Anti-Depressants and Mood Stabilizers -- Segars Flashcards Preview

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Flashcards in Anti-Depressants and Mood Stabilizers -- Segars Deck (30):
1

TCAs - drugs (2 classes) - 6 total

Despiramine, Nortriptyline, Imipramine, Amitriptyline, Doxepin

Amoxapine

2

TCAs - MoA

Like what other class?

Block reuptake of NE and 5-HT from synaptic cleft

SNRI's

3

***TCAs - side effects

Anti-alpha: tachy, ortho hypotension, dysrhythmias

Anti-muscarinic: dry mouth, urinary retention, blurred vision

Anti-histamine: sedation

4

TCAs - overdose

3 Cs -- coma, cardiotoxicity, convulsions

5

How does TCA overdose cause cardiotoxicity?

Like what?

Sodium channel blockade (like Quinidine or Class 1A antiarrhythmics) --> slows conduction --> sloped phase 0, prolonged repolarization

6

SSRIs - drugs (7)

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodone
Vortioxetine

FLashbacks PARalyze SEnior CITizens

7

SSRIs - MoA

Selective inhibition of SEROTONIN reuptake by SERT --> enhanced, prolonged serotonin neurotransmission

8

Why are SSRIs better than TCAs?

MUCH less side effects

9

Mental status changes, muscle stiffness and hyperreflexia, autonomic instability (sweating, shivering, tremors), hyperthermia

What can cause it?

How to remember?

Serotonin syndrome

ANYTHING that increases serotonin (SSRIs, TCAs, MAOIs)

3 A's
- Activity of neuromuscular (clonus, hyperreflexia, hypertonia, tremor, seizure)
- Autonomic instability (hyperthermia, diaphoresis, diarrhea)
- Agitation (mental)

10

CYP450 inhibitor (SSRI)

LEAST inhibition of CYP450 (SSRI)

Fluoxetine

Citalopram/Sertraline

11

SSRIs - side effects





SNRIs (non-TCAs) - side effects

SARAs - side effects

Serotonin syndrome
Sedation
Insomnia
Weight gain
GI distress

SAME

SAME

12

SNRIs (non-TCAs) - drugs (4)

Venlafaxine/Desvenlafaxine
Duloxetine
Levomilnacipran

13

SARAs - drugs (3)


MoAs of each

Mirtazapine - block pre-synaptic alpha-2 receptors, 5-HT2 receptors, 5-HT3 receptors, and H1 receptors

Nefazodone, Trazodone - block receptors: 5-HT (SSRI), 5-HT2a, and alpha-1 (post-synaptic)

14

Specific SARA side effect that may be used purposefully?

Sedation (Mirtazapine) - for insomnia + depression

15

Bupropion - MoA

Use?

Major side effect?

NDRI -- inhibits re-uptake of NE (NET) and dopamine (DAT)

Smoking cessation

Agitation/insomnia (stimulation)

16

MAOs - MoA

Drugs? (4)

IRREVERSIBLY inhibit MOA, increasing NE, 5-HT, and DA

MAO Takes Pride In Shanghai
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Selegiline

17

MAOs - side effects



Major one? Explain.

Tranylcypromine = stimulation/insomnia
- Amphetamine derivative

Expected SEs (ortho hypo, sexual dysfunction, weight gain)

***Hypertensive crisis -- ingest TYRAMINE (cheese, wine) and get significant catecholamine release
- MAO-A in GI is required for tyramine metabolism

18

MAOs - caution in who?

Anyone on another 5-HT/NE affecting drug...
- Sympathomimetics, anti-HTNs, SSRIs, TCAs, SNRIs, etc.

19

Which MAO is good for avoiding hypertensive crisis?

Selegiline - low dose

20

Enuresis - treatment

Imipramine (TCA)

21

Neuromuscular pain, fibromyalgia, diabetic peripheral neuropathy...treatment?

Duloxetine

22

Stress incontinence...treatment?

Duloxetine

23

Mood Stabilizer drugs (4)



What are the first 3?

Carbamazepine
Lamotrigine
Valproic acid
Lithium

Anti-seizure meds

24

Lithium - MoAs (2?)

Inhibits calcium-dependent and depolarization-provoked release of NE and DA

Inhibits inositol monophosphate, causing decreased cerebral inositol
- Valproate and Carbamazepine do a similar thing

25

Lithium - used for what? (4)

- Mania
- Bipolar disorder
- Suicide risk reduction in bipolar disorder
- AUGMENTATION in UNIPOLAR depression

26

***Lithium - drug interactions

Other agents that affect Na/K in the kidney...
- Thiazides (Na loss, Li+ reabsorption)
- Lisinopril
- NSAIDs (altered renal perfusion)

27

Issue w/ using Lithium

VERY narrow therapeutic window

28

***Lithium - major side effects (2)

Others?

Nephrogenic diabetes insipidus, teratogen

Tremor, hypothyroidism (inhibits iodination), polyuria

LMNOP

29

Differentiate uses of the anti-seizure meds in mood stabilization

Divalproex/Valproate = ACUTE bipolar

Carbamazepine = acute AND maintenance bipolar

Lamotrigine = maintenance bipolar TYPE 2 (no crazy mania)

30

***Side effects of 3 anti-seizure meds used here

Carb = 3A4 INDUCER

Valproate = 2D6 INHIBITOR

Lam = 2C9 INHIBITOR