Antidepressants and antianxiety Flashcards by Saloni Malik

What is the mechanism of lithium?

not established, possibly related to inhibition of phophoinositol cascade

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What is the clinical use of lithium?

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

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What are the main side effects of lithium?

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

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What teratogenic effects are associated with lithium?

Ebstein anomaly in newborn

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Where is lithium excreted?

Kidneys. Most reabsorbed at PCT with Na+.

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What diuretic use is implicated in lithium toxicity?

Thiazides

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What is the mechanism of buspirone?

Stimulates 5-HT1A receptors

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What is the clinical use of buspirone?

Generalized anxiety disorder.

*Does not cause sedation/addiction/tolerance.

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How long does buspirone take to take effect?

1-2 weeks.

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Does buspirone interact w/ alcohol?

No. (Vs barbituates/benzos).

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What does the enzyme MAO do?

Converts norepi and epi to downstream metabolites (VMA)

Breaks down dopamine and 5-HT as well

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What is the mechanism of SSRIs?

5-HT specific reuptake inhibitors

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What is the clinical use of SSRIs?

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

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What are the side effects of SSRIs?

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

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How long do SSRIs take to work?

4-8 weeks

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What kinds of drugs cause serotonin syndrome?

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

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What characterizes serotonin syndrome?

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

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What is the treatment for serotonin syndrome?

Cyproheptadine - 5HT2 receptor antagonist.

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What class of drug are venlafaxine and duloxetine?

SNRIs

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What is the mechanism of venlafaxine and duloxetine?

Inhibit 5-HT and norepi reuptake

What is the clinical use of venlafaxine?

Depression and generalized anxiety disorder

What is the clinical use of duloxetine?

Depression, diabetic peripheral neuropathy

What is the toxicity of SNRIs?

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

What drug class are amitriptyline, nortriptyline?

TCAs

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

TCAs

What is the mechanism of TCAs?

Inhibit 5-HT and norepi reuptake

What is the clinical use of TCAs?

Major depression, peripheral neuropathy, chronic pain, migraine

What is an additional clinical use of clomipramine?

OCD

What are the serious side effects of TCAs?

Convulsions, Coma, Cardiotoxicity (arrythmias, long QT). | - Resp depression, hyperpyrexia, confusion/hallucinations in elderly.

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

tachycardia, urinary retention, dry mouth. | alpha1: postural hypotension

Which TCAs have more pronounced anticholinergic effects ?

3ry (amitryptyline > nortriptyline).

What can be given w/ TCAs for prevent arrythmia?

NaHCO3.

What drug class is tranylcypromine?

MAOi

What drug class is phenelzine

MAOi

What drug class is isocarboxazid?

MAOi

What drug class is selegiline?

selective MAO-B inhibitor

What is the mechanism of MAOis?

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

What is the clinical use for MAOis?

Atypical depression, anxiety

What is the toxicty of MAOi + wine and cheese?

Wine and cheese contain tyramine. Precipitates hypertensive crisis.

What other medications are contraindicated with MAOis?

SSRIs, TCAs, St. John's wort, meperidine, dextromorphan --> prevent serotonin syndrome.

What is the toxicity of MAOis?

HTN crisis, CNS stimulation

What is the mechanism of bupropion?

Increases norepi and dopamine; mechanism unknown.

What are the clinical uses of bupropion?

Depression, smoking cessation.

What is the toxcity of bupropion?

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

What is the mechanism of mirtazapine?

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

What is the toxicity of mirtazapine?

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

What is the mechanism of trazodone?

Primarily blocks 5-HT2 and alpha1-adrenergic receptors.

What is the clinical use of trazodone?

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

Toxicity of trazodone?

Sedation, nausea, postural hypertension, priapsim (trazoBONE)