Pharm2 6 Neuro pt4 Flashcards
Antidepressants
Usually falls into one of three categories:
Monoamine oxidase inhibitors (MAOIs)
Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs)
What is monoamine oxidase? (it’s inhibited by MAOIs)
an enzyme that terminates the actions of many neurotransmitters including dopamine, norepinephrine, epinephrine, serotonin
Were once widely used for depression, now useful only when other, newer, safer drugs fail
Have a significant side-effect profile
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs) easily interact with __ precipitating __
Easily interact with tyramine containing foods precipitating hypertensive crisis
Prototypical MAOI:
Phenelzine sulfate (Nardil®)
Phenelzine sulfate (Nardil®) Indications Mechanism of action
Indications: Major depression unresponsive to other pharmacotherapies
Mechanism of action: irreversibly inhibits MAO, intensifying NE at the synaptic cleft
Phenelzine sulfate (Nardil®)
Adverse Effects
Contraindications
Adverse Effects: Hypertension, tacharrythmias, delerium, mania, anxiety, convulsions, constipation, dry mouth, orthostatic hypotension, insomnia, anorexia, weight loss
Contraindications: Allergy, suicidal ideations, concurrent use of opiods, TCAs or SSRIs
Tricyclic Antidepressants (TCAs)
MoA
What’s the deal with these?
Inhibit the re-uptake of neurotransmitters norepinephrine and serotonin into pre-synaptic nerve terminals
Although a better cardiovascular risk profile than MAOIs, still have significant side effects and risks
Replaced largely by SSRIs
Prototypical Tricyclic Anti-depressant:
Imipramine (Tofranil®)
Imipramine (Tofranil®)
Indications
Mechanism of action
Indications: Major depression, OCD
Mechanism of action: Inhibit the re-uptake of neurotransmitters norepinephrine and serotonin into pre-synaptic nerve terminals
Imipramine (Tofranil®)
Adverse Effects
Contraindications
Adverse Effects: urinary retention, glaucoma, cardiovascular disease, epilepsy, suicidal ideations, psychosis, diabetes, hyperthyroidism, renal or hepatic dysfunction, potentiates many drugs, esp. ETOH and CNS depressants
Contraindications: Within 14 days of MAOIs, acute s/p AMI
TCAs are used less often today than in the past because of newer, better drugs but are still commonly used to treat…
depression in those unresponsive to newer, safer drugs
What’s the problem with TCAs?
TCA overdoses are very difficult to treat and almost always fatal
Be watchful of any patient who appears suicidal while taking TCAs
Prototypical Selective Serotonin Reuptake Inhibitors:
Fluoxetine (Prozac®)
Fluoxetine (Prozac®)
Indications
Mechanism of action
Indications: Mild to moderate depression, OCD, Bulimia Nervosa, Premenstrual Dysphoria, Post-Traumatic Stress Disorder
Mechanism of action: Selectively inhibits the re-uptake of serotonin in the pre-synaptic nerve terminals
Fluoxetine (Prozac®)
Adverse Effects
Contraindications
Adverse Effects: nausea, insomnia, somnolence, mania/hypomania, anorexia, weight loss, decreased libido, anorgasmia, rash, increased CNS stimulation, serotonin syndrome
Contraindications: Allergy, MAOIs within 14 days, bipolar disorder
Bipolar Disorder (Manic-Depression) The main treatment remains
Lithium, with or without adjunctive therapy (esp. other mood stabilizers such as Tegretol, Depakote)
What’s the problem with Lithium, dude?
Lithium has an extremely narrow therapeutic range and is easily displaced by common OTC medications
Prototypical Mood Stabilizer:
Lithium (Eskalith®)
Lithium (Eskalith®)
Indications
Mechanism of action
Indications: Bi-polar disorder, mania with depressive symptoms
Mechanism of action: Unknown, thought to alter NE, dopamine, serotonin reducing their activity ultimately resulting in mood stabilization after ~ 2-3 weeks
Lithium (Eskalith®)
Adverse Effects
Contraindications
Adverse Effects: Polyuria, polydipsia, drowsiness, tremor, nausea, vomiting, diarrhea, seizures, arrhythmias, hypotension, metalic taste
Contraindications: Allergy, suicidal ideations, potentiated toxicity with diuretics, ACE-I, NSAIDs, and many others; multiple drug-drug interactions
Any patient on lithium requires what?
Requires periodic check of serum levels
___ easily interacts with Tyramine containing foods.
and what foods is this found in?
Monoamine Oxidase Inhibitors (MAOIs)
certain meats, cheeses, wines
Patient ate a tyramine containing food (some kind of cheese & wine) and their BP shot to 260/140 and is at risk of stroke.
What happened?
MAOI interaction with tyramine containing food
What psych drug causes very dry mouth (mouth clicks as they talk to you) & trouble peeing?
Nardil
with tca’s and suicide, Within 30 minutes of taking 5 of these tablets, there’s nothing that can be done to reverse it. They go into:
cardiac arrhythmia that is untreatable.
What side effect affects Prozac’s dosing? how?
Nausea, so you titrate upwards. get over it after a few days
___’s side fx include both weight gain and anorxia. which is more common?
Prozac
gain
Tendency to sleep more, get fat, and not want to have sex
Decreased libido & can’t have an orgasm despite how long. what psych drug?
Prozac
Describe Serotonin Syndrome
very rare! Can happen in any drug that hits the serotonin receptor. Tendency to get mental status changes, bp goes up and down, ataxia, and if you withdraw the serotonin inhibitor it goes away.
Name 4 drugs that can cause Serotonin syndrome
b/c they hit serotonin receptor
Proac, antimigraine drugs (Imitrex, Sumatriptan), Dextromethorfan
Danger about Lithium
Lithium is loosely protein bound, so it can easily become toxic.
What psych med can leave a really bad taste in your mouth?
Lithium
