Mood Stabilizers Flashcards
Biogenic Amine Hypothesis
Depression is due to deficiency of monoamines, such as NE, Serotonin at key sites in the brain
MOA of Antidepressants
Inhibits reuptake of NE by blocking NET
Inhibits reuptake of 5-HT by blocking SERT
Tertiary Amine TCAs
Amitriptyline (Elavil®)
Clomipramine (Anafranil®)
Imipramine (Tofranil®)
Doxepine (Aponal®)
Trimipramine (Surmontil®)
Dosulepine/ Dothiepin (Prothiaden®)
Secondary Amine TCAs
Desipramine (Norpramin®)
Protriptyline (Vivactil®)
Nortryptyline (Pamelor®)
A/Es of TCAs
Orthostatic Hypotension
Autonomic Side Effects
Cardiac Conduction Delays & Heart Block
Sexual Dysfunction
Sedation
Seizures
Weight Gain
Cardiac dysrhythmia
Process involved in the biotransformation of Amitriptyline to Nortriptyline
N-demethylation
Useful in the treatment of Nocturnal Enuresis (Bed Wetting) due to its Anticholinergic Effects
Imipramine
Treatment of TCAs Toxicity
NaHCO3
MOA of Selective serotonin reuptake inhibitors (SSRIs)
Inhibits reuptake of 5-HT!
Most widely used drugs for treatment of depression and anxiety disorders
SSRIs
TF: SSRIs are much safer than TCAs, as it seldom cause cardiac arrhythmia and seizures
True
Selective Serotonin Reuptake Inhibitor
(SSRIs)
- Fluoxetine
- Paroxetine
- Fluvoxamine
- Sertraline
- Citalopram
- Escitalopram
Fluoxetine
Depression
Panic
Bulimia
Anorexia nervosa
OCD
Converted to Norfluoxetine
Half-life: 2.5 Days
Fluvoxatine
OCD, panic attack
Can be used for elderly
Sertraline
SE: Sedation
Paroxetine
For hot flushes and perimenopause (Low dose)
A/Es of SSRIs
Increase alertness
Nervousness
Dizziness
Insomnia
Serotonin Norepinephrine Reuptake
Inhibitor (SNRI)
Duloxetine - For neuropathic pain & GAD
Venlafaxine - Less affinity to NE reuptake
Milnacipran - For fibriomyalgia
Levomilnacipran (S-isomer)
Noradrenaline Reuptake Inhibitor (NaRI)
Raboxetine
Selective Serotonin Reuptake Enhancer (SSRE)
Tianeptine (Stablon®)
Non-Selective Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil®)
Isocarboxacid
Tranylcypromine (Parnate®)
Selective MAOI-A
Moclobemide (Aurorix®)
Selective MAOI-B
Selegeline (Eldepryl®)
MAOIs + SSRIs
Serotonin Syndrome
MAOIs + Tyramine
Hypertension Crisis
Weak inhibitor of the neuronal reuptake of dopamine, norepinephrine, and serotonin
Bupropion
Bupropion MOA
Noncompetitive antagonist at nicotinic cholinergic receptors
Bupropion clinical uses
Smoking deterrent
Treatment of obesity (Bupropion + Naltrexone)
5-HT2 antagonists
Nefazodone (Serzone®) - Hepatotoxic
Trazodone (Desyrel®) - Cause Priapism (prolonged, painful erection)
- ZODONE
Tetracyclic antidepressant, alpha 2 receptor blocker
Mirtazapine - cause agranulocytosis
Extracts of St. John’s Wort
Hypericin - fewer SE, less effective
Mania
Delusion
Increased libido
Elevated mood
Talkativeness
Lithium carbonate MOA
Reduces formation of Inositol triphosphate (IP3)
1st line treatment & prevention of bipolar disorder
Lithium
Diuretics + Lithium carbonate
Increase Li toxicity
Adverse Effects of Lithium carbonate
Low Therapeutic Index
Tremor, N/V
Neurotoxic
Cardiotoxic
Polyuria
Hypothyroidism
Teratogenic (Eibstein anomaly)
Idiosyncratic Reactions of Lithium Carbonate
Nephrogenic DI
Thyroid abnormalities
Ebstein Anomaly
Alteration Levels of:
a. Acetazolamide
b. “xanthine” drugs
c. Sodium competes with Li excretion
*Increased levels of ACEi, NSAIDs, Thiazide Diuretics
Alternative drugs for Bipolar disorder
Carbamazepine
Lamotrigine
Valproic acid
Benzodiazepine - relieve manic symptoms
For rapid cycling bipolar disorder and has better safety profile than Lithium
Valproic Acid
For acute mania and prophylaxis for depressive phase of bipolar disorder
Carbamazepine (Tegretol)
Atypical Psychotics can be used for Bipolar Disorder
Risperidone
Olanzapine
Aripiprazole
Arsenapine
