Antidepressants - Antimanic agents [4]

Question 1

Buproprion blocks what

Answer 1

DA reuptake
NE reuptake

(it is a NDRI)
bad for comorbid anxiety

not first line tx for anxiety disorders -SSRI

Question 2

Most dangerous antidepressants to use in schizo?

Answer 2

f

fluoxetine
SSRI

Question 3

Monoamine theory of depression

Answer 3

Depression is associated with decreased NE/5HT levels
(antidepressant drugs share property to enhance NE-5HT-DA availability)
- effects on amines immediate, but mood doesnt elevate for 2-3 weeks

• shifted focus to NT effects on receptors and downstream sig molecules

Question 4

Neurodegenerative hypothesis

Answer 4

major depression associated with neuronal loss (neural apoptosis) in PREFRONTAL CORTEX and HIPPOCAMPUS
- antidepressants act by inhibiting-reversing loss by stimulating neurogenesis

Question 5

SSRI

Answer 5

Fluoxetine
paroxetine
escitralopram
- best drugs for depression + most anxiety

Question 6

SNRI

Answer 6

Venlafaxine

- good in chronic pain

Question 7

Trazodone

Answer 7

Mixed serotonin reuptake blocker/receptor antagonist

- will help you sleep better if depressed

Question 8

Amitriptyline

Answer 8

TCA - NET/SERT reuptake inhibitor

• like typical low potency antipsychotics bc they also block a1, H1, muscarinic r
• 3rd line bc sedative action unlike SNRI, SSRIs, NDRIs

Question 9

SSRI Acute side effects

Answer 9

Acute effects (goes away with time)

• Nausea-diarrhea (increased serotonin effects)
• activation-insomnia
• restlessness (akathisia)

(giddy up drug)
- make sure you rule out mania

Question 10

SSRI Chronic side effects

Answer 10

Delayed onset

• weight gain
• sexual dysfunction
• cognitive blunting
• withdrawl upon discontinuation

Question 11

SNRI side effects

Answer 11

HTN
Anxiety

(venlafaxine) - more NE - more vasoconstriction

Question 12

NDRIs side effects

Answer 12

tremor
insomnia
anxiety
seizure at high dose

(bupropion) - mild stimulant action

Question 13

TCADs side effects

Answer 13

1. sedation
2. antimuscarinic effects
3. cardiovascular (sudden death in overdose - EK abnormalities)
4. orthostatic hypotension
5. Neurologic (seizure in overdose)

(Amitriptyline - NET/SERT reuptake inhibitor)

Question 14

MAOIs side effects

Answer 14

Postural Hypotension (blocks a1)
Seizure, shock, hyperthermia in overdose (bc you increase in DA, 5HT, NE)

(Phenylzine)

Question 15

concommitant use of SSRI and MAOIs can result in __________

Answer 15

serotonin syndrome

Question 16

MAOIs DDI

Answer 16

hypertensive crisis with drugs or foods high in tyramine (decongestants, beer, wine, cheese)

Question 17

Antimanic agent

Answer 17

Lithium carbonate

• slow onset
• use dependence (greatest effects on cells with highest level of activity)
• interferes with PIP recycling Gq protein

Question 18

Lithium interferes with Gq proteins, but it can also lead to interference with Gs and Gi (adenylyl cyclas), which can lead to which side effects?

Answer 18

In thyroid: HYPOthyroidism

In kidney: Polyuria - polydipsia

Question 19

Adverse effects of lithium

- which DDIs should you watch out for?

Answer 19

very narrow therapeutic index
- minor → moderate → severe toxicities

severe: seizures, stupor, coma

Diuretics and NSAIDS can increase lithium levels

Question 20

Lithium dosage may need to be decreased in pts taking thiazide diuretics why?

Answer 20

bc it can increase Lithium levels leading to
adverse effects (fine tremor, GI upset, muscle weakness --> confusion, sedation, lethargy --> seizure, stupor, coma