Psych Flashcards
5 classes of psychotropics
Antidepressants • Stimulants • Mood Stabilizers • Anxiolytics and Hypnotics • Antipsychotics (Neuroleptics)
Classes of Antidepressants
Tricyclic antidepressants Monoamline oxidase inhibitors SSRI SNRI Atypical Antidepressants
Tricyclic antidepressants (TCAs) MOA
prevent the reuptake of both norepinephrine and serotonin (5-HT) into presynaptic nerve terminals
Monoamine oxidase inhibitors (MAOIs) MOA
block the action of monoamine oxidase, an enzyme that breaks down neurotransmitters inside the presynaptic nerve terminals. In other words, MAOIs slow the destruction of norepinephrine, dopamine, and serotonin, increasing the levels of these neurotransmitters in the brain.
SSRI MOA
prevent the reuptake of serotonin into presynaptic nerve terminals.
SNRI MOA
prevent the reuptake of serotonin and norepinephrine into presynaptic nerve terminals.
TCA Disadvantages
– Action on histamine and Ach – Orthostatic hypotension – Cardiac effects – Potential death via overdose
5-HT
5-hydroxtryptamaine
TCA used in
Migraine prevention, sleep, depression, and chronic pain
TCA consideration
taper off if they have been on long term to prevent symptoms of withdrawal or relapse of depression
TCA side effects
anticholinergic side effects due to histamine and Ach action.
TCA is a bad option
for people with active SI due to risk for overdose.
MAOI disadvantages
Hypertensive crisis/Tyramine – Drug interactions – Orthostatic hypotension – Serotonin syndrome
MAOI are not used
1st, 2nd or 3rd line. Used for treatment resistant or refractory depression
MAOI interact with
virtually everything
foods that contain tyramine
aged foods, like processed meats, beef or chicken liver,, yogurt, peperoni, bologna, sour cream, bananas, raisons, soy sauce, beer, whine, yeast, chocolate. CAN LEAD TO A HYPERTENSIVE CRISIS
If tyramine in foods isn’t enough then MAOI
cause cause orthostatic hypotension and possibly serotonin syndrome
Serotonin helps regulate
perceive pain, sleep (cycling between non REM and REM), emotional states, mood, anxiety
SSRI disadvantages
GI side effects – Sexual dysfunction – Take time to work
SSRI GI effects are
transient and go away in a week or two
SSRI receptors are mostly found in our
Gut. 90 to 95%
SSRI sexual dsyfunction
sexual dysfunction tends to not go away
SSRI time it takes to work
4 to 6 weeks
SSRI benefits
cheap and low toxicity
SNRI may have more
benefit for lethargic, fatigue-based symptoms
SNRI and SSRI not all
not all are created equally. Depending on the brand it may have a greater affinity for one neurotransmitter over another. As an example sertraline as a greater effect for dopamine then others. It can also be impacted by dose. An example of this would be effexor that has a greater impact on serotonin at lower doses and will not have an impact on norepi until you reach higher dosese
SNRI used
anxiety, depression, panic, chronic pain
SNRI side effects
headache, GI, insomnia, sexual side effects, dose dependent increased BP`
Atypical Antidepressants include
NDRI and others
NDRI example
bupropion (wellbutrin, Zyban)
NDRI lowers
seizure threshold/ alcohol
Bupropion does not cause
weight gain or sexual dysfunction, which makes it an appealing option for some clients
off-lable use of NDRI
ADHD, chronic fatigue, medication induced sexual dysfunction
Mirtazapine, trazodone benefits
Faster onset than SSRIs – Lower incidence of sexual SE
mirtazapine, trazadone SE
Sedation, weight gain
Zyban is used for
smoking cessation
Be mindful of what with bupropion
people who use ETOH or have a seizure disorder, because it can lower the threshold and make it easier to have a seizure
histamine contributes to
sedation and weight gain
Serotonin syndrome
Too much serotonin in the synaptic cleft
signs of serotonin syndrome
Tremor, myoclonus, altered mental status • Agitation, diarrhea, fever, diaphoresis • Hyperreflexia, delirium, coma, death
serotonin syndrome can develop within
several hours
treatment of serotonin syndrome
stop taking and and use supportive measures
