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aNeuro exam 4: Lindsey's > Antidepressants and Mood Stabilizers > Flashcards

Antidepressants and Mood Stabilizers Flashcards

1
Q

Recognize the different classes of antidepressants and general ideas about mechanism of action.

A 
SSRIs = block 5HT pre-synaptic reuptake pump 
SNRIs = block 5HT AND NE reuptake pumps
TCAs = block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and α-1
MAOIs = irreversibly inhibit MAO-A and MAO-B --> increase levels of 5-HT and NE
others = Buproprion, Mirtazapine, Trazodone and nefazodone, Vilazodone, VNS, DBS, TMS
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2
Q

What are the 3 phases of treatment for mood disorders?

A

acute tx
continuation phase
maintenance phase

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3
Q 
What are these drugs:
fluoxetine
paroxetine
sertraline
citalopram
escitalopram
fluvoxamine
vilazodone
A

SSRIs

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4
Q 
What are these drugs:
venlafaxine
desvenafaxine
duloxetine
milnacirin
levoilnaciprin
A

SNRIs

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5
Q 
What are these drugs:
amitryptiline
nortriptyline
desipramine
imipramine
doxepin
trimipramine
protriptyline
amoxapine
A

TCAs

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6
Q 
What are these drugs:
phenelzine
selegeline
tranylcypromine
isocarbxazid
A

MAOIs

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7
Q

Why would you choose a TCA?

A

very effective
severe depression
can monitor blood levels
fewer SEs

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8
Q

Why would you avoid a TCA?

A 
hypotension
orthostasis
dry mouth 
constipation
weight gain
sexual dysfunction
DANGEROUS IN OD- give short supply
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9
Q 
Name the drug class, based on its SEs:
hypotension
orthostasis
dry mouth 
constipation
weight gain
sexual dysfunction
DANGEROUS IN OD- give short supply
A

TCAs

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10
Q

Why would you choose an MAOI?

A

effective in non-responsive pts

atypical depression

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11
Q

Why would you avoid using an MAOI?

A 
hypotension
orthostasis
dry mouth
constipation
urinary retention
sexual dysfunction
weight gain 
HYPERTENSIVE CRISIS- TYRAMINE RXN
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12
Q 
Name the drug class, based on its SEs:
hypotension
orthostasis
dry mouth
constipation
urinary retention
sexual dysfunction
weight gain 
HYPERTENSIVE CRISIS- TYRAMINE RXN
A

MAOIs

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13
Q

Why would you choose an SSRI?

A

safe, effective

also for anxiety, panic, OCD, PTSD, premenstrual dysphoric disorder

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14
Q

Why would you avoid SSRIs?

A 
diarrhea
nausea
jitteriness/anxiety
SEXUAL DYSFUNCTION
drug interactions: P450 INHIBITION
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15
Q 
Name the drug class, based on its SEs:
diarrhea
nausea
jitteriness/anxiety
SEXUAL DYSFUNCTION
drug interactions: P450 INHIBITION
A

SSRIs

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16
Q

What is the best studied, best proven drug for bipolar disorder?

A

lithium

17
Q

Describe the general timeline of response to antidepressants.

A

takes weeks to work (4-16 weeks)

18
Q

Discuss issues around treatment of bipolar disorder.

A

bipolar = 3 phases: manic, depressive, and future episodes
NO drugs truly work in all 3 phases
Mania tx is effective but not so much bipolar depression

19
Q

Describe basic medication strategies for treating bipolar mania and depression.

A

PT will likely be taking several (3) drugs at once

mania = everything EXCEPT lamotrigine and olanzapine + fluoxetine (Symbyax)
depression = ONLY olanzapine + fluoxetine (Symbyax), quetiapine, and lurasidone
20
Q

What drugs for bipolar disorder are NOT effective for the mania?

A

lamotrigine

olanzapine + fluoxetine (Symbyax)

21
Q

What drugs for bipolar disorder DO treat the depression?

A

olanzapine + fluoxetine (Symbyax)
quetiapine
lurasidone

22
Q

What are the following drugs useful for in the tx of bipolar disorder?
olanzapine + fluoxetine
quetiapine
lurasidone

A

bipolar depression

23
Q

What drugs for bipolar disorder are effective for maintenance?

A

lithium
lamotrigine
aripiprazole
olanzapine

24
Q 
What are the following drugs useful for in the tx of bipolar disorder?
lithium
lamotrigine
aripiprazole
olanzapine
A

maintenance

25
Q

What drugs for bipolar disorder are effective for relapse prevention?

A

lithium

olanzapine

26
Q

What are the following drugs useful for in the tx of bipolar disorder?
lithium
olanzapine

A

relapse prevention

27
Q

Do you prescribe antidepressants for bipolar depression?

A

NO

28
Q

What is the mechanism of action of Buproprion (Wellbutrin)?

A

increases whole-body NE, weakly blocks reuptake of DA

29
Q

What is the mechanism of action of Mirtazapine?

A

blocks 5-HT2A, 5-HT2C, 5-HT3, α-2-adrenergic receptors

30
Q

This drug increases whole-body NE and weakly blocks reuptake of DA.

A

Buproprion (Wellbutrin)

31
Q

This drug blocks 5-HT2A, 5-HT2C, 5-HT3, and α-2-adrenergic receptors.

A

Mirtazapine

32
Q

This drug’s most potent action is blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE.

A

Trazodone and nefazodone

33
Q

What is the mechanism of action for Trazodone and nefazodone?

A

blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE

34
Q

How does Vilazodone work?

A

an SSRI + 5HT1A partial agonist

35
Q

Name the drug that is an SSRI + 5HT1A partial agonist.

A

Vilazodone

36
Q

What are the positive and negatives to using Buproprion (Wellbutrin)?

A 
\+ = NO sexual dysfunction, NO weight gain, activating
- = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS
37
Q

Name the drug:
+ = NO sexual dysfunction, NO weight gain, activating
- = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS

A

Buproprion (Wellbutrin)

38
Q

What are the positive and negatives to using Mirtazapine?

A 
\+ = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION
- = Daytime somnolence, WEIGHT GAIN
39
Q

Name the drug:
+ = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION
- = Daytime somnolence, WEIGHT GAIN

A

Mirtazapine

aNeuro exam 4: Lindsey's (37 decks)

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