Depression and Bipolar Disorder Flashcards
Which anti-depressents don’t have a black box warning for suicidal thinking in young adults and younger
None of them
MAOI available in transdermal patch
Selegiline
Serum lithium is monitored regularly to avoid toxicity. What variable tends to increase lithium? What are minor and major side affects?
Decreased sodium (fever, sweating, certain drugs) decreases Li excretion. Hand tremors…..to ataxia, seizures, arrhythmias, and coma.
Class of drugs and one specific drug which inhibits SERT and NET
SNRI: duloxetine (duo effect)
Two MOAI’s
Phenelzine and Selegiline
What is the mechanism of action of bupropion that allows it to be combined with other anti-depressants (which as a rule are not combined)?
blocks DAT > NET
Two side affects of buproprion? What side affect does bupropion not share with the SSRI’s and is used off-label to treat
Weight loss and increased risk of seizures. Does not cause sexual dysfunction and used off-label to treat SD caused by SSRI’s.
SA of SSRI’s AAA:PISSSER:CCC
5HT2 receptors: agitation, akathesia, anxiety initially, panic attacks, insomnia, sexual dysfunction
Serotinon syndrome
5HT3 receptors: Sick (nausea, diarrhea, etc.)
Efficacy decreases > 18 months, Rebound w rapid withdrawl, Category c, Competes for CYP 2D6 (drug interactions), Contraindicated with MAO
Which SSRI is better tolerated and is used for PTSS (PTSD)
Sertaline
Which anti-depressant can be lethal due to overdose due to cardiovascular effects
Amitripyline
Which class of anti-depressants acts irreversibly and faster than the others?
The MOAI’s
Which antidepressent has the most side effects? How is it metabolized and what reuptake/receptors does it act upon?
TCA: amitriptyline. Half is metabolized to NORTRIPYLINE (by CYP 2D6) and other metabolites (30hr 1/2 life) which act on 5 receptors: inhibit SERT and NET; block M1, M1, Alpha 1.
Anti-depressant used for pts. with insomnia. What is it’s major side affect?
Mertazapine: somnolence and weight gain
