Psych: Antidepressants Flashcards
Which antidepressant is also used for nicotine withdrawal and smoking cessation?
Bupropion
Which antidepressant is also used for enuresis?
Imipramine
Which antidepressant is also used for neuropathic pain (diabetic, fibromyalgia, and chronic MSK pain)
Duloxetine
Which antidepressant is also used for stress incontinence?
Duloxetine
What are the 5 R’s?
Response (50% reduction in sx) Remission Recovery (6-12 months) Relapse (return of sx before recovery) Recurrance (return of sx after recovery)
What is the withdrawl symptoms of ALL antidepressants?
FINISH
Flu-like Insomnia Nausea Imbalance Sensory disturbances Hyperarousal
MOA of citalopram and escitalopram?
SSRIs
-block SERT reuptake of seritonin
MOA of fluoxetine, paroxetine, and sertraline?
SSRIs
-block SERT reuptake of seritonin
MOA of vilazodone? (2)
SSRI (blocks SERT)
Partial agonist of 5HT1A
MOA of vortioxetine? (4)
SSRI (blocks SERT)
Partial agonist of 5HT1B
Full agonist at 5HT1A
Full antagonist of 5HT1D
MOA of isocarboxazid, phenelzine, and tranylcypromine?
MAO Inhibitors
-increase NE, DA, and 5HT
MOA and ROI of selegiline?
MOA-B inhibitor only
-increases DA for parkinson’s
Worn asa patch
MOA of Venlafaxine, Desvenlafaxine, and duloxetine?
SNRI’s
-increases NE and 5HT
MOA of levomilnacipran?
SNRI
-increases NE and 5HT
Which drugs are secondary amines TCA drugs? (AND)
Amoxapine
Nortripyline
Desipramine
MOA of Amitriptlyine, clomipramine, doxepin, and imipramine?
SNRI’s (TCAs)
- 5HT=NE
- also block H1, muscarinincs, and a1
Tertiary amines
MOA of nortriptyline and desipramine?
SNRI’s (TCAs)
- NE>5HT
- also block H1, muscarinics, and a1
Secondary amines
What older drug class has the most histamine, anticholinergic, and adrenergic side effects
TCAs
CNS sedation, sexual dysfunction, weight gain, and withdrawal symptoms
What are the two significant side effects of SSRI’s?
Serotonin syndrome
Suicidality
MOA of bupropion?
Selectively inhibits pre-synaptic uptake of NE and DA
-blocks NET and DAT
Also some evidence of causing some more release
MOA of mirtazapine?
Blocks presynaptic a2 and 5ht and post-synaptic 5HT2 blocker
-also H1 blockade (sedation)
MOA of Nefazodone?
Post synaptic a1 and 5HT2 blocker
-also H1 blockade (sedation)
MOA of trazodone?
Postsynaptic a1 and 5HT2 blocker
-also H1 blockade (sedation)
MOA, ROI, and clinical use of esketamine?
NMDA receptor antagonist used for treatment-resistant depression
Administered intranasally
MOA and clinical use of brexanolone?
IV infused GABAa receptor agonist for treatment-resistant post partum depression
Which SSRI has least effects on CYP450? (2)
Vortioxetine and escitalopram
What are the three key systems are affected by TCAs?
Cardiovascular (a1 agonism)
-tachycardia, orthostatics, dysrhythmias
Anticholinergic (muscarininc)
-dry mouth, uriniary retention. blurred vision
CNS
-depression, sedation
What are the three C’s of TCAs?
Coma
Cardiotoxicity (conduction abnormalities)
Convulsion
What are the three C’s of TCAs?
Coma
Cardiotoxicity (conduction abnormalities)
Convulsion
Does mirtazapine have SERT/NET activity?
nope
Adverse effects of mirtazapine?
Sedation and weight gain
Adverse effects of trazodone?
Sedation and orthostatics
Adverse effects of trazodone?
Sedation and orthostatics
Serious adverse effect of bupropion?
Seizure
-especially in bulemics or anorexia; other volunerable pts
How long should you wait after stopping MAOs before starting most SSRIs?
2 weeks minimum
How long should you wait after stopping fluoxetine before starting other meds?
5 weeks
What is the major concern with MAO inhibitors?
Hypertensive crisis
-especially after eating tyramine containing foods (cheese, wine, peas)
What antiseizure meds can be used as mood stabilizers?
Cabamazepine
Valproate
Lamotrigine
What ion was first established for mood disorders (bipolar disorder)
Lithium
How does lithium work in mood disorders?
Inhibits dopamine release, downregulates NMDA recepotrs, and promotes GABAergic neurotransmission
What intracellular changes does lithium cause?
Lithium inhibits IP3, PKC, MARCKS, and GSK-3
What neuroprotective changes does lithium cause?
Increases CERB, which produces BDNF and Bcl-2
What is the renal side effect of lithium?
nephrogenic diabetes insipidus
-polyuria and polydipsia that doesnt change with ADH
Is lithiums therapeutic index large or small?
Small
-monitor closely
What meds increase lithium toxicity?
Diuretics (especially thiazides)
ACEi (especially lisinopril)
NSAIDs
Does lithium cause suicidal ideations?
Nope, actually can reduce the risk
Clinical use for valproate in bipolar disorder?
Acute bipolar disorder ONLY
-not maintainence
Clinical use for lamotrigine in bipolar disorder?
Maintenance of bipolar disorder ONLY
-not acute
Clinical use for carbamazepine in bipolar disorder?
Acute and maintenance of bipolar disorder
Carbamazepine is a CYP450 _______ (inducer or inhibitor)?
Inducer
MOA of amoxapine?
SNRI’s (TCAs) and increases DA
- NE>5HT
- also block H1, muscarinics, and a1
What two antidepressant drugs increase dopamine?
Buproprion and Amoxapine
