and other drugs that impact Na/K

A
  • Diuretics (especially thiazides, hydrochlorothiazide)
  • ACEIs: especially Lisinopril
  • NSAIDs
35
Q

why is lithium difficult to monitor

A

narrow therapeutic agent

-.6-1.0 mEq/mL

36
Q

what mood stabilizer is a major CYP450 inhibitor

A

Carbamazepine

Behavioral science (18 decks)

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