Chapter 54 - Depression & Mood Stabilization

Question 1

imipramine (Tofranil)

Answer 1

Class: Tricyclic Antidepressants (TCAs)

Question 2

imipramine (Tofranil)
MOA:
Uses:
AE:
BBW: 
Other:

Answer 2

MOA: Blocks the reuptake of norepinephrine serotonin at synapse, thus increasing the action of both neurotransmitters
Uses: Depression, enuresis (nighttime bed wetting)
AE: Sedation, dysrhythmias, orthostatic hypotension, anticholinergic effects, weight gain. Abrupt withdrawl can cause cholinergic rebound
BBW: Increased risk SI in ages 18-24
Other: Monitor levels, take at bedtime (can cause sedation)

Question 3

fluoxetine (Prozac)

Answer 3

Class: Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 4

fluoxetine (Prozac)
MOA:
Admin:
Uses:
AE:
BBW:
Contra:

Answer 4

MOA: Blocks the reabsorption of serotonin in the brain. This helps elevate mood.
Admin: Take in morning, take with food
Uses: Depression and its associated anxiety, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder
AE: GI symptoms, sexual dysfunction, CNS stimulation, GI bleeding, in diabetics –> hypoglycemia, serotonin syndrome (too much serotonin reuptake causes hypertensive crisis: hyperpyrexia - 105+, extreme agitation, muscle rigidity, seizures –> can lead to coma)
BBW: SI 18-24 yrs age, do not abruptly withdrawl (can cause GI upset, dizziness, anxiety, insomnia, headaches can be caused by abrupt withdrawl)
Contra: with MAOI (must be off med at least 2 weeks before starting another drug in class –> effects serotonin)

Question 5

venlafaxine (Effexor)
MOA:
Uses:
AE:
BBW:
Contra:

Answer 5

MOA: Increases the levels of serotonin and norepinephrine in the brain, preventing reuptake of these neurotransmitters
Uses: Depression, anxiety
AE: CNS effects, GI effects, cardiovascular effects, GU effects, dermatologic effects
BBW: risk of SI in 18-24 yrs age
Contra: with MAO inhibitor, pregnancy

Question 6

phenelzine (Nardil)
MOA:
Uses:
AE:

Answer 6

MOA: Improves mood by binding irreversibly to MAO, increasing concentrations of epinephrine, norepinephrine, serotonin and dopamine in CNS
Uses: Depression
AE: Hypertensive crisis (with tyramine - red meat, salami, beer, aged cheeses, red wine - foods), dysrhythmias, drowsiness, dizziness, sexual dysfunction, orthostatic hypotension

Question 7

• bupropion (Wellbutrin)
• mirtazapine (Remeron)
• trazadone (Desyrel)
• St. John’s Wort (OTC)

Answer 7

Class: Atypical Antidepressants

Question 8

lithium carbonate

Answer 8

Class: Mood-Stabilizing Agents

Question 9

lithium carbonate
MOA:
Uses:
AE:
Caution:

Answer 9

MOA: Unknown; affects synthesis, release and reuptake of several neurotransmitters in the brain (Ach, dopamine, GABA, NE)
Uses: Mania in bipolar disorder
AE: Metallic taste, hand tremors, nausea, polyuria, polydipsia, diarrhea, muscle weakness, fatigue, edema, weight gain
Caution: Do not abruptly withdrawl; monitor drug levels for toxicity (0.5 - 1.2 mEq/L)