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BPS > Segars: antidepressants and Mood stabilizers > Flashcards

Segars: antidepressants and Mood stabilizers Flashcards

1
Q

General Antidepressants MOA?

A
  • serotonergic or noradrenergic nt system effects

- primarily, block 5HT and NE re uptake by presynaptic transporters (SERT, NET, or both)

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2
Q

What are the MAOI’s

A
  • monamine oxidase inhibitors
  • Isocarboxazid
  • Phenelzine
  • Selegine
  • Tranylcypromine
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3
Q

What are the 3 amine TCA?

A
  • amitriptyline
  • clomipramine
  • doxepin
  • imipramine
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4
Q

secondary amine TCAs

A
  • amoxapine
  • desipramine
  • nortiptyline
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5
Q

SSRI

A
  • serotonin-selective reuptake inhibitors
  • Citalopram
  • Escitalopram
  • Fluoxetine
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6
Q

What is the one NDRI?

A
  • Buprpion

- Noradrenergic dopamine reuptake inhibitor

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7
Q

What are the SSRI’s?

A
  • Cittalopram
  • excitalopram
  • fluoxetine
  • paroxetine
  • sertraline
  • vilazodone
  • cortioxetine
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8
Q

SSRI MOA

A

-inhibits reuptake of serotonin…. like the name says

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9
Q

Side effects of SSRI’s

A
  • CNS
  • Sexual df
  • weight gain
  • Acute withdrawal rxns: flu like sx (all antidepressants have this)
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10
Q

Serious effects of SSRIs?

A
  • serotonin syndrome:
  • sweating
  • hyperreflexia
  • myoclonus
  • shivering
  • Suicidality!!!!!!!
  • highest risk in children/adolescents/young adults
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11
Q

drug drug interactions of SSRI’s (CYP450)

A
  • most is fluoxetine (borad and strong inhibitor of CYP450)

- Least is citalopram and sertraline (mild inhibitors)

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12
Q

SNRI’s

A

-selectively inhibit the pre synpatic reuptake of serotonin (via SERT) and norepinephrin (via NET)

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13
Q

difference between the 3 and 2 TCA’s?

A
  • 3 inhibits both NE/5HT relatively equally

- 2 gets NE> 5HT

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14
Q

What other receptors are involved with TCA’s

A
  • H1
  • Muscarinic
  • alpha 1 adrenergic
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15
Q

What are the 3 key TCA system side effects?

A
  • CV: tachy, ortho hypotension, dysrhythmias
  • Anticholinergic: dry mouth, urinary retention, blurred vision
  • CNS (histamine): sedation and whatnot
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16
Q

Toxic ingestion of TCA’s

A
  • three C’s
  • Coma
  • Cardiotoxicity
  • convulsions
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17
Q

SARA

A
  • selectively block post synaptic alpha 1 receptors on NE neurons
  • Trazodone
  • Nefazodone
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18
Q

What does Mirtazapine do?

A

-selectively blocks pre synaptic alpha 2 receptors

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19
Q

Which SARA has weight gain as a side efect?

A

-Mirtazapine

20
Q

NDRI’s

A
  • bupropion

- selectively inhibits pre synaptic reuptake of NE and dopamine (via DAT)

21
Q

side effects of NDRI’s

A

-seizures

22
Q

MAOI’s

A

-inhibit MAO increases levels of monoamines in neuronal vesicles and increase amount so fNE, 5HT, and DA released

23
Q

MAOI’s names

A

-Isocarboxazid
=Phenelzine
-Selegiline
-Tranylcypromine

24
Q

What do we do if there is drug interactions with 5HT/NE affecting drugs?

A
  • 2 week wash out perior
  • risk of serotonin syndrome
  • risk of htn crisis
25
Q

What is the major concern with MAOI’s?

A

-hypertensive crisis

26
Q

What are some tyramine containg foods that will gibve us a htn crisis?

A
  • cheeses
  • fava beans
  • fermented or pickled meats
  • processed pickled, or cured meats
  • tap beer
  • yeast
  • over ripe fruits
  • soy/fish/shrimp sauces
27
Q

What are the 5 R’s for general antidepressant efficacy?

A
  • response
  • remission
  • recovery: 2-6 months
  • relapse: return of sx after remission
  • recurrence: return of sx after recovery
28
Q

What is a thing that we have to keep in mind about all antidepressants?

A
  • withdrawal syndrome

- do slow titration downward

29
Q

What are the 2 things we can use for Mood disorders

A
  • Anti-seizure agents: Carbamazepine, Lamotrigine, divalproate/valproic acid
  • lithium**
30
Q

Lithium

A

-inhibits Ca dependent and depolarization provoked release of NE and DA

31
Q

What is the lithium side effects?

A
  • Polyuria (polydipsia

- clinical picture of Nepthrogenic diabetes insipidus

32
Q

What is lithium?

A
  • a monovalent ion
  • competes with Na for kidney reabsorption
  • resistance to ADH
33
Q

What are the drug interactions with lithium?

A
  • diuretics, especially thiazides
  • ACEI’s: lisinopril
  • NSAIDs: through alteration of renal perfusion
34
Q

Is lithium a narrow therapeutic agent?

A

-yes

35
Q

What is the broad CYP450 inhibitor that we have to remember?

A

-Carbamazepine!

36
Q

Which class of drugs are bad generally because they have a lot of anticholinergic effects?

A
  • TCA antidepressants
  • Amitriptyliine
  • Amoxapine
  • Clomipramine
  • Desipramine
  • Doxepin
  • Imipramine
  • Nortiptylline
  • this class had a lot of + signs in that chart
37
Q

Which drug class along with TCA’s gave us drowsiness

A
  • Serotonin modulators
  • Trazodone
  • Nefazodone
  • but not Vilazodone
38
Q

Which drug class along with TCA’s gave us orthostatic hypotension?

A
  • MOAI’s
  • Isocarboxazid
  • Phenelzine
  • Selegilline
  • Tranylcypromine
  • (trazodone will also do this)
39
Q

What other side effect was relatively unique to TCA’s besides anticholinergic effects

A

-QTc prolongation

40
Q

Which class would give us insomnia/agitation?

A
  • SSRI’s
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Paroxetine
  • Sertraline
41
Q

Which drug along with the TCA’s will give us weight gain?

A

-Mirtazapine

42
Q

Which 2 drug classes along with TCA’s give us Sexual dysfunction?

A
  • SSRI’s

- MOAI’s…. but not Selegilline, that had like no + signs by it :)

43
Q

What are the signs and sx of hypertensive crisis?

A
  • Severe headache
  • nausea/comiting
  • sweating/severe anxiety
  • nosebleeds
  • tachycardia
  • chest pain
  • changes in vision
  • shortness of breath
  • confusion
44
Q

Which 2 SARA’s block the post synaptic alpha 1 receptors?

A
  • Trazodone

- Nefazodone

45
Q

Which SARA will block the pre synaptic alpha2 receptors?

A

-Mirtazapine

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