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Kaplan: CNS Pharmacology > Drugs Used for Depression, Bipolar Disorders, and Attention Deficit Hyperactivity Disorders, and Attention Deficit > Flashcards

Drugs Used for Depression, Bipolar Disorders, and Attention Deficit Hyperactivity Disorders, and Attention Deficit Flashcards

1
Q

What is the Amine Hypothesis?

A

the idea that deletion of neurotransmitters like NE, 5HT and DA cause severe depression as indicated by treatment with drugs like reserpine

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2
Q

Primary strategy for treating depression?

A

raise NE, and 5HT

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3
Q

What does the acronym SSRIs stand for?

A

selective serotonin reuptake inhibitors

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4
Q

What is the good way to remember the SSRIs by name? (a common suffix)

A

the “xetines” like fluoxetine and paroxetine but also sertraline, citalopram, and fluvoxamine

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5
Q

MOA of SSRIs?

A

selective blockade of 5HT reuptake

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6
Q

What are the uses of SSRIs?

A
  • major depression
  • OCD
  • bulimia
  • anxiety disorders
  • premenstrual dysphoric disorder
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7
Q

What are the S/E of SSRIs?

A

anxiety, agitation, bruxism, sexual dysfunction, weight loss

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8
Q

Toxicity to remember common with SSRIs?

A

serotonin syndrome

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9
Q

What are the symptoms of serotonin syndrome?

A

sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures

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10
Q

What are some other drugs that when combined with SSRIs could lead to serotonin syndrome?

A

MAOIs, TCAs, and meperidine

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11
Q

Which SSRIs inhibit cytochrome P450?

A

fluvoxamine and fluoxetine

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12
Q

Which SSRI has the least drug interactions?

A

citalopram

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13
Q

What is the MOA of TCAs?

A

non-specific blockade of 5HT and NE reuptake

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14
Q

TCA suffix?

A

“pramine”

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15
Q

What are some TCA drug names?

A

amitryptyline
imipramine
clomipramine

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16
Q

Uses of TCAs?

A

major depression

phobic and panic states

OCD

Neuropathic pain

enuresis

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17
Q

What are other MOAs of TCAs besides its main serotonin and NE blocking properties?

A

muscarinic and alpha blockade

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18
Q

Toxicity of TCAs and how to remember?

A

3C’s coma, convulsions, and cardiotoxicity

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19
Q

What are some drug interactions of TCAs to remember?

A

Hypertensive crisis with MAO inhibitors

serotonin syndrome with SSRIs MAOIs, and meperidine

prevent antihypertensive action of alpha 2 agonists

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20
Q

What is an important suffix to remember for SNRIs?

A

“lafaxines”

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21
Q

MOA of SNRIs

A

inhibit reuptake of both serotonin and NE

22
Q

S/E of SNRIs?

A

anorexia, somnolence, increase BP, SIADH, hepatotoxicity (duloxetine)

23
Q

List/Name the SNRI drugs.

A

venlafaxine, desvenlafaxine, duloxetine

24
Q

Toxicity of SNRIs?

A

serotonin syndrome with MAOIs, TCAs and meperidine

25
Q

MAOI MOA?

A

irreversible inhibition of MAO-A and MAO-B

26
Q

Use of MAOIs?

A

atypical depression

27
Q

Name some MAOI inhibitors?

A

phenelzine and tranylcypromine

28
Q

Drug interactions of SNRIs

A
  • serotonin syndrome
  • NE inc. can lead to hypertensive crisis
  • drug releasers like tyramine, TCAs, a1 agonists, and levodopa should be avoided
29
Q

Name some other Antidepressants not in the SSRI, SNRI, or TCA category.

A

trazodone, bupropion, mirtazapine

30
Q

S/E trazodone.

A

cardiac arrhythmias and priapism, hypotension, sedation, etc

31
Q

Trazodone MOA?

A

blocks 5HT reuptake
blocks 5-HT2B and 5HT2B receptors
alpha blocker
histamine blocker

32
Q

Bupropion MOA?

A

dopamine and NE reuptake blocker

33
Q

Use bupropion?

A

smoking cessation but not main choice

34
Q

Mirtazapine MOA?

A

a2 antagonist

35
Q

S/E of Mirtazapine?

A

weight gain

36
Q

Benefit of using SNRIs over TCAs?

A

like TCA but less autonomic effects

37
Q

Benefit of bupropion of trazodone.

A

because doesn’t affect 5HT it has less sexual S/E

38
Q

Lithium is the DOC for what condition?

A

bipolar disorders

39
Q

MOA lithium?

A

prevents recycling inositol (dec PIP2) by blocking inositol monophosphatase

dec cAMP

40
Q

What type of drugs should be avoided when using lithium?

A

lithium is cleared entirely by kidney so drugs that decrease GFR or inhibit sodium reabsorption in nephron may decrease its clearance and increase t1/2. Ex: NSAIDs, ACEI, ARBs, and most diuretics.

41
Q

What is an important distinction to make between the MOA of SSRIs and trazodone?

A

SSRIs block serotonin reuptake while trazodone blocks serotonin reuptake but also serotonin receptors themselves.

Trazodone also has H1 and alpha blockade

42
Q

S/E of Lithium.

A

narrow TI

tremor, flu-like symptoms, life-threatening seizures

hypothyroidism and goiter

nephrogenic diabetes insipidus (dec ADH effect)

43
Q

How can lithium cause hypothyroidism and goiter?

A

dec. TSH effects and inhibits 5’-deiodinase

44
Q

How does lithium cause nephrogenic diabetes insipidus?

A

decreases ADH effect because blocks V2 receptors so water can’t be reabsorbed

45
Q

What do you treat lithium induced nephrogenic diabetes insipidus with? Why?

A

amiloride

lithium competes for binding to sodium channels on the principal cells of the collecting duct (ENaC channels) if block these sodium channels then lithium can’t come in and decrease ADH effect. More aquaporin channels are produced so water can be reabsorbed

46
Q

What are other drugs used to treat bipolar disorder besides lithium?

A

valproic acid and carbamazepine

47
Q

What are the teratogenic effects of using lithium?

A

Epstein anomaly (malformed tricuspid valve

48
Q

Does using methylphenidate or amphetamine have some cardiovascular toxicity?

A

yes

49
Q

What is the MOA of atomoxetine?

A

selective NE reuptake inhibitor

50
Q

S/E atomoxetine?

A

similar to TCAs

Kaplan: CNS Pharmacology (8 decks)

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