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Pharmacology > Antidepressants and Mood Stabilizers > Flashcards

Antidepressants and Mood Stabilizers Flashcards

1
Q

What is the Amine hypothesis?

A

Loss of neurotransmitters DA, NE, and 5-HT causes mood changes and depression. Drugs that treat depression ⇡ those neurotransmitters.

Beta antagonists and alpha2 agonists (clonidine) ⇡ depression

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2
Q

The 1st line treatment for depression aka the first choice of antidepressants are…

A

SSRI’s

“-etine”

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3
Q

A negative effect of antidepressants are…

A

Suicidal thoughts. They have boxed “Suicide warnings”

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4
Q

Washouts period for switching to MAOI’s is…

A

4-5 weeks.

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5
Q

Pregnancy safe antidepressants are…

A
  • Fluoxetine
  • Sertraline
  • Citalopram

(All are SSRIs)

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6
Q

List the MAOI’s

A
  • Phenelzine
  • Tranylcypromine
  • Isocarboxazid
  • Moclobemide
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7
Q

MOA of MAOI’s

A

MAO(a) ⇡NE, Epi, 5-HT, DA, Tyramine

MAO(b) ⇡DA
* Drugs like Selegeline target MAO(b) to treat Parkinson’s disease

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8
Q

Use of MAOI’s?

A

To treat refractory depression. Depression that does not respond to other medications.

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9
Q

When taking MAOIs, avoid foods high in…

A

TYRAMINE such as…aged cheese and meats, red wine, soy sauce, chocolate, avocado, sauerkraut

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10
Q

Drug-food interactions with MAOI causes…

A

hypertensive crisis

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11
Q

What are the symptoms of hypertensive crisis?

A
  • Occipital headache
  • Stiff neck
  • Nausea/vomiting
  • Photophobia
  • Palpitations
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12
Q

What drug can be used to treat hypertensive crisis associated with tyramine toxicity?

A

Phentolamine

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13
Q

MOA of Tricyclic antidepressants (TCA)?

A

Block NE and 5-HT re-uptake (NET, SERT)

Block alpha1, M, and H1 receptors

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14
Q

Side effects of TCA?

A

B/c TCS’s block alpha1, M, and H1 receptors, side effects are…

  1. orthostatic hypotensions
  2. dry mouth, constipation, urinary retention
  3. Sedation, weight gain
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15
Q

What are the TCA’s and their usages?

A
  1. Ipramine ⟼ Eneuresis (bed wetting)
  2. Desipramine ⟼ Least anticholinergic effect
  3. Chlomipramine ⟼ OCD
  4. Amitriptyline ⟼ migraine prophylaxis, neuropathic pain
  5. Amoxapine ⟼ D2 blockade. So, some parkinsonism can be seen.
  6. Nortriptyline
  7. Doxepin
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16
Q

Symptoms of Serotonin syndrome?

A
  • Rigidity
  • Hyperthermia (104 - 106 F)
  • Mydriasis
  • Tachycardia
  • HTN
  • Myoclonus
  • Delirium
  • GI symptoms (not present in NMS)

^ Occurs within 24 hrs.

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17
Q

Serotonin syndrome can be treated with…

A

Sodium bicarbonate

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18
Q

Overdose of TCA’s can cause… (3 C’s)?

A

Coma, Convulsion, Cardiotoxicity

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19
Q

SSRI’s can be used to treat?

A
  • Anorexia
  • PTSD
  • Depression
  • OCD
20
Q

What are the SSRI’s?

A
  • Fluoxetine (Prozac)
  • Fluvoxamine
  • Paroxetine
  • Sertraline
  • Citalopram
  • Escitalopram

“-etine”
Don’t have muscarinic effects
Safe in overdose since less cardiovascular effects and seizures

21
Q

Toxicities in serotonin syndrome?

A
  • Bleeding abnormalities
  • Impotence
  • Serotonin syndrome
  • Weight gain (b/c of 5-HT2c blockade)
22
Q

SNRI’s used for?

A

Depression, fibromyalgia, neuropathic pain. They have no effect on H1, alpha1, and M receptors.

23
Q

What are the SNRI’s?

A
  • Duloxetine
  • Venlafaxine
  • Desvenlafaxine
  • Mitracipram
24
Q

Bupropion MOA?

A

Inhibits DAT, NET, DA, and NE reuptake

SMOKING CESSATION non-competitive antagonist at the nicotine receptor

No sexual effect since Serotonin is not involved.

Reduces seizure threshold in anorexic pts.

25
Q

Varenicline

A

Chantex; for smoking cessation. Partial nicotine receptor agonist.

Has no effect on depression.

26
Q

MOA of Mirtazapine?

A

alpha2 antagonist. opposite of clonidine.

⇡NE and 5-HT release

27
Q

Side effects of Mirtazapine?

A
  • Weight gain (H1, 5-HT2 blockade)
  • Sedationl

No sexual dysfunction
No nausea
Anxiolytic

28
Q

MOA of Trazodone?

A

Antagonizes 5-HT2 receptors; Serotonin reuptake inhibitor and blocker

29
Q

Side effects of Trazodone?

A

Blocks H1 ⤑ Sedative (Sleepy)

Blocks alpha 1 ⤑ priapism, orthostasis, maybe sexual dysfunction

30
Q

Increased trazodone effects when…

A

Taking with inhibitors of CYP3A4 like grapefruit juice

31
Q

Nefazodone

A

Not used much b/c of potential hepatotoxicity

32
Q

MOA of lithium? (bipolar disorder)

A

blocks inosine 5’ monophosphatase (Gq)

33
Q

Na+ ____ promotes Li+ ____.

A

loss, reabsorption

Hence, toxicity with diuretics

34
Q

NSAIDs, ACE inhibitors facilitate Li+ ____ in the PCT.

A

Reabsorption

35
Q

Amiloride

A

Blocks Na+ channels so Na+ stays. If Na+ stays, enhances Li+ excretion.

36
Q
  • Narrow therapeutic index
  • Tremors with the use of beta blockers
  • Leukocytosis
  • polyuria, polydipsia
  • Hypothyroidism
  • Ebstein anomaly

^all are associated with which drug for the treatment of bipolar disorder?

A

Lithium

37
Q

Valproic acid blocks…?

A

Na+ channels and T-type Ca2+ channels (so, used for seizures also)

38
Q

MOA of Valproic acid?

A
  1. ⇣ glutamate at NMDA receptor
  2. blocks degredation of GABA
  3. ⇡GABA receptor action
  4. ⇡ GABA synthesis

Potentiates GABA in one of those ways ^

39
Q

Side effects of valproic acid?

A

Weight gain, hepatitis, valproate syndrome (includes spina bifida) so do NOT use in pregnancy

40
Q

MOA of Carbamazepine?

A

Blocks Na+ channels and blocks NE reuptake

41
Q

Carbamazepine usage?

A
  1. Tonic-clonic seizure
  2. trigeminal neuralgia
  3. Bipolar disorder
42
Q

Side effects and toxicity of carbamazepine?

A
  • SIADH (water “intoxication”)
  • Aplastic anemia
  • Steven Johnson Syndrome (HLA allele)
  • Teratogen; do NOT use in pregnancy
43
Q

MOA of Lamotrigine?

A
  • Potentiates GABA by decreasing glutamate

* Blocks voltage gated Na+ channels

44
Q

Lamotrigine is used for?

A

Seizures (partial tonic clonic, absence), manic phase of BP disorder, Lennox-gastaut syndrome,

45
Q

Toxicity with Lamotrigine?

A

Steven Johnson Syndrome - Rash

46
Q

Atypical antipsychotics target _____, while typical antipsychotics target DA.

A

Serotonin

47
Q

Atypical antipsychotics all prolong…?

A

QT interval

Pharmacology (3 decks)

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