pharmacology: depression, bipolar, ADHD Flashcards
what is the acute mechanism of antidepressants?
increase NE and 5HT
what are the drug classes used in depression?
MAOi, TCAs, SSRIs
what are the MAOis?
phenelzine and tranylcypromine
MAOi mechanism and clinical uses
inhibition of MAO A (causes increased NE and 5HT) and MAO B (increase DA)
clinical: atypical depressions
what are the drug interactions associated with MAOis?
- increased NE = hypertensive crisis (increased BP, arrhythmias, excitation, hyperthermia
(esp with tyramine, TCa, alpha 1 agonists and levodopa) - increased 5HT = serotonin syndrome (sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures)
(esp with SSRIs, TCAs, meperidine
what are the TCAs?
amitriptyline, imipramine, clomipramine
TCAs mechanism
nonspecific blockade of 5HT and NE reuptake
what are the major uses of TCAs?
neuropathic pain (amitriptyline) enuresis -involuntary urination- (imipramine)
side effects TCAs? toxicity?
side effects: muscarinic and alpha blockade
toxicity: 3 Cs: coma, convulsions, cardiotoxicity
TCA toxicity
HTN crisis with MAOi
serotonin syndrome with SSRIs, MAOi, meperidine
prevent antihypertensive action of alpha2 agonists
what are the SSRIs
fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine
SSRI mechanism (fluoxetine, paroxetine, sertraline, citalopram,, fluvoxamine)
selective blockade of 5HT reuptake
SSRI clinical uses
major depression, OCD, bulimia, anxiety disorders, premenstrual dysphoric disorder
side effects of SSRIs and toxicity
anxiety, gitation, bruxism (grinding teeth - think serotonin with GI manisfestations including increased salivation), sexual dysfunction, weight loss
toxicity: serotonin syndrome
bupropion mechanism and use
dopamine reuptake blocker used in smoking cessation
