Non-atypical antidepressants & mood stabilizers

Question 1

TCAs (2 endings & an exception)

Answer 1

-pramines
-tryptalines
+doxepin

Amitrptyline
Imipramine
Nortriptyline
Desipramine

SNRI, block mACh, 5-HT, H, & alpha

incompletely absorbed by 1st pass. High lipid sol, highly protein bound, long t1/2. block clonidine. CI with physostigmine. Anticholinergic. Tons of AE (OrHTN, weight, sex dysf)

Question 2

SSRIs (5)

Answer 2

fluoxetine
fluvoxamine
sertraline
paroxetine
citalopram
escitalopram

inhibit CYP2D6, 2C19=self-inhibition of metabolism.
Nausea, sex dysfn. Fewer than others.
CI: MAOIs - serotonin syndrome

Question 3

MAOIs (3)

Answer 3

tranylcypramine
isocarboxazid
phenylzine

irreversible blockade of MAO (so buildup of NE, 5-HT, tyramine from MAO-A, and DA from MAO-B)

cns stim, agitation, euphoria 2-6 wks. CNS activation doesn’t attenuate. OHTN, weight gain, sex dysfn. Sympathomimetics cause hypertensive rxn. tryptophan, cheese, turkey, beer

not 1st line (after others, ECT) except for panic disorder & agoraphobia.

Question 4

fluoxetine

Answer 4

SSRI

Question 5

fluvoxamine

Answer 5

SSRI

Question 6

sertraline

Answer 6

SSRI

Question 7

paroxetine

Answer 7

SSRI increased risk of birth defects

Question 8

citalopram

Answer 8

SSRI

Question 9

selegeline

Answer 9

MAO-B Inhibitor

Question 10

phenylzine

Answer 10

MAOI

Question 11

desapramine

Answer 11

best TCA for somatoform disorders

Side FX mildest

Question 12

imapramine converts to

Answer 12

desapramine

Question 13

onset w/i 24h OD or concurrent MAOI & SSRI. Overstimulation of 5-HT1A R in central grey and medulla. Hyperreflexia, hyperpyrexia, tremor, shivering, myoclonus, agitation, seiqures, delirium, CV collaps, coma. Fatal unless meds discontinued. Also triggered by amphetamines, MDMA, LSD, buspirone

Answer 13

serotonin syndrome

Question 14

amitryptaline converts to

Answer 14

nortryptaline

Question 15

MAOI action & receptor subtypes

Answer 15

irreversible blockade of MAO

NE, 5-HT, tyramine = MAO-A
DA = MAO-B

Question 16

4 mood stabilizers

Answer 16

Lithium, Valproate, Carbamazapine, Lamotrigine

Question 17

Lithium

Answer 17

unknown MOA (maybe inhibition of inositol phosphate signaling or NT-stim adenyl cyclase activity)

Narrow therapeutic range, CatD teratogen, tremor, ataxia, aphasia, sedation, edema, hypothyroid, neph DI, brady/tachycardia, acne, foliculitis, psoriasis exacerbation. ADE includes diuretics and NSAIDs.

Question 18

Lamotrigine

Answer 18

less teratogenic alternative to lithium

Question 19

valproate

Answer 19

CatX

Ca/Na/GABA actions.

Inhibits own metabolism & others via CYP2C inhibition. Sedation, LFTs required.

Question 20

Carbamazapine

Answer 20

Na channel blocker - prolongs recovery from inactivation. Mood stabilizer, seizures, also trigeminal neuralgia.

bound to albumin, poor sol. CYP3A4 to active metabolite with 20-36hr t1/2.

Induces UGTs, CYP2C, 3A.

Diplopia & ataxia! plastic anemia & rash.

Question 21

escitalopram

Answer 21

Single enantiomer of racemate citalopram