Exam 3 Neuro Part 4 Drugs Flashcards
anti depressive therapy - general
2 weeks to see improvement in physical sx
6-8 weeks to see emotional sx improvement
SSRI indication
depression
SSRI MOA
inhibit reuptake of 5-HT in CNS
SSRI drugs
citalopram (Celexa)
escitalopram (Lexapro)
first line depression med
SSRI due to efficacy and tolerability
OR
SNRI esp if concomitant neuropathic pain or fibromyalgia
SSRI common AEs
less anticholinergic and cvd effects than other classes
HA, n/v/d, insomnia, sexual side effects
SSRI less common AEs
hyponatremia
bleeding (impaired platelet aggregation
SSRI other uses
eating disorder PTSD anxiety OCD bipolar disorder vasomotor menopausal sx
SNRI MOA
inhibit reuptake of 5-HT and NE in CNS
SNRI indication
depression
SNRI common AE
ha, nausea, dry mouth, sweating, sexual dysfunction, insomnia
SNRI other uses
tons
fibromyalgia, migraine prevention
SNRI drugs
venlafaxine (Effexor)
bupropion (Wellbutrin) class
DA/NE reuptake inhibitor
bupropion (Wellbutrin) indication
often adjunct to reduce sexual dysfunction in depression
bupropion (Wellbutrin) MOA
inhibits NE and DA uptake
bupropion (Wellbutrin) common AE
ha, nausea, insomnia, tremor, dry mouth, decrease appetite
seizure risk
bupropion (Wellbutrin) other uses
ADHD, smoking cessation , weight loss
mirtazapine (Remeron) class
a2 antagonist
mirtazapine (Remeron) indication
used as adjunct therapy in depression
less common
mirtazapine (Remeron) MOA
stops inhibition of 5-HT and NE so increases release
mirtazapine (Remeron) common AEs
sedation
increase appetite (weight gain)
dry mouth
constipation
vilazodone (Viibryd) indication
depression
vilazodone (Viibryd) MOA
inhibits NE reuptake but also acts as a 5-HT receptor agonist
vilazodone (Viibryd) AE
n/d headache
vortioxetine (Trintellix) MOA
unclear
likely inhibits 5-HT reuptake
causes increased NE, ACh, and DA activity in prefrontal cortex
common AEs
nausea and sexual dysfunction
tricyclic antidepressants indication
depression
less commonly used bc of safety
tricyclic antidepressants MOA
inhibits 5-HT and NE reuptake
other receptor blockage contributes to AE
tricyclic antidepressants common AE
weight gain sexual dysfunction sedation (histamine) antichoningic effects (muscarinic) hypotension and dizziness (alpha)
tricyclic antidepressants serious AE
overdose!!
cardiac conduction abnormalities due to blocking cardiac Na channels
tricyclic antidepressants other uses
neuropathic pain
migraine prevention
insomnia
MAO inhibitors indication
depression
typically last line option
MAO inhibitors MOA
increase 5-HT, NE and dopamine by inhibiting MAO enzyme
MAO inhibitors common AE
OH
weight gain
sexual dysfunction
MAO inhibitors serious AEs
HIGH risk of serotonin syndrome (so must separate from other antidepressants by several weeks if changing treatment)
risk of hypertensive crisis
first line anxiety treatment
SSRI and SNRI
when is propranolol used in anxiety
long term panic attacks and prn for phobias
reduces sympathetic stimulation related to palpitations and tremors
when are benzodiazepines used in anxiety
only for acute treatment
when is buspirone used in anxiety
maintenance in generalized anxiety
benzodiazepines drugs
alpazolam (Xanax)
benzodiazepines MOA
binds BZD receptors on GABA channels to enhance GABA inhibitory effects
benzodiazepines dosing
avoid as maintenance therapy due to psychotic and physiologic dependence
- taper off if long term use
benzodiazepines common AE
sedation
ataxia
memory problems
benzodiazepines less common AEs
paradoxical excitement or anxiety
benzodiazepines contraindications
caution in elderly due to build up of metabolites
buspirone (Buspar) MOA
unclear
known to bind to 5-HT and dopamine recepors
buspirone (Buspar) advantages
no abuse risk
limits motor, memory, concentration impairments
buspirone (Buspar) disadvantages
dizziness
3 weeks to see impact
possibly less effective in severe anxiety
metabolized by CYP - DDI
FGA indication
schizophrenia
2nd line treatment due to AE
FGA - general
aka conventional or typical
marketed before 1990
previously called “neuroleptics”
SGA - general
aka novel or atypical
marketed after 1990
less EPS and TD
more likely 1st line
FGA MOA
block d2 receptors where excess DA may contribute to positive sx
FGA AEs
EPS is acute or delayed
SGA indication
schizophrenia
1st lines treatment
SGA drugs
quetiapine (Seroquel)
SGA MOA
block d2 receptors (more affinity for 5- HT tho)
SGA AE
variable bc variable effect on histamine, muscarinic and alpha receptor
less frequent EPS
high risk for metabolic dysfunction
- glucose and lipid abnormalities
- weight gain
monitor for dyslipidemia and diabetes
primary treatment for acute depressive episodes (bipolar)
SSRI
bupropion
primary treatment for acute manic episodes (bipolar)
lithium
primary treatment for maintenance treatment in bipolar
lithium
lithium indication
bipolar disorder
- management of episode
- used combo bc takes 5-10 days for response
- prevention of further mani and depressive episodes
lithium AE
GI (n/v/d, abdominal cramps) weight gain polydipsia and uria CNS fine hand tremor fatigue muscle weakness
LITHIUM TOXICITY
valproic acid (VPA) indication
acute manic bipolar episodes
boxed warning: hepatoxicity usually within first 6 months
carbamazepine indication
used in manic and mixed episodes and for maintenance of bipolar
boxed warning: SJS and toxic epidermal necrolysis
lamotrigine indication
alternative to lithium for bipolar depressive episodes
boxed warning: serious skin rash, can be life threatening, more common in kids
