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Neuro Exam 3 > Pharmacology of Mood Disorders > Flashcards

Pharmacology of Mood Disorders Flashcards

1
Q

selective serotonin reuptake inhibitors (SSRIs) - MOA

A

*inhibit serotonin transporter (SERT), decreasing 5-HT (serotonin) reuptake, leading to MORE 5-HT in the synapse

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2
Q

SSRI - meds in the class

A

*sertraline
*citalopram
*escitalopram
*fluoxetine
*paroxetine

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3
Q

sertraline - drug class

A

SSRI

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4
Q

citalopram - drug class

A

SSRI

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5
Q

escitalopram - drug class

A

SSRI

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6
Q

fluoxetine - drug class

A

SSRI

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7
Q

paroxetine - drug class

A

SSRI

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8
Q

sertraline - MOA

A

inhibit 5-HT reuptake (SERT)

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9
Q

citalopram - MOA

A

*inhibit 5-HT reuptake (SERT)
note - SSRI

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10
Q

escitalopram - MOA

A

*inhibit 5-HT reuptake (SERT)
note - SSRI

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11
Q

fluoxetine - MOA

A

inhibit 5-HT reuptake (SERT)

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12
Q

paroxetine - MOA

A

inhibit 5-HT reuptake (SERT)

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13
Q

first line SSRIs

A

*sertraline
*citalopram
*escitalopram

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14
Q

uses of SSRIs

A

*depression
*anxiety disorders
*OCD
*PTSD
*bulimia

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15
Q

ADEs of SSRIs

A

best tolerated antidepressants, but ADEs include:
*sexual dysfunction
*drowsiness or insomnia; headache
*weight gain
*GI upset
*serotonin syndrome

note - increase in suicidal ideation in those < 25 yo, but no increase in suicidal death

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16
Q

serotonin syndrome - cause

A

*too much serotonin
*usually from drug interactions or overdose (OD)

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17
Q

serotonin syndrome - symptoms

A

*CNS: delirium, agitation, restlessness, coma
*autonomic: diaphoresis, tachycardia, hyperthermia, hypertension
*neuromuscular: hyperreflexia, clonus, tremor

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18
Q

serotonin syndrome - treatment

A

*discontinue causative agents
*supportive care
*sedation with benzos, if needs

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19
Q

selective serotonin-norepinephrine reuptake inhibitors (SNRIs) - MOA

A

*inhibit SERT and NET, decreasing 5-HT and NE reuptake, leading to MORE 5-HT and NE in the synapse

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20
Q

SNRIs - meds in the class

A

*venlafaxine
*duloxetine

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21
Q

venlafaxine - drug class

A

SNRI

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22
Q

duloxetine - drug class

A

SNRI

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23
Q

venlafaxine - MOA

A

inhibit 5-HT and NE reuptake (SERT & NET)
note - SNRI

24
Q

duloxetine - MOA

A

inhibit 5-HT and NE reuptake (SERT & NET)

25
Q

uses of SNRIs

A

*depression
*anxiety disorders
*fibromyalgia
*chronic pain
*neuropathy

26
Q

ADEs of SNRIs

A

ADEs of SSRIs PLUS:
*hypertension & tachycardia
*more likely to be CNS stimulating than sedating

27
Q

tricyclic antidepressants (TCAs) - MOA

A

*inhibit 5-HT and NE reuptake

note - like SNRIs but hit other receptors (H1, Ach, and alpha-1), leading to more ADEs

28
Q

important TCA med to know

A

amitriptyline

29
Q

amitriptyline - drug class

A

tricyclic antidepressant (TCA)

30
Q

amitriptyline - MOA

A

*inhibits 5-HT and NE reuptake (SERT & NET)
note - TCA

31
Q

uses of TCAs (amitriptyline)

A

*depression (not used for this much now)
*pain disorders
*migraine
*prophylaxis
*insomnia
*neuropathy

32
Q

ADEs of TCAs (amitriptyline)

A

MOA of ADEs: H1 receptor blockade, Ach receptor blockade, and alpha-1 receptor blockade
*anticholinergic effects (dry mouth, urinary retention, etc)
*sedation, weight gain (antihistamine effects)
*cardiac conduction abnormalities (QTc prolongation, heart block)
*orthostatic hypotension (alpha-blocker)
*sexual dysfunction
*serotonin syndrome

*overdose = cardiac, coma, & convulsions

33
Q

3 C’s of TCA overdose

A

cardiac, coma, and convulsions

34
Q

bupropion - MOA

A

*inhibits NET and DAT, leading to increased NE and DA
*CNS-activating

note - NO effect on 5-HT

35
Q

uses of bupropion

A

*depression (common “second drug”)
*smoking cessation

36
Q

ADEs of bupropion

A

*anxiety
*insomnia/agitation
*increased BP
*tremor
*headache
*weight loss
*SEIZURES (lowers sz threshold; don’t use in pts with sz disorder)
*NO SEXUAL DYSFUNCTION

37
Q

unique properties of bupropion

A

*no effect on 5-HT
*no sexual dysfunction
*lowers sz threshold (do not use for pts with seizures)

38
Q

mirtazapine - MOA

A

*central pre-synaptic alpha-2 antagonist, leading to increased 5-HT and NE

39
Q

uses of mirtazapine

A

*insomnia
*increase appetite
*depression (not really used for this)

40
Q

ADEs of mirtazapine

A

MOA of ADEs: H1 receptor blockade, alpha 2 receptor blockade
*sedation
*increased appetite and weight gain
*dry mouth
*serotonin syndrome
*little sexual dysfunction

41
Q

trazodone - MOA

A

*“serotonin modulator” - primarily a potent 5-HT2a antagonist

42
Q

uses of trazodone

A

*insomnia in depressed pts

43
Q

ADEs of trazodone

A

MOA of ADEs: H1 receptor blockade and alpha-1 receptor blockade
*PRIAPISM
*dizziness
*sedation
*headache
*GI disturbances
*orthostatic hypotension
*serotonin syndrome
*little sexual dysfunction

44
Q

monoamine oxidase inhibitors (MAOIs) - MOA

A

*inhibit monoamine oxidase (the enzyme that breaks down neurotransmitters)
*leading to increased 5-HT, NE, & DA

45
Q

MAOIs - meds in class

A

*phenelzine
*selegiline
*tranylcypromine

46
Q

uses of MAOIs

A

last resort for treatment-resistant depression

47
Q

ADEs of MAOIs

A

*orthostatic hypotension
*CNS stimulation or depression
*dizziness
*HA
*hypertensive crisis
*sexual dysfunction
*serotonin syndrome
*DRUG INTERACTIONS

48
Q

drug interactions of MAOIs

A

*don’t use with other 5-HT agents or sympathomimetic agents
*avoid high tyramine diet

49
Q

lithium - MOA

A

unknown

50
Q

uses of lithium

A

bipolar disorder

51
Q

ADEs of lithium

A

*tremor
*GI upset
*polyuria/polydipsia
*dizziness
*leukocytosis
*seizures
*confusion
*coma
*arrythmias

52
Q

drug interactions of lithium

A

NSAIDs and thiazide diuretics decrease lithium clearance (increase the risk of toxicity)

53
Q

LiTHIUM mnemonic for lithium

A

Low Thyroid
Heart (Ebstein anomaly)
Insipidus (nephrogenic diabetes insipidus)
Unwanted Movements (tremor)

54
Q

elimination of lithium

A

*RENAL elimination
*important to monitor frequently if renal function impaired or changing
*avoid if CrCl < 30 mL/min

55
Q

symptoms if antidepressant is discontinued quickly (discontinuation syndrome)

A

flu-like syndrome, dizziness, fatigue, HA, nausea

Neuro Exam 3 (31 decks)

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