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antidepressants and mood stabilizers > antidepressants and mood stabilizers > Flashcards

antidepressants and mood stabilizers Flashcards

1
Q

Depression

A

chemical imbalance between 3 neurotransmitters

  • norepinephrine
  • serotonin
  • dopamine
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2
Q

Antidepressants

A
  • orally administered
  • 90-95%bound to plasma proteins
  • metabolized by the liver with metabolites excreted in urine
  • long half lives
  • relatively small therapeutic index
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3
Q

Classes of antidepressant drugs

A
  • tricyclics
  • Selective Serotoni Reuptake Inhibitors (SSRI’s)
  • Sellective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI’s)
  • Atypical
  • Monoamine Oxidase Inhibitors (MAOI’s)
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4
Q

Tricyclics

A

Attempt to remedy depression by inactivating the amine pump on the presynaptic nere terminal and limiting the reuptake of both NE and serotonin. May also have effects at muscarinic, histamine , and alpha receptors.

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5
Q

Tertiary Amine Tricyclics

A

-amitryptyline-can be given IM

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6
Q

Tertiary Amine Tricyclics

A

-clomipramine - given for OCD, not very selective,

can cause seizures

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7
Q

Doxepin (sinequan)

A
  • tertiary amine tricyclics
  • increased sedation
  • no CV side effects
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8
Q

Imipramine (Tofranil)

A
  • Tertiary amine tricyclic
  • can be given IM
  • long actin pamoate formula is available
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9
Q

Trimipramine (Surmontil)

A

-Tertiary Amine Tricyclic

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10
Q

Secondary Amine Tricyclics

A
  • RX for sleepy depressive
  • have affinity for serotonin and added affinity for the NE transporter
  • add back the sympathetic component
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11
Q

Amoxapine (Asendin)

A

-Secondary Amine Tricyclic
_dibenzodiazipe that is a metabolite of the antipsychotic loxapine
-It has a dopaminergic and adrenergic mechanism

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12
Q

Desipramine (norpram)

A
  • Secondary Amine Tricyclics
  • metabolite of imipramine

-

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13
Q

maprotiline (ludiomil)

A

_Secondary Amine Tricyclic

  • new
  • increased ptotential for seizures
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14
Q

nortryptyline (pamelor)

A
  • Secondary Amine Tricyclic
  • metaolite of amitryptyline
  • elderly patients
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15
Q

protryptryptyline (vivactil)

A
  • Secondary Amine Tricyclic
  • lacks sedative properties
  • RX for sleepy depressives
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16
Q

Selective Serotonin Reuptake Inhibitors (SSRI’s)

A
  • often 1st choice for monopolar depression
  • most effective in the treatment for premenstrual dysphoric disorder (PMDD)
  • safer side effect profile
  • work on the serotonin side
17
Q

citalopram (celexa)

A

-SSRI

-

18
Q

escitalopram (lexapro)

A
  • SSRI

- adolescents approved

19
Q

fluoxetine (prozac)

A
  • SSRI

- 72 hr half life

20
Q

fluvoxamine (luvox)

A

-SSRI

21
Q

Paroxetine (paxil)

A
  • SSRI
  • anticholinergic side effects
  • social phobia
22
Q

setraline (zoloft)

A

-SSRI

36 hr half life

23
Q

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI’s)

A

-fewer antimuscarinic and antihistaminic effects than the tricyclics and have more of an adrenergic effect compared to the SSRIs

24
Q

duloxetine (cymbalta)

A
  • SNRI
  • 1:10 affinidy for serotonin (5-HT) and NE transporters
  • First approval drug for fibromyalgia
25
Q

milnacipran (ixel)

A
  • SNRI
  • 1:1 affinity for 5 HT and NE transporters
  • second approved drug for fibromyalgia
26
Q

venlafazine (effexor)

A
  • SNRI
  • withdrawal and rebound effects
  • 1:30 affinity for the 5 HT and NE transporters
27
Q

desvenlafaxine (pritiq)

A
  • SNRI

- isomer of venlafaxine

28
Q

Atypical

A

do not fit in any catagory

29
Q

bupropion (wellbutrin/zyban)

A
  • Atypical
  • no sexual side effects
  • no serotonin
  • block reuptake of dopamins, NE
  • 3 fold increase in risk of seizures
30
Q

nefazodone (serzone)

A

-BLACK BOX -liver failure (life threatening)
-serotonergic mechanisms
-

31
Q

mirtazapine (remeron)

A
  • Atypical
  • sedation common adverse effect
  • blocks histamine receptors
  • block 5 HT2A, alpha 1 and alpha 2 centrall receptors
32
Q

reboxetine (edronax)

A
  • Atypical

- inhibits NE

33
Q

trazadone (desyrel)

A
  • Atypical
  • sedative hypnotic for those with difficulty sleeping
  • drug of choice for sleep
  • priapism
34
Q

vilazodone (viibryd)

A
  • Atypical
  • new “dual action”
  • blocks sertonin reuptake transporter and acts as a partial agonist at the 5HT1Areceptor
  • low incidence of sexual side effects
35
Q

Monoamine Oxidase Inhibitors (MAOI’s)

A
  • refractory depression

- inactivates the enzyme (MAO) that metabolizes NE and serotonin

36
Q

MAOI’s

A
  • isocarboxazid (marplan)
  • phenelzine (nardil)
  • tranylcypromine (Parnate)
37
Q

antidepressant side effects

A
  • sedation

- CV- orthostatic hypotension, tacycardia,

antidepressants and mood stabilizers (1 decks)

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