PHARM - anxiety, depression, and mania drugs Flashcards
(31 cards)
leading SSRI and others
- CITALOPRAM
- escitalopram
- fluoxetine
- paroxetine
- fluvoxamine
leading serotonin acting TCA
chlomipramine
leading SNRI and others
- VENLAFAXINE
- desvenlafaxine
- duloxetine
leading NDRI
bupropion
leading NE acting TCA and others
- NORTRYPTILINE
- imipramine
- amitriptyline
- desipramine
leading MAO-Is
- phenelzine
- tranylcipramine
most of the cells that use serotonin as a primary signaling messenger are in the
Raphe nucleus
citalopram SEs and interactions
- SSRI
- increased suicidal ideation up to age 25
- GI, sexual, sleep, sweating, hyponatremia, mania
- QTc elongation - risk of Torsade’s at high doses
- R enantiomer has weak 2D6 inhibition, can increase levels of TCAs and MAOIs
NE predominant nerve cells are mostly found in the…
Locus Coeruleus
venlafaxine SEs and interactions
- SNRI
- increased suicidal ideation up to age 25
- GI, sex, sleep, sweating, hyponatremia, mania
- diastolic BP increase
secondary vs tertiary amines (TCAs “SNRIs”), drugs and benefits
tertiary - imipramine, amitriptyline, chlomipramine
secondary - nortriptyline, desipramine
secondary are better because they have less side effects and are focused more toward NE than serotonin
nortriptyline SE and interactions
- TCA
- weight gain, sedation, ACh, hypotension, arrhythmia, sexual, sweating
- 2D6 inhibition
- interacts with MAO-I, TCA, tramadol
- lethal in overdose
bupropion SE and interactions
- NDRI
- SEs - insomia, tremors, tinnitus, seizures
- no sexual side effects because it doesn’t affect serotonin
- interactions - 2D6, MAO-I, TCA, tramadol, levodopa
how do MAO-Is work? switching from AD to MAO-I?
- shut down monoamine oxidase, increasing amount of all three monoamines, NE, serotonin, and dopamine
- need a two week wash out period when switching from AD
- MAO-Is are third line ADs because of side effects but may be more effective overall because of the triple action
major MAO-I side effects
- serotonin syndrome - when drugs that increase serotonin are added (mereprine, Libby Zion)
- dietary tyramine - precursor to monoamines
mirtazapine mechanism
- NaSSA, dual reuptake
- blocks A2 (NE), 5HT receptors, and H1 histamine receptors
mirtazapine SE and interactions
- sedating, weight gain, histamine block
- do not combine with MAO-I
bupropion least likely to cause….
mania
bupropion may reduce….
sexual side effects of ADs
what are the two major MAO-Is and what are their main SEs?
phenelzine - sedating
tranylcypromine - stimulating
what are SARIs and what is their mechanism?
- serotonin 2A antagonists
- block 5HT2A, 5HT2C, A1
5 therapeutic uses of BZDs
- sedative
- anxiolytic
- seizure
- muscle relaxant
- anterograde amnesia/anesthesia
what is the basic BZD mechanism?
- positive allosteric modulator
- binds and increases receptor affinity for GABA
- Cl- rushes into cell
- hyperpolarization, now greater energy needed to stimulate cell
diazepam mechanism
- non-selective BZD
- binds any receptor with alpha 1-3, 5
- anywhere in brain
