Antidepressants and Mood Stabilizers 1 Flashcards
general antidepressants moa
- all affect serotonergic and/or noradrenergic nt systems
- block 5HT and/or NE re-uptake by pre-synaptic transporters (SERT, NET)
- secondary mechanisms of a few agents block pre and/or post-synaptic R’s
other antidepressant indications- nicotine withdrawal
bupropion
other antidepressant indications- enuresis
(involuntary urination)
imipramine
other antidepressant indications- diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain
-duloxetine
other antidepressant indications- stress incontinence
-duloxetine
tricyclics (TCA’s)- tertiary amines
-amitriptyline
-clomipramine
-doxepin
-imipramine
(ACDI)
tricyclics (TCA’s)- secondary amines
-amoxapine
-desipramine
-nortriptyline
(ADN)
NDRI’s
(Noradrenergic-Dopamine Reuptake Inhibitors)
-bupropion
SARA’s
(Serotonin-Adrenergic R Antagonists)
- mirtazapine
- nefazodone
- trazodone
SSRI’s
(Serotonin-Selective Reuptake Inhibitors) -escitalopram -fluoxetine -sertraline -paroxetine -citalopram -vilazodone -vortioxetine (CEFPSVV)- Effective For Sadness, Panic, and Compulsions.. V
SNRI’s
(Serotonin-Noradreneric Reuptake Inhibitors) -desvenlafaxine -duloxetine -levomilnacipran -venlafaxine -all TCA's (DDLV)
SNRI’s + DA
-amoxapine
MAOI’s
-phenelzine
-isocarboxazid
-tranylcypromine
-selegiline
(PITS of despair)
SSRI’s-moa
(Selective serotonin reuptake inhibitor)
- inhibit the pre-synaptic reuptake of serotonin (via SERT)
- much less impact on histamine, muscarinic, and adrenergic R’s (fewer SE’s vs TCA’s)
- SE’s- acute withdrawal rxns (concern w all categories)- flu like sx’s
SSRI’s- SE’s
- CNS
- sexual dysfxn
- wt gain/loss
- acute withdrawal rxns (concern w all categories)- flu like sx’s
SSRI’s- rare SE’s (toxic settings)
- QT prolongation
- hyponatremia
- serotonin syndrome- sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors (inc risk when given w other serotonin-affecting agents)
- suicidality- highest risk in children/adolescents/young adults
serotonin syndrome (vs neuroleptic malignant syndrome)
- serotonergic agents
- hyper-reflexia
- clonus
- dilated pupils
- hyper-active bowel sounds
neuroleptic malignant syndrome (vs serotonin syndrome)
- dopaminergic agents
- hypo-reflexia
- normal pupils
- normal or dec bowel sounds
SSRI’s- drug-drug interactions
(CYP450)
- most- fluoxetine (Broad and strong inhibitor)
- least- citalopram and sertraline (mild inhibitors)
SNRI’s (incl TCA’s)- moa
(Serotonin-norepinephrine reuptake inhibitor)
- inhibit the pre-synaptic reuptake of serotonin (via SERT) AND NE (via NET)
- 3 amines- inhibit NE/5-HT equally
- 2 amines- inhibit NE > 5-HT
SNRI’s (incl TCA’s)- also block other R’s
- histamine (H1)
- muscarinic (cholinergic)
- alpha1 (adrenergic)
TCA’s- 3 key SE’s
- CV (alpha)- tachycardia, orthostatic hypotension, dysrhythmias
- Anticholinergic (muscarinic)- dry mouth, urinary retention, blurred vision
- CNS (histamine)- sedation, dizziness, seizures
TCA’s- toxic ingestion
3 C’s:
- coma
- cardiotoxicity (conduction abnormalities)- quinidine-like effect (slows phase 0 depolarization via Na channel blockade- slows conduction)
- convulsions
Non-TCA SNRI’s- SE’s
-similar to SSRI’s, with less risk of sexual dysfxn
SARA’s- moa
(Serotonin-Adrenergic R Antagonists)
- act like SSRI’s and also block post-synaptic alpha1 R’s on NE neurons and post-synaptic 5-HT2A- Trazodone and Nefazodone
- blocks pre-synaptic alpha2 R’s on NE and 5HT neurons- Mirtazapine- NO SERT/NET activity; H1 blockade
SARA’s- SE’s
- CNS (sedation)- most w Trazodone/Mirtazapine
- orthostatic hypotension- Trazodone
- wt gain- Mirtazapine
NDRI’s- moa
(Norepinephrine-Dopamine Reuptake Inhibitors)
-inhibit pre-synaptic reuptake of NE (via NET) and dopamine (via DAT)
NDRI’s- SE’s
-seizures! (dose-dependent)
MAOI’s- moa
- inhibition of MAO- inc levels of monoamines in neuronal vesicles and inc amts of NE, 5-HT, and DA released
- all nonselective (MAO A/B), except selegiline (B-selective)
MAOI’s- drug interactions w 5-HT/NE affecting drugs
- anti-hypertensives, amphetamines, SSRIs/TCAs/SNRIs- 2 wk wash-out period (fluoxetine- 5 wks)
- serotonin syndrome
- hypertensive crisis
MAOI’s- major concern?
Hypertensive crisis
- inhibit MAO-A necessary in GI for tyramine metabolism
- inc tyrosine- induce catecholamine release and hypertensive crisis
hypertensive crisis- signs, sx’s
- severe HA
- N/V
- sweating/severe anxiety
- nosebleeds
- tachycardia
- chest pain
- changes in vision
- SOB
- confusion
tyramine containing foods/beverages
- aged cheeses
- fava/broad/soy beans
- pickled meets/poultry/fish
- cured meats/sausages
- tap beers, red wine
- over ripe fruit
