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IC Part 2 > Drugs for Mood Disorders > Flashcards

Drugs for Mood Disorders Flashcards

1
Q

Pathophys of depression

A

may involve noradrenergic or serotonergic neurotransmission

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2
Q

Bipolar disorder

A

periods of depression altering with periods of mania or hypomania (inc activity, dec need for sleep, racing thoughts, elevated mood or irritability, inc self esteem, grandiose ideation, psychotic symptoms, harmful to self or others–> manic)

tx with mood stabilizing agents and antidepressants (depression) or antipsychotics (mania) as needed

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3
Q

Antidepressants

A 
tx depressive symptoms resulting in euthymia (normal mood)- should not elevate mood in non-depressed people 
-four major classes: 
MAOI
TCAs
SSRIs
Misc
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4
Q

Mechanism of antidepressants

A

inc synaptic availability of NE and/or serotonin
-therapeutic effects develop over timea and several weeks of tx may be required before maximal effects are achieved (requires the downregulation and compensatory changes to result in therapeutic effect)

ultimate effect due to:

  • secondary changes in receptors- down regulation of a2 and b receptors
  • inc in brain derived neurotrophic factor in hippocampus
  • cognitive changes, supported by proven efficacy of cognitive therapy
  • combination of these effects
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5
Q

MAOIs

A

Phenelzine
Tranylcypromine

Increase synaptic availability of norepinephrine and serotonin by blocking catabolism
-irreversibly inhibit MAOa (NE and 5-HT) and MAOb (DA)

-in individuals not adequately treated by other antidepressants

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6
Q

Side effects of MAOI

A

postural hypotension, weight gain, sexual dysfunction

GI side effects

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7
Q

Overdose on MAOI

A

unusual but can cause seizures, shock, delirium, hyperthermia

potentiate action of other sedatives such as alcohol

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8
Q

MAOIs interactions

A

numerous drug interactions
esp when used with any drug that increases serotonin or acts at 5-HT receptors–> fatal “serotonin syndrome”
-tremor, muscle rigidity, hyperthermia, htn, tachycardia, myoclonus

food interactions- tyramine containing foods–> htnsive crisis

precautions must be observed for 2 weeks after cessation of drug bc irreversibly inactivation of MAO

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9
Q

older TCAs

A

amitriptyline

nortriptyline

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10
Q

newer TCAs

A

clomipramine- improved side effect profiles

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11
Q

TCA mechanism

A

Inhibit reuptake of norepinephrine and/or serotonin at NE and 5-HT transporters

potent antagonists at various receptors including cholinergic, histamnergic, and alpha-adrenergic

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12
Q

Side effects of TCA

A

anticholinergic effects, orthostatic hypotension, sexual dysfunction, sleepiness, arrythmias,

discontinuation syndrome

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13
Q

TCAs overdose

A 
life threatening (suicide risk)- coma, arrythmias, seizures, cardiac effects 
adverse interactions with MAOIs
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14
Q

SSRIs

A

fluoxetine, sertraline, paroxetine, citalopram, escitalopram

inhibit reuptake of serotonin (selective for serotonin, not specific- can inhibit reuptake of NE at higher doses)

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15
Q

SSRI side effects

A

GI symptoms, decreased libido, sexual dysfunction

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16
Q

SSRI overdose, interactions

A

adverse drug interactions with MAOIs- serotonin syndrome

CYP2D6 interactions for fluoxetine (and metabolites) and paroxetine

low risk of fatal overdose

discontinuation syndrome for drugs with short 1/2 lives and anti-muscarinic

adverse effects in pregnancy, enters breast milk, risk of pulmonary htn in newborn

17
Q

NE and 5-HT uptake inhibitors

A

Duloxetine, venlafaxine (high inc of discont syndrome), desvenlafaxine, levomilnacipran

newer drugs with improved overall side effect profiles

18
Q

NE uptake inhibitor

A

Maprotiline

19
Q

Vilazodone

A

5-ht uptake inhibitor plus other things
5-HT1a partial agonist
SE: nausea, vomiting constipation, insomnia

20
Q

Vortioxetine

A

serotonin uptake inhibitor plus 5-HT3 antagonist, 5-HT1a agonist

Nausea, vomiting, constipation

21
Q

Mirtazepine

A

inc 5-ht and NE release by blocking a2 receptors on nerve terminals

22
Q

Bupropion

A

inhibits dopamine reuptake as well as effects on 5-ht and NE

lower incidence of sexual dysfunction

SE: CNS stimulation, anxiety, agitation, insomnia, dizziness, sweating, aggravation of psychosis, seizures

23
Q

Amoxapine

A

inhibits reuptake of 5-HT and NE and is a dopamine antagonist- antipsychotic activity

SE: similar to TCAs but also causes EPS and tardive dyskinesia because dopamine antagonism

originally for psychotic depression

24
Q

Trazodone

A

Sedating at sub-antidepressant doses
5Ht2A antagonist
Weak inhibitor of NET and SERT
Short acting

Used as hypnotic and pre-anesthetic

PRIAPISM!!!!!

25
Q

antidepressant metabolism and excretion

A

hepatic metabolism
eliminated in 7-10 days (except fluoxetine which has active metabolites)

more rapid in children- slower in the aged–> adjust dose

26
Q

Black box warning for antidepressants

A

inc risk of suicidal thinking and behavior in children, adolescents, young adults with major dep disorder and other psych disorders

27
Q

Lithium

A

affect ion transport, serotonin system, PI cascade, or arachidonic acid signaling

absorbed rapidly but accumulates slowly in brain (6-10 days for therapeutic levels)
95% excreted in urine

28
Q

Lithium side effects

A

low therapeutic index
tremor (common, treat with propranolol)
polydipsia and polyuria- nephrogenic diabetes insipidus
acne

29
Q

Lithium overdose

A

tremor, nausea, vomiting, diarrhea, sedation

severe: ataxia, confusion, coma,arrhythmias, death

30
Q

contraindications for lithium

A

renal or cv disease

pregnancy- teratogenic

31
Q

carbamazepine

A

dec glutamate
blood dyscrasias
used for partial seizures

mood stabilizer

32
Q

valproic acid

A

enhances GABAergic transmission
used for seizures
mood stabilizer

33
Q

lamotrigine

A

inc inactivation of Na channels
absence and partial seizures
mood stabilizer

34
Q

Mood stabilizers

A

used for the swings between depression and mania for bipolar disorder

IC Part 2 (27 decks)

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