CHAPTER 10: ANTIDEPRESSANTS- Atypical, TCAs, MAOIs, Lithium Salts Flashcards
ATYPICAL Antidepressants
- drugs
bupropion, mirtazapine, negazodone, trazodone, vilazodone, vortioxetine
ATYPICAL: Bupropion
- indications
- MOA
- half life
- AE
Indication: depression and smoking cessation/cravings
MOA: weak inhib of NE/DA reuptake
half life: short, need more than once a day dose or ER formulation
AE: dry mouth, sweatng, tremor, HIGH DOSE seizures (PT w epilepsy at high risk)
ATYPICAL: mirtazapine
- MOA
- effect
- AE
MOA: block 5-HT2 and a2 autoreceptors (inc NE neurotranmiss)
- sedative bc of potent antihistaminic activity
- drowsy effects good for depressed pt having trouble sleeping
- no AE like those of TCAs
- no sexual func interference
AE: inc appetite and weight gain
TCAs: Tricyclic Antidepressants
- MOA
- inhibit neurotransmitter reuptake, INC adrenergic and serotonergic neurotransmission
- block 4 receptors: serotonergic, a adrenerg, histaminic, muscarinic
TCAs: actions
- improve mood 50-70%
- onset of mood elevation is SLOW
- taper TCAs to minimize discontd syndrome and cholinergic rebound effects
TCAs: therapeutic uses
-imipramine
-amitriptyline
-doxepin
- moderate to severe depression
- panic disorders
IMIPRAMINE: for bed wetting in kids
AMITRIPTYLINE: prevent migraine, treat chronic pain syndromes
LOW DOSES TCAs (doxepin): treat insomnia
TCAs: Adverse effects
Muscarinic Blockade:
- blurred vision, xerostomia, urinary retention, constipation, aggravation glaucoma and tachy, worsen arrhythmias
alpha-adrenergic blockade:
- orthostat hypo, reflex tachy
- imipramine most likely to cause orthostat, nortriptyline least likely
H1 blockade (histamine): sedation
metabolic: weight gain
endocrine: sexual dysfunc, erectile dysfunc, anorgasmia in women
TCAs: drug-drug interactions
MAOIs: hyperthermia, seizures, coma, death
SSRIs: serotonin syndrome
- cimetidine and rantidine, inc in TCA therapeutic and adv effects
ANTICOAGULANTS: inc risk of arrhythmia and hypertension w sympathomimetics or clonidine
NARROW TI can be lethal (imipramine)
MAOIs: Monoamine Oxidase Inhibitors
-reversibly or irreversibly inactivate MAO enz, neurotransmitters can escape degradation–> accumulate in presyn neuron, leak into synaptic space
-selegiline used for PD, only one avail as transdermal
- use of MAOI limited, complicated dietary restrictions required
MAOIs: MOA
- inc storage of NE, 5-HT, DA within neuron
- cause excess neurotransmitters to diffuse into synaptic space
- drugs inhib MAO in brain and periphery (liver and gut)
MAOIs: therapeutic uses
-depressed PT unresponsive to other antidepressants
-last line agents due to drug-drug and drug-food interactions
MAOIs: adverse effects
- tyramine rich foods: hypertensive crisis (occipital headache, stick neck, tachy, nausea, hypertensive, arrhythmias, seizures, stroke)
- drowsiness, orthostat hypo, blurred vision, dry mouth, constipation
MAOIs: drug-drug interactions and food-drug interactions
drug-drug
- other antidepressants: serotonin syndrome
- methyldopa: sympathomimetic effects inc
- insulin/oral antidiabetics: additive hypoglycemia
drug-food
- tyramine: inc BP
MANIA AND BIPOLAR: lithium salt treatments
MOA is UNKNOWN
therapeutic uses:
- acutely and prophylaxis management bipolar PTs
- delayed onset of action, used in conjugation w low dose of high potent anxiolytics and antipsychotics to stabilize behavior
MANIA AND BIPOLAR: lithium salts adverse effects
- LOW TI, can be TOXIC
- headache, dry mouth, polydipsia
-polyuria: inc urination
-polyphagia: extreme hunger
-gi distress, tremor, dizzy, fatigue, dermatologic reactions, sedation, fine hand tremor
HIGH plasma levels indicate toxicity
- ataxia, slurred speech, confusion, convlusion, coarse tremors
