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Psych > Antidepressants and Mood Stabilizers 1 > Flashcards

Antidepressants and Mood Stabilizers 1 Flashcards

1
Q

general antidepressants moa

A
  • all affect serotonergic and/or noradrenergic nt systems
  • block 5HT and/or NE re-uptake by pre-synaptic transporters (SERT, NET)
  • secondary mechanisms of a few agents block pre and/or post-synaptic R’s
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2
Q

other antidepressant indications- nicotine withdrawal

A

bupropion

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3
Q

other antidepressant indications- enuresis

A

(involuntary urination)

imipramine

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4
Q

other antidepressant indications- diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain

A

-duloxetine

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5
Q

other antidepressant indications- stress incontinence

A

-duloxetine

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6
Q

tricyclics (TCA’s)- tertiary amines

A

-amitriptyline
-clomipramine
-doxepin
-imipramine
(ACDI)

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7
Q

tricyclics (TCA’s)- secondary amines

A

-amoxapine
-desipramine
-nortriptyline
(ADN)

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8
Q

NDRI’s

A

(Noradrenergic-Dopamine Reuptake Inhibitors)

-bupropion

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9
Q

SARA’s

A

(Serotonin-Adrenergic R Antagonists)

  • mirtazapine
  • nefazodone
  • trazodone
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10
Q

SSRI’s

A 
(Serotonin-Selective Reuptake Inhibitors)
-escitalopram
-fluoxetine
-sertraline
-paroxetine
-citalopram
-vilazodone
-vortioxetine
(CEFPSVV)- Effective For Sadness, Panic, and Compulsions.. V
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11
Q

SNRI’s

A 
(Serotonin-Noradreneric Reuptake Inhibitors)
-desvenlafaxine
-duloxetine
-levomilnacipran
-venlafaxine
-all TCA's
(DDLV)
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12
Q

SNRI’s + DA

A

-amoxapine

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13
Q

MAOI’s

A

-phenelzine
-isocarboxazid
-tranylcypromine
-selegiline
(PITS of despair)

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14
Q

SSRI’s-moa

A

(Selective serotonin reuptake inhibitor)

  • inhibit the pre-synaptic reuptake of serotonin (via SERT)
  • much less impact on histamine, muscarinic, and adrenergic R’s (fewer SE’s vs TCA’s)
  • SE’s- acute withdrawal rxns (concern w all categories)- flu like sx’s
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15
Q

SSRI’s- SE’s

A
  • CNS
  • sexual dysfxn
  • wt gain/loss
  • acute withdrawal rxns (concern w all categories)- flu like sx’s
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16
Q

SSRI’s- rare SE’s (toxic settings)

A
  • QT prolongation
  • hyponatremia
  • serotonin syndrome- sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors (inc risk when given w other serotonin-affecting agents)
  • suicidality- highest risk in children/adolescents/young adults
17
Q

serotonin syndrome (vs neuroleptic malignant syndrome)

A
  • serotonergic agents
  • hyper-reflexia
  • clonus
  • dilated pupils
  • hyper-active bowel sounds
18
Q

neuroleptic malignant syndrome (vs serotonin syndrome)

A
  • dopaminergic agents
  • hypo-reflexia
  • normal pupils
  • normal or dec bowel sounds
19
Q

SSRI’s- drug-drug interactions

A

(CYP450)

  • most- fluoxetine (Broad and strong inhibitor)
  • least- citalopram and sertraline (mild inhibitors)
20
Q

SNRI’s (incl TCA’s)- moa

A

(Serotonin-norepinephrine reuptake inhibitor)

  • inhibit the pre-synaptic reuptake of serotonin (via SERT) AND NE (via NET)
  • 3 amines- inhibit NE/5-HT equally
  • 2 amines- inhibit NE > 5-HT
21
Q

SNRI’s (incl TCA’s)- also block other R’s

A
  • histamine (H1)
  • muscarinic (cholinergic)
  • alpha1 (adrenergic)
22
Q

TCA’s- 3 key SE’s

A
  • CV (alpha)- tachycardia, orthostatic hypotension, dysrhythmias
  • Anticholinergic (muscarinic)- dry mouth, urinary retention, blurred vision
  • CNS (histamine)- sedation, dizziness, seizures
23
Q

TCA’s- toxic ingestion

A

3 C’s:

  • coma
  • cardiotoxicity (conduction abnormalities)- quinidine-like effect (slows phase 0 depolarization via Na channel blockade- slows conduction)
  • convulsions
24
Q

Non-TCA SNRI’s- SE’s

A

-similar to SSRI’s, with less risk of sexual dysfxn

25
Q

SARA’s- moa

A

(Serotonin-Adrenergic R Antagonists)

  • act like SSRI’s and also block post-synaptic alpha1 R’s on NE neurons and post-synaptic 5-HT2A- Trazodone and Nefazodone
  • blocks pre-synaptic alpha2 R’s on NE and 5HT neurons- Mirtazapine- NO SERT/NET activity; H1 blockade
26
Q

SARA’s- SE’s

A
  • CNS (sedation)- most w Trazodone/Mirtazapine
  • orthostatic hypotension- Trazodone
  • wt gain- Mirtazapine
27
Q

NDRI’s- moa

A

(Norepinephrine-Dopamine Reuptake Inhibitors)

-inhibit pre-synaptic reuptake of NE (via NET) and dopamine (via DAT)

28
Q

NDRI’s- SE’s

A

-seizures! (dose-dependent)

29
Q

MAOI’s- moa

A
  • inhibition of MAO- inc levels of monoamines in neuronal vesicles and inc amts of NE, 5-HT, and DA released
  • all nonselective (MAO A/B), except selegiline (B-selective)
30
Q

MAOI’s- drug interactions w 5-HT/NE affecting drugs

A
  • anti-hypertensives, amphetamines, SSRIs/TCAs/SNRIs- 2 wk wash-out period (fluoxetine- 5 wks)
  • serotonin syndrome
  • hypertensive crisis
31
Q

MAOI’s- major concern?

A

Hypertensive crisis

  • inhibit MAO-A necessary in GI for tyramine metabolism
  • inc tyrosine- induce catecholamine release and hypertensive crisis
32
Q

hypertensive crisis- signs, sx’s

A
  • severe HA
  • N/V
  • sweating/severe anxiety
  • nosebleeds
  • tachycardia
  • chest pain
  • changes in vision
  • SOB
  • confusion
33
Q

tyramine containing foods/beverages

A
  • aged cheeses
  • fava/broad/soy beans
  • pickled meets/poultry/fish
  • cured meats/sausages
  • tap beers, red wine
  • over ripe fruit

Psych (16 decks)

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