Adtl. Practice: Pharmacology Flashcards
(28 cards)
SSRI MOA
Selective serotonin reuptake inhibitor
-inhibits serotonins reuptake in presynaptic neurons in CNS
1st line tx for depression, generally well tolerated
SSRI drugs (6)
- sertraline
- citalopram
- escitalopram
- paroxetine
- fluoxetine
- fluoxetine
SSNRI MOA
selective serotonin NE reuptake inhibitor
inhibits reuptake serotonin and NE in presynaptic neurons
-more specific than TCAs, safer and better tolerated
also 1st line tx for depression
SSNRI drugs (4)
- duloxetine
- venlafaxine
- disvenlafaxine
- levominalcipran
TCAs MOA
Tricyclic antidepressants
inhibitor presynaptic reuptake of norepineprhine and serotonin
antagonizes histamine, alpha-adrenergic and muscarinic receptors, cardiac sodium channels
*3rd line, OD can occur in 1 week supply
TCAs (9)
- amitriptyline
- imipramine
- Doxepin
- Clomipramine
- Despipramine
- Nortriptyline
- meprotiline
- proptriptyline
- desipramine
Bupropion MOA
1st line tx, augmenting agent for depression
inhibits reuptake transporters of synaptic dopamine, NE- with not serotonergic effects
Mirtazapine MOA
1st line agent with compelling reason for depression
antagonizes presynaptic alpha-1 adrenergic receptors
-increases NE, 5-HT at postsynaptic 5-HT receptors
Vortioxetine MOA
1st line agent for depression
SSRI with 5-HT 1a agonism, mixed antagonist, partial agonist
Nefazodone/Trazodone MOA
3rd line/augmenting
antagonist at postsynaptic 5hts, inhibits reuptake serotonin
Vilazodone
3rd line agent(new) for depression
serotonin reuptake inhibitor and 5-ht 1a receptor partial agonist
SPARI
MAOIs MOA
3rd+ line agent for MDD
inhibition monamine oxidizing enzymes MOAs, causing increased concentrations of NE, 5-HT, and dopamine in neuronal synapse
**food and drugs contraindicate often
MAOIs drugs (4)
- tranylcypromine
- isocarboxazid
- phenelzine
- selegiline
Esketamine-sporavato
indication
augmentation MDD
- severe depression that failed 2 trial antidepressants for adequate dose and duration
- REMS program
Antipsychotics in depression (4)
- ariprazole
- brexpiprazole
- olanzapine
- quetiapine
Lithium
indication
MOA
I: bipolar disorder in acute manic episode and mtnc.
M: inorganic cation with multiple functions in CNS
- alter cation transport across cellular membranes
- influences reuptake of serotonins, NE, GABA
- postsynaptic D@ receptor sensitivity decreases
- cAMP second msgr system
Lithium monitoring
- CBC, TSH, CMP w Ca 2x within 1st 6 months then periodically
- pregnancy, cardiac abnormalities can occur in 1st trimester
- EKG
- Serum levels
* narrow therapeutic index
Lithium drug ineractions
Thiazides Ace-inhibitors Loop diuretics Arbs Nsaids Sodium
Valproic Avid/ Divaloprex
indication
MOA
bi polar disorder, actor manic of mixed epidosed
- enhances GABA, inhibits reuptake
- normalized sodium and calcium channels
Carbamazepine
indication
MOA
bipolar disorder in acure manic or mixed episodes
-blicks voltage-sensitive sodium channels, stimulates release of ADH, NMDA
Lamotrigine
bipolar I disorder-maintenance
- can be used in depression as well
- not for acute mania
MOA: black voltage-gates sodium channels
-decreases glutamate release
Antipsychotics for Bipolar (4)
- cariprazine
- lurasidone
- olanzapine/fluoxetine
- quetiapine
Antipsychotics for manic/mixed epsiodes
- ariprazole
- asenapine
- cariprazine
- olanzapine
- quetiapine
- risperidone
- ziprasidone
1st genration/Typical antipsychotics MOA (4)
- dopamine- DA D2 receptor blockade
- therapeutic effect - muscarinic- M1 receptor blockade
- Histaminic- H1 receptor blockade
- Alpha-a1 receptor blockade
* agents differ in potency and receptor affinity
