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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
Varenicline
Chantex; for smoking cessation. Partial nicotine receptor agonist. Has no effect on depression.
26
MOA of Mirtazapine?
alpha2 antagonist. opposite of clonidine. | ⇡NE and 5-HT release
27
Side effects of Mirtazapine?
* Weight gain (H1, 5-HT2 blockade) * Sedationl No sexual dysfunction No nausea Anxiolytic
28
MOA of Trazodone?
Antagonizes 5-HT2 receptors; Serotonin reuptake inhibitor and blocker
29
Side effects of Trazodone?
Blocks H1 ⤑ Sedative (Sleepy) | Blocks alpha 1 ⤑ priapism, orthostasis, maybe sexual dysfunction
30
Increased trazodone effects when...
Taking with inhibitors of CYP3A4 like grapefruit juice
31
Nefazodone
Not used much b/c of potential hepatotoxicity
32
MOA of lithium? (bipolar disorder)
blocks inosine 5' monophosphatase (Gq)
33
Na+ ____ promotes Li+ ____.
loss, reabsorption Hence, toxicity with diuretics
34
NSAIDs, ACE inhibitors facilitate Li+ ____ in the PCT.
Reabsorption
35
Amiloride
Blocks Na+ channels so Na+ stays. If Na+ stays, enhances Li+ excretion.
36
* 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?
Lithium
37
Valproic acid blocks...?
Na+ channels and T-type Ca2+ channels (so, used for seizures also)
38
MOA of Valproic acid?
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
Side effects of valproic acid?
Weight gain, hepatitis, valproate syndrome (includes spina bifida) so do NOT use in pregnancy
40
MOA of Carbamazepine?
Blocks Na+ channels and blocks NE reuptake
41
Carbamazepine usage?
1. Tonic-clonic seizure 2. trigeminal neuralgia 3. Bipolar disorder
42
Side effects and toxicity of carbamazepine?
* SIADH (water "intoxication") * Aplastic anemia * Steven Johnson Syndrome (HLA allele) * Teratogen; do NOT use in pregnancy
43
MOA of Lamotrigine?
* Potentiates GABA by decreasing glutamate | * Blocks voltage gated Na+ channels
44
Lamotrigine is used for?
Seizures (partial tonic clonic, absence), manic phase of BP disorder, Lennox-gastaut syndrome,
45
Toxicity with Lamotrigine?
Steven Johnson Syndrome - Rash
46
Atypical antipsychotics target _____, while typical antipsychotics target DA.
Serotonin
47
Atypical antipsychotics all prolong...?
QT interval

Pharmacology (3 decks)

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