CNS II- Antidepressants, Bipolar/ADHD, Antipsychotics Flashcards
Monoamine MOA
MOA: essentially all available drugs work to increase NA, 5HT
Tricyclic antidepressants
MOA: block reuptake of norepinephrine and serotonin, action at H1, AcH, 5HT2a, alpha NE receptors plus NE and 5Ht uptake
Amitriptyline (elavil)
- nortriptyline, imipramine
Tricyclic antidepressants AE
sedation, CV effects: tachycardia, orthostatic hypotension, antimuscarinic effects, weight gain, panic disorder, enuresis, ADD, IBS
Antimuscarinic AE
blurred vision
dry eyes, mouth
tachycardia
dyspepsia
constipation
retention
SSRI- selective serotonin reuptake inhibitors (3)
fluoxetine (prozac)
sertraline (zoloft)
citalopram (celexa)
Uses: anxiety disorders, GAD, panic disorders, OCD, eating disorders, PTSD
SSRI’s AE
agitation
confusion
sweating
tremors
fever
produce restlessness
insomnia
N/V
decreased libido, sexual function
SNRI- serotonin/norepinephrine reuptake inhibitors (2)
venlafaxine (effexor)
duloxetine (cymbalata)
uses: GAD, diabetic and neuropathic pain, hot flashes, PTSD, autism
Bupropian
antidepressant
MOA not clear
uses: nicotine addiction, prevention of SAD, neuropathic pain, weight loss, depression in bipolar
Bupropian AE
increase libido and sexual function
weight loss
seizures
insomnia
mirtazepine
MOA: 5-HT and NE by blockade of presynaptic receptors
uses: antidepressant, weight gain, minimal sexual dysfunction
monamine oxidase inhibitors (MAOI) (1)
MOA: inhibit enzyme that degrades catecholamines and serotonin in nerve terminals
selegine (emsam)- transdermal antidepressant
MAOI AE
anxiety, insomnia
orthostatic hypotension
food interaction can cause HTN crisis
Lithium
used for bipolar disorder, mood stabilizer
MOA unknown
Other mood stabilizer
valproic acid (depakote)- acute mania
olanzapine - severe mania, or symptoms of psychosis
resperidone - severe mania, or symptoms of psychosis
Methylxanthines
MOA: probably antagonist at adenosine receptors, nonspecific stimulants
uses: stimulant
caffeine, theophylline, theobromine
Methylxanthines AE
withdrawal headdaches
excess timualtion
GI irritation
Amphetamines
MOA: blocks reuptake and cause release of catecholamines
uses: ADHD, increase alertness, reduce fatigue, improve task performance, reduce negative behavior
Amphetamines (4)
amphetamine (adderall)
methylphenidate (ritalin)
dexmethylphenidate (focalin)
daytrana- transdermal methylhenidate patch
Amphetamines AE
insomnia
anorexia
cardiac stimulant- increase HR, BP
tolerance
physical dependence/ addiction potential
lisdexamfetmaine (vyvanse)
additional stimulant
FDA approved
Non-stimulants for ADHD (3)
atomoxetine (strattera)
guanfacine (intuniv)
clonidine
Conventional (FGA’s) antipsychotics
MOA: block DA receptors
more effect on positive than negatice S/S
Atypical (SGA’s) antipsychotics
MOA: moderate blockade of DA receptors with potent blockade of 5HT receptors
effective for positive and negative S/S
Antipsychotic effects
dysphoria
impair cognitive performance
Phenothiazines (4)
MOA: block dopamine receptors
thiothixene (navane)
chlorpromazine (thorazine)
prochloperazine (compazine)
promethazine (pherergan)
Non-phenothiazines
MOA: block dopamine receptors
haldoperidol (haldol)
droperidol (inapsine)
Conventional (FGA) antipsychotics AE
pseudoparkinsonism
dystonia
akathisia
tardive dyskinesia
sedation
orthostatic hypotension
sexual dysfunction
antimuscarinic effects
Atypical (SGA) antipsychotics AE
weight gain
increase glucose
hyperlipidemia
sedation
antimuscarinic effects
extrapyramidal effects
Clozapine (clozaril)
MOA: blocks DA4 but also 5HT2, alpha and H1
uses: most effective agent fro schizophrenia
-reduces suicide
Other SGA’s (5)
risperidone
olanzapine
quetiapine
aripiprazole (abilify)
cariprazine (vraylar)
Ariprprazole (abilify)
MOA: partial agonist at 5HT and D2 receptors, DA system atabilizer
Uses: psychosis, bipolar mania, ASD, major depressive disorder, aggresion in AD
BBW: increase mmortality and suicidal thoughts in depression
causes compulsive behaviors (gambling, eating, shopping, sex)
Ariprprazole (abilify) AE
BBW: increase mmortality and suicidal thoughts in depression
causes compulsive behaviors (gambling, eating, shopping, sex)
Cariprazine (vraylar)
has D2/5HT2 effect + D3
uses: schizophrenia, bipolar mania
BBW: increase mortality in elderly dementia patients
Cocaine
MOA: reuptake of DA, NE, 5HT, also local anesthetic action, vasoconstriction
Amphetamines
MOA: block catecholamine uptake and cause release t1/2: 10 hrs
methamphetamine moa: halogenated amphetamine which increase entry into brain and central effects, t1/2: 5hrs
MDMA (ecstasy)
mehthylenedioxy- derivatives of methamphetamine
MOA: binds to 5HT transporter and causes profound release of 5HT
Ecstasy AE
relaxed mood
enhanced empathy
introspection and communication
sweating
tachycardia
fatigue
muscle spasms
Ketamine
MOA: NMDA antagonist, dissociative anesthetic, unpleasant dreams, hallucinations
uses: useful for pediatric procedures outside, depression, pain
LSD
MOA: acts at multiple sites in brain and spinal cord, probably through 5HT2 receptors
Other drugs for drug abuse
canniboids
psilocybin (magic mushrooms)
dextromethorphan (DXM)
