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Antidepressants / Bipolar drugs Flashcards

1
Q

MOA/Neurochemical Effects: Block reuptake of NE and/or 5HT
Desipramine = NE-selective
Imipramine = NE and 5HT

Higher concentration of NT at their receptors

A

Tricyclic Antidepressants
Desipramine (Norpramin)
Imipramine (Tofranil)

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2
Q

Clinical Effects: Elevation in mood (2-3 wks delayed)

Causes antimuscarinic effects, sleepiness, lightheadedness in those who don’t have depression

A

Tricyclic Antidepressants
Desipramine (Norpramin)
Imipramine (Tofranil)

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3
Q

AE/Toxicity: Weight gain, drowsiness, dry mouth, blurred vision, constipation, drowsiness, lightheadedness, orthostatic hypotension, arrhythmias, cardiac arrest, seizures

A

Tricyclic Antidepressants
Desipramine (Norpramin)
Imipramine (Tofranil)

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4
Q

TI is low&raquo_space; lethality in overdose

Metabolized by CYP2D6 (E is inhibited by fluoxetine)

A

Tricyclic Antidepressants
Desipramine (Norpramin)
Imipramine (Tofranil)

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5
Q

MOA/Neurochemical Effects: Irreversibly blocks MAO-A (NE and 5HT) and MAO-B (DA)

Increased NT in vesicles/released/action at R

A

Monoamine Oxidase Inhibitors

Phenelzine (Nardil)

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6
Q

AE/Toxicity: Serotonin Syndrome (overactivation of 5HT2A  hyperthermia), potentiates sympathomimetic amines (tyramine hypertensive crisis)

A

Monoamine Oxidase Inhibitors

Phenelzine (Nardil)

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7
Q

Low TI

Do not start until 14 days following discontinuation of SSRIs

A

Monoamine Oxidase Inhibitors

Phenelzine (Nardil)

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8
Q

MOA/Neurochemical Effects: Blocks reuptake of 5HT from synapse (5HT2A R)  can trigger actions postsynaptically or bind to autoreceptors & inhibit more 5HT release

A

Selective Serotonin Reuptake Inhibitors
Fluoxetine (Prozac),
Sertraline (Zoloft), Escitalopram (Lexapro)

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9
Q

AE/Toxicity: Nausea, diarrhea, weight loss, sexual dysfunction, anxiety, nervousness, insomnia (NOT sedating like TCAs)
Black box warning  suicide

A

Selective Serotonin Reuptake Inhibitors
Fluoxetine (Prozac),
Sertraline (Zoloft), Escitalopram (Lexapro)

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10
Q

Should NOT be used alone in bipolar  can flip switch to manic

A

Selective Serotonin Reuptake Inhibitors
Fluoxetine (Prozac),
Sertraline (Zoloft), Escitalopram (Lexapro)

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11
Q

MOA/Neurochemical Effects: SNRI – blocks 5HT + NE reuptake

Efficacy improves with increasing dose (increase dose: only 5HTalso NEalso DA)

A

Venlafaxine (Effexor)

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12
Q

Clinical Effects: Effect on mood driven by same mechanism as TCAs but does NOT affect NE/HA/ACh R (less AE)

A

Venlafaxine (Effexor)

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13
Q

AE/Toxicity: Contraindicated in patients on MAOIs

A

Venlafaxine (Effexor)

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14
Q

Atypical (dual/mixed action)

May be mediated by 3 different monoamines (depends on dose)

A

Venlafaxine (Effexor)

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15
Q

Blocks presynaptic α2 receptor on NE neurons (autoR) and 5HT neurons (heteroR)  increases NE and 5HT levels

A

Mirtazapine (Remeron)

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16
Q

MOA/Neurochemical Effects: Injectable anesthetic, NMDA antagonist (glutamate)

17
Q

Clinical Effects: Single dose improves depression sx in 2 hrs, effects last for 1 wk

18
Q

AE/Toxicity: Nightmares and hallucinations

19
Q

AZD6765 = NMDA channel blocker with low rates of psycho AE

20
Q

Tricyclic Antidepressants

A

Desipramine (Norpramin)

Imipramine (Tofranil)

21
Q

Monoamine Oxidase Inhibitors

A

Phenelzine (Nardil)

22
Q

Selective Serotonin Reuptake Inhibitors

A

Fluoxetine (Prozac),

Sertraline (Zoloft), Escitalopram (Lexapro)

23
Q

MOA/Neurochemical Effects: Effects postsynaptic neuron – alters gene expression implicated in long-term neuroplastic events  long-term mood stabilization

A

Lithium Carbonate

Lithobid, Eskalith

24
Q

Clinical Effects: Effective in 60-80% of those with bipolar, therapeutic effect seen in 5-21 days

Prevents mood swings –increases euthymia range

A

Lithium Carbonate

Lithobid, Eskalith

25
Q

AE/Toxicity: Therapeutic: fatigue, weakness, slurred speech, ataxia, tremor, excessive thirst/urination
Toxic: LOC, coma, muscular rigidity, hyperreflexia, tremor, muscle fasciculations (TI LOW)

A

Lithium Carbonate

Lithobid, Eskalith

26
Q

Tolerance to AE after 4 wks (except for tremor and urination/thirst)

Renal clearance reduced 25% by diuretics

A

Lithium Carbonate

Lithobid, Eskalith

27
Q

MOA/Neurochemical Effects: Anticonvulsant

A

Valproic Acid

Depakene

28
Q

Clinical Effects: Efficacy similar to Li+, superior to Li+ for rapid-cycling bipolar

A

Valproic Acid

Depakene

29
Q

Appropriate 1st line therapy for some (can combine with Li+)

A

Valproic Acid

Depakene

30
Q

Anticonvulsant

A

Carbamazepine

Tegretol

31
Q

Prophylaxis of bipolar disorder

A

Carbamazepine

Tegretol

32
Q

Fluoxetine (Prozac),

Sertraline (Zoloft), Escitalopram (Lexapro)

A

Selective Serotonin Reuptake Inhibitors

33
Q

Phenelzine (Nardil)

A

Monoamine Oxidase Inhibitors

34
Q

Desipramine (Norpramin)

Imipramine (Tofranil)

A

Tricyclic Antidepressants

NRO (22 decks)

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