Antidepressants and Mood Stabilizers 2 Flashcards
1
Q
Anticholinergic effects
A
-TCAs!!! (desipramine is least)
2
Q
drowsiness
A
-TCAs!!
3
Q
orthostatic hypotension
A
- TCAs!! (nortriptyline least)
- SARA’s- trazodone +++
- MAOIs
4
Q
QTc prolongation
A
- TCAs!!
- SARAs- trazodone
5
Q
wt gain
A
- TCAs!!
- SARAs- mirtazapine ++++
6
Q
sexual dysfxn
A
- SSRIs!!
- TCAs (except amoxapine, desipramine, nortriptyline)
- MAOIs (except selegiline)
7
Q
general antidepressant efficacy- 5 R’s
A
- response= 50% reduction in sx’s (not well, just better)- partial response is >25% reduction, <50%
- remission= sx free
- recovery- 2-6 months of remission
- relapse- return of sx’s AFTER remission but b/f recovery
- recurrence- return of sx’s after recovery
8
Q
general antidepressant efficacy- goal
A
- remission/recovery
- if a pt doesnt respond after 8 wks- switch to a diff moa
9
Q
all antidepressants are assoc w?
A
- withdrawal syndrome!!- slow titration downward is recommended
- sx’s- dizziness, HA, nervousness, nausea, insomnia, flu-like aches
10
Q
Mood stabilizers
A
(tx for bipolar pts)
- Antiseizure agents- carbamazepine, lamotrigine, divalproate/valproic acid
- Lithium
11
Q
Lithium- moa
A
- inhibits calcium-dep and depolarization-provoked release of NE and DA- inhibits R blockers and substances that stim/inhibit G-prot syn/actions
- interfere w Gs and Gi- keep them in inactive state
12
Q
Lithium- SE’s
A
Lithium- SE’s
-polyuria (polydipsia)- clinical picture of Nephrogenic Diabetes Insipidus!!
13
Q
Lithium- polyuria
A
monovalent ion
- handled by kidneys similar to Na/K
- Li+ competes w Na for kidney reabs
- chronic Li+ ingestion can lead to resistance to ADH, resulting in polyuria/polydipsia
14
Q
Lithium- drug interactions
A
w other agents impacting Na/K
- diuretics (thiazides)
- ACEIs (lisinopril)
- NSAIDs
- narrow therapeutic agent
15
Q
Lithium- indications
A
- acute and maintenance tx of mania/bipolar disorder
- augmentation in unipolar depressive pts w inadequate response to antidepressant tx
