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Neuro Muscular Psych Block 1 > Antidepressants and Mood Stabilizers > Flashcards

Antidepressants and Mood Stabilizers Flashcards

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1
Q

Selective Serotonin Reuptake Inhibitors

Examples (7)

A 
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodone
Vortioxetine
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2
Q

Selective Serotonin Reuptake Inhibitors
Mechanisms of Action
General (1) Vilazodone (1) Vortioxetine (3)

A

Block presynaptic SERT to decrease reuptake

Partial 5-HT 1A agonist

Partial 5-HT 1B agonist
Full 5-HT 1A agonist
Full 5-HT 1D,3,7 antagonist

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3
Q

Selective Serotonin Reuptake Inhibitors

Serious Side Effects (4) and CYP450 Drug Considerations (1/2)

A

QT Prolongation
SIADH-like Hyponatremia
Serotonin Syndrome: Clonus*
Suicidality

CYP450:
Fluoxetine is a STRONG inhibitor
Vortioxetine and Escitalopram DO NOT inhibit

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4
Q

Serotonin Norepinephrine Reuptake Inhibitors

Examples (5)

A 
All TCA's
Desvenlafaxine
Venlafaxine
Duloxetine
Levomilnacipran
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5
Q

Duloxetine Indications (5)

A 
Depression
Diabetic Peripheral Neuropathy
Fibromyalgia
Musckuloskeletal Pain
Stress Incontinence
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6
Q

Secondary Tri-Cyclic Agent Examples (3)

A

Amoxapine
Desipramine
Nortriptyline

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7
Q

Tertiary Tri-Cyclic Agent Examples (4)

A

“ACID”

Amitriptyline
Clomipramine
Imipramine
Doxepin

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8
Q

Imipramine Indications (2)

A

Depression

Enuresis

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9
Q

Tri-Cyclic Agents
Receptor Cross Reactivity (3) with Side Effects (2/3/3)
Overdose Symptoms (3)

A

H1 Receptors: Sedation and Dizziness

Muscarinic: Dry mouth, Urinary Retention, Blurry Vision

alpha-1 Receptors: Tachycardia, Orthostatic Hypotension, Arrhythmias*

Overdose:
Coma, Cardiotoxicity, Convulsions,

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10
Q

Serotonin-Adregneric Receptor Antagonists

Examples (2/1) with Mechanisms of Action (4/3)

A

Trazodone and Nefazodone:

Block presynaptic SERT
Block postsynaptic alpha-1 receptors
Block postsynatpic 5-HT2 receptors
BlockH1 receptors

Mirtazapine:

Block presynatpic alpha-2 receptors
Block postsynaptic 5-HT 2/3 receptors
Block H1 receptors

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11
Q 
Serotonin-Adrenergic Receptor Antagonists
Side Effects (3)
A

Sedation
Orthostatic hypotension
Weight gain

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12
Q

Bupropion

Mechanism of Action (2) Indications (2) Side Effects (4)

A

Inhibits presynaptic NE and DA reuptake (NDRI)
Increases NE/DA release via VMAT2

Depression
Nicotine Withdrawal

Agitation
Insomnia
Weight Loss
Seizures (especially if high dose or seizure Hx)

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13
Q

Monoamine Oxidase Inhibitors

Examples (4) and Side Effects (3)

A

Isocarboxazid
Phenelzine
Selegiline (Beta selective)
Tranylcypromine

Drug Interactions with other serotonin-targeting drugs
(requires 2 week washout of prior drug, 5 if fluoxetine)
Serotonin Syndrome
**Hypertensive Crisis (via Tyramine excess)

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14
Q

Hypertensive Crisis Symptoms (8)

A 
Severe headache
N/V
Sweating
Severe anxiety
Nosebleeds
Tachycardia
CP/SOB
Vision changes
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15
Q

Esketamine

MOA, Indication, Administration, Side Effects (2)

A

NMDA-receptor (Glutamate) antagonist

Treatment-resistant depression with ongoing therapy

Nasal spray, observed at least two hours

Elevated BP
Dissociation

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16
Q

Brexanolone

MOA, Indication, Administration, Side Effects (2)

A

Allopregnenalone analog: GABAa receptor allosteric modulator

Post Partum depression

60 hour IV infusion

Somnolence
Loss of consciousness

17
Q

Lithium
Indications (2) Actions (4), Side Effects (2)
Drug Interactions (3) Toxicity Effects (5)

A

Mood stabilizer for Bipolar I Mania
Unipolar Depression

Neuroprotection and proliferation
Inhibits Dopamine transmission
Decreases NMDA receptor
Increases GABA

Polyuria/Polydipsia (Nephrogenic Diabetes Insipidus)

Diuretics
ACE-Inhibitors
NSAIDs

*Narrow therapeutic range: 0.6-1.2 mEq/L
Hypothyroidism (goiter)
Tremor
Confusion
Leukocytosis
Seizures
18
Q

Anti-Seizure Agents

Examples (3) with Indications, Side Effect

A

Valproic Acid: Acute Bipolar I

Lamotrigine: Maintenance of Bipolar I/II

Carbamazepine: Acute/Maintenance of Bipolar I

Major CYP450 Inducer

19
Q

Antidepressant Acute Withdrawal Syndrome

Symptoms (6)

A

“FINISH”

Flu
Insomnia
Nausea
Imbalance
Sensory Disturbances
Hyperarousal

Neuro Muscular Psych Block 1 (7 decks)

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