B7-069 Drugs for Mood Disorders Flashcards
depression is treated with
antidepressants
periods of mania or hypomania alternating with periods of depression or euthymia
bipolar disorder
bipolar disorder is treated with
mood stabilizing agents
the mechanism of all […] involves increasing synaptic availability of NE and/or serotonin
antidepressants
antidepressants requires […] of treatment before maximal effects are achieved
several weeks
(delayed effect of antipsychotics is much longer)
ultimate effect of antidepressants may be related to [3]
secondary changes in receptors
increases in brain derived neurotrophic factor
cognitive changes
MOA of MAOIs
irreversibly inhibit MAO-a (NE and 5-HT) and MAO-b (DA)
MAOIs [2]
phenelzine
tranycypromine
side effects of MAOIs [3]
postural hypotension
weight gain
sexual dysfunction
(due to effects at many receptors, not used often anymore)
taking MAOIs in conjunction with tyramine-containing foods can cause
hypertensive crisis
MAOIs have numerous drug interactions that can lead to potentially fatal […] if administered with other drugs that increase 5-HT availability
serotonin syndrome
tremor, muscle rigidity, hyperthermia, hypertension, tachycardia, myoclonus are symptoms of […]
serotonin syndrome
HAHA= Hyperthermia, Autonomic dysfunction, Hyperreflexia, Altered mental status
serotonin syndrome is no joke, HAHA
wait […] after stopping MAOIs before starting serotonergic drugs or stopping dietary restrictions
two weeks
-iptyline
-ipramine
are what class?
tricyclic antidepressants
tricyclic antidepressants she said to know [3]
amitriptyline
nortriptyline
clomipramine (newer)
inhibit the reuptake of NE or serotonin at the NE and 5-HT transporters
TCAs
potent antagonists at cholinergic, histaminergic, and a-adrenergic receptors
TCAs
minor side effects of TCAs [4]
anticholinergic effects (dry mouth, constipation, dementia, blurry vision)
orthostatic hypotension
weight gain
sexual dysfunction
present a major suicide risk
TCAs
overdose/interactions of TCAs [4]
Coma
Arrhythmias
Seizures
Cardiac Effects
Tri-CyCliCs (3 Cs): Convulsions, Coma, Cardiotoxicity
-etine
-prams
what class are these?
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs she said to know [5]
fluoxetine
sertraline
paroxetine
citalopram
escitalopram
inhibit 5-HT reuptake
SSRIs
minor side effects of SSRIs [3]
GI symptoms
decrease libido
sexual dysfunction
what SSRI is particularly known to cause GI effects?
fluoxetine
SSRIs that are CYP2D6 inhibitors [2]
fluoxetine
paroxetine
SSRI with active metabolites and have really long half life
fluoxetine
5-HT and NE uptake inhibitors
SNRIs
SNRIs she said to know [3]
duloxetine
venlafaxine
milnacipran
NRI (NE uptake inhibitor) [1]
maprotiline
increases 5-HT and NE release by blocking a-2 receptors on nerve terminals
mirtazapine
(mirtAzApine = 2 a-s, a2 receptors)
inhibits dopamine reuptake
bupropion
what atypical antipsychotic has a lower incidence of sexual dysfunction compared to SSRIs?
bupropion
sedating at sub-antidepressant doses
primarily used hypnotic and pre-anesthetic
trazodone
can cause priapism
trazodone
dopamine antagonist
causes EPS and tardive dyskinesia
amoxapine
TCA
non-competitive NMDA receptor antagonist
esketamine
nasal spray used for treatment-resistant depression
esketamine
neuroactive steroid GABA-a receptor positive modulator but mechanism not fully understood
brexanolone
approved for postpartum depression
brexanolone
antidepressants increase the risk of suicidal thinking and behavior in […]
children
what classes can be used to treat generalized anxiety and panic disorder? [3]
SSRIs
TCAs
MAOIs
can be used to treat OCD [2]
SSRIs
clomipramine (TCA)
mood stabilizers to prevent mood swings in bipolar disorder [4]
lithium carbonate
valproic acid
carbamazepine
lamotrigine
may affect the arachidonic acid signaling
lithium
therapeutic levels of lithium are reached in […] days
6-10 days
more than […]% of lithium is excreted in urine
95%
side effects of lithium [3]
tremor
acne
polydipsia/polyuria (DI)
is lithium safe in pregnancy?
no-cardiac abnormalities
antidepressant most likely to cause arrhythmias
amitriptyline
inhibits dopamine uptake and has notable side effects including anxiety, agitation, and increased risk of seizures
bupropion
newest TCA with much improved side effect profile
clomipramine
inhibits the reuptake of both serotonin and NE
does not have a TCA structure
low risk of fatal overdose
duloxetine
SNRI
the tyramine in certain wines and cheeses can cause sympathetic crisis if consumed with
MAOIs
taking SSRIs with […] can greatly increase the risk of serotonin syndrome
MAOIs
antidepressants safe for older people with orthostatic hypotension
SSRI
common adverse effects of lithium
nausea/vomiting
polydipsia
tremor
acne
anticonvulsants that are also effective mood stabilizers in bipolar disorder [2]
carbamazepine
valproic acid
antipsychotic used in the treatment of acute mania
haloperidol
is lithium a teratogen?
yes
