Pharmacology of Mood Disorders Flashcards
selective serotonin reuptake inhibitors (SSRIs) - MOA
*inhibit serotonin transporter (SERT), decreasing 5-HT (serotonin) reuptake, leading to MORE 5-HT in the synapse
SSRI - meds in the class
*sertraline
*citalopram
*escitalopram
*fluoxetine
*paroxetine
sertraline - drug class
SSRI
citalopram - drug class
SSRI
escitalopram - drug class
SSRI
fluoxetine - drug class
SSRI
paroxetine - drug class
SSRI
sertraline - MOA
inhibit 5-HT reuptake (SERT)
citalopram - MOA
*inhibit 5-HT reuptake (SERT)
note - SSRI
escitalopram - MOA
*inhibit 5-HT reuptake (SERT)
note - SSRI
fluoxetine - MOA
inhibit 5-HT reuptake (SERT)
paroxetine - MOA
inhibit 5-HT reuptake (SERT)
first line SSRIs
*sertraline
*citalopram
*escitalopram
uses of SSRIs
*depression
*anxiety disorders
*OCD
*PTSD
*bulimia
ADEs of SSRIs
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
serotonin syndrome - cause
*too much serotonin
*usually from drug interactions or overdose (OD)
serotonin syndrome - symptoms
*CNS: delirium, agitation, restlessness, coma
*autonomic: diaphoresis, tachycardia, hyperthermia, hypertension
*neuromuscular: hyperreflexia, clonus, tremor
serotonin syndrome - treatment
*discontinue causative agents
*supportive care
*sedation with benzos, if needs
selective serotonin-norepinephrine reuptake inhibitors (SNRIs) - MOA
*inhibit SERT and NET, decreasing 5-HT and NE reuptake, leading to MORE 5-HT and NE in the synapse
SNRIs - meds in the class
*venlafaxine
*duloxetine
venlafaxine - drug class
SNRI
duloxetine - drug class
SNRI
venlafaxine - MOA
inhibit 5-HT and NE reuptake (SERT & NET)
note - SNRI
duloxetine - MOA
inhibit 5-HT and NE reuptake (SERT & NET)
uses of SNRIs
*depression
*anxiety disorders
*fibromyalgia
*chronic pain
*neuropathy
ADEs of SNRIs
ADEs of SSRIs PLUS:
*hypertension & tachycardia
*more likely to be CNS stimulating than sedating
tricyclic antidepressants (TCAs) - MOA
*inhibit 5-HT and NE reuptake
note - like SNRIs but hit other receptors (H1, Ach, and alpha-1), leading to more ADEs
important TCA med to know
amitriptyline
amitriptyline - drug class
tricyclic antidepressant (TCA)
amitriptyline - MOA
*inhibits 5-HT and NE reuptake (SERT & NET)
note - TCA
uses of TCAs (amitriptyline)
*depression (not used for this much now)
*pain disorders
*migraine
*prophylaxis
*insomnia
*neuropathy
ADEs of TCAs (amitriptyline)
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
3 C’s of TCA overdose
cardiac, coma, and convulsions
bupropion - MOA
*inhibits NET and DAT, leading to increased NE and DA
*CNS-activating
note - NO effect on 5-HT
uses of bupropion
*depression (common “second drug”)
*smoking cessation
ADEs of bupropion
*anxiety
*insomnia/agitation
*increased BP
*tremor
*headache
*weight loss
*SEIZURES (lowers sz threshold; don’t use in pts with sz disorder)
*NO SEXUAL DYSFUNCTION
unique properties of bupropion
*no effect on 5-HT
*no sexual dysfunction
*lowers sz threshold (do not use for pts with seizures)
mirtazapine - MOA
*central pre-synaptic alpha-2 antagonist, leading to increased 5-HT and NE
uses of mirtazapine
*insomnia
*increase appetite
*depression (not really used for this)
ADEs of mirtazapine
MOA of ADEs: H1 receptor blockade, alpha 2 receptor blockade
*sedation
*increased appetite and weight gain
*dry mouth
*serotonin syndrome
*little sexual dysfunction
trazodone - MOA
*“serotonin modulator” - primarily a potent 5-HT2a antagonist
uses of trazodone
*insomnia in depressed pts
ADEs of trazodone
MOA of ADEs: H1 receptor blockade and alpha-1 receptor blockade
*PRIAPISM
*dizziness
*sedation
*headache
*GI disturbances
*orthostatic hypotension
*serotonin syndrome
*little sexual dysfunction
monoamine oxidase inhibitors (MAOIs) - MOA
*inhibit monoamine oxidase (the enzyme that breaks down neurotransmitters)
*leading to increased 5-HT, NE, & DA
MAOIs - meds in class
*phenelzine
*selegiline
*tranylcypromine
uses of MAOIs
last resort for treatment-resistant depression
ADEs of MAOIs
*orthostatic hypotension
*CNS stimulation or depression
*dizziness
*HA
*hypertensive crisis
*sexual dysfunction
*serotonin syndrome
*DRUG INTERACTIONS
drug interactions of MAOIs
*don’t use with other 5-HT agents or sympathomimetic agents
*avoid high tyramine diet
lithium - MOA
unknown
uses of lithium
bipolar disorder
ADEs of lithium
*tremor
*GI upset
*polyuria/polydipsia
*dizziness
*leukocytosis
*seizures
*confusion
*coma
*arrythmias
drug interactions of lithium
NSAIDs and thiazide diuretics decrease lithium clearance (increase the risk of toxicity)
LiTHIUM mnemonic for lithium
Low Thyroid
Heart (Ebstein anomaly)
Insipidus (nephrogenic diabetes insipidus)
Unwanted Movements (tremor)
elimination of lithium
*RENAL elimination
*important to monitor frequently if renal function impaired or changing
*avoid if CrCl < 30 mL/min
symptoms if antidepressant is discontinued quickly (discontinuation syndrome)
flu-like syndrome, dizziness, fatigue, HA, nausea
