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Psychiatry - Pharmacology > Antidepressants and antianxiety > Flashcards

Antidepressants and antianxiety Flashcards

1
Q

What is the mechanism of lithium?

A

not established, possibly related to inhibition of phophoinositol cascade

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2
Q

What is the clinical use of lithium?

A
  • Mood stabilizer for bipolar disorder. Blocks relapse/acute manic events.
  • SIADH (decreases nephron sensitivity to ADH)
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3
Q

What are the main side effects of lithium?

A 
LMNPO"
Movement (tremors)
Nephrogenic DI
hypOthyroidism
Pregnancy problems
* narrow therapeutic window*
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4
Q

What teratogenic effects are associated with lithium?

A

Ebstein anomaly in newborn

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5
Q

Where is lithium excreted?

A

Kidneys. Most reabsorbed at PCT with Na+.

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6
Q

What diuretic use is implicated in lithium toxicity?

A

Thiazides

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7
Q

What is the mechanism of buspirone?

A

Stimulates 5-HT1A receptors

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8
Q

What is the clinical use of buspirone?

A

Generalized anxiety disorder.

*Does not cause sedation/addiction/tolerance.

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9
Q

How long does buspirone take to take effect?

A

1-2 weeks.

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10
Q

Does buspirone interact w/ alcohol?

A

No. (Vs barbituates/benzos).

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11
Q

What does the enzyme MAO do?

A

Converts norepi and epi to downstream metabolites (VMA)

Breaks down dopamine and 5-HT as well

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12
Q

What is the mechanism of SSRIs?

A

5-HT specific reuptake inhibitors

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13
Q

What is the clinical use of SSRIs?

A

Depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD

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14
Q

What are the side effects of SSRIs?

A

GI distress, SIADH, sexual dysfunction (anorgasmia, decr libido)

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15
Q

How long do SSRIs take to work?

A

4-8 weeks

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16
Q

What kinds of drugs cause serotonin syndrome?

A

Any drug that increases serotonin. MAOis, SNRIs, TCAs, SSRIs.

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17
Q

What characterizes serotonin syndrome?

A

Hyperthermia, confusion, CV instability, flushing, diarrhea, seizures, HYPERREFLEXIA.

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18
Q

What is the treatment for serotonin syndrome?

A

Cyproheptadine - 5HT2 receptor antagonist.

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19
Q

What class of drug are venlafaxine and duloxetine?

A

SNRIs

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20
Q

What is the mechanism of venlafaxine and duloxetine?

A

Inhibit 5-HT and norepi reuptake

21
Q

What is the clinical use of venlafaxine?

A

Depression and generalized anxiety disorder

22
Q

What is the clinical use of duloxetine?

A

Depression, diabetic peripheral neuropathy

23
Q

What is the toxicity of SNRIs?

A

HTN most common. Also stimulant effects, sedation, nausea.

24
Q

What drug class are amitriptyline, nortriptyline?

A

TCAs

25
Q

What drug class are imipramine, desipramine, clomipramine, amoxapine, and doxepin?

A

TCAs

26
Q

What is the mechanism of TCAs?

A

Inhibit 5-HT and norepi reuptake

27
Q

What is the clinical use of TCAs?

A

Major depression, peripheral neuropathy, chronic pain, migraine

28
Q

What is an additional clinical use of clomipramine?

A

OCD

29
Q

What are the serious side effects of TCAs?

A

Convulsions, Coma, Cardiotoxicity (arrythmias, long QT).

- Resp depression, hyperpyrexia, confusion/hallucinations in elderly.

30
Q

What are the anticholinergic and alpha1-blocking side effects of TCAs?

A

tachycardia, urinary retention, dry mouth.

alpha1: postural hypotension

31
Q

Which TCAs have more pronounced anticholinergic effects ?

A

3ry (amitryptyline > nortriptyline).

32
Q

What can be given w/ TCAs for prevent arrythmia?

A

NaHCO3.

33
Q

What drug class is tranylcypromine?

A

MAOi

34
Q

What drug class is phenelzine

A

MAOi

35
Q

What drug class is isocarboxazid?

A

MAOi

36
Q

What drug class is selegiline?

A

selective MAO-B inhibitor

37
Q

What is the mechanism of MAOis?

A

Inhibit MAO, decrease breakdown of “amine” neurotransmitters. Norepi, 5-HT, dopamine

38
Q

What is the clinical use for MAOis?

A

Atypical depression, anxiety

39
Q

What is the toxicty of MAOi + wine and cheese?

A

Wine and cheese contain tyramine. Precipitates hypertensive crisis.

40
Q

What other medications are contraindicated with MAOis?

A

SSRIs, TCAs, St. John’s wort, meperidine, dextromorphan –> prevent serotonin syndrome.

41
Q

What is the toxicity of MAOis?

A

HTN crisis, CNS stimulation

42
Q

What is the mechanism of bupropion?

A

Increases norepi and dopamine; mechanism unknown.

43
Q

What are the clinical uses of bupropion?

A

Depression, smoking cessation.

44
Q

What is the toxcity of bupropion?

A

Stimulant effects (tachy, insomnia), headache, seizures in anorexic/bulemic patients. No sexual side effects.

45
Q

What is the mechanism of mirtazapine?

A

Alpha-2 antagonist; increase release of norepi and 5-HT, and potent 5-HT2 and 5HT3 receptor antagonist.

46
Q

What is the toxicity of mirtazapine?

A

Sedation (can be desirable)
Incr appetite, weight gain (can be desirable)
Dry mouth

47
Q

What is the mechanism of trazodone?

A

Primarily blocks 5-HT2 and alpha1-adrenergic receptors.

48
Q

What is the clinical use of trazodone?

A

Used primarily for insomnia, as high doses are needed for antidepressant effects

49
Q

Toxicity of trazodone?

A

Sedation, nausea, postural hypertension, priapsim (trazoBONE)

Psychiatry - Pharmacology (3 decks)

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