Anti-Depressants/Mania Flashcards

1
Q

Desipramine (Norpramin), Imipramine (Tofranil)

A
  • Tricyclic antidepressant (TCA)
  • Blocks reuptake of NE selectively

Adverse effects:

  • Blocks muscarinic receptor- 50% experience dry mouth and tachycardia. Takes 2-3 wks. Acute confusional state, constipation, glaucoma
  • Weight gain (histamine receptor block)
  • Orthostatic hypotension (block alpha 1 receptor)
  • Low therapeutic index, don’t give more than one week supply (can commit suicide with this)

Interactions

  • Potentiates central depressants
  • Increases inactivation of levodopa!
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2
Q

Phenelzine (Nardil)

A
  • MAO inhibitor (1st drugs to treat depression)
  • IRREVERSIBLY blocks the oxidative deamination of monoamines (e.g. NE & 5-HT)
  • Very low therapeutic index, toxicity need to hospitalize for 1 week due to loss of MAO, treat symptomatically

Interactions: Potentiates sympathomimetic amines, results in circulating TYRAMINE with certain foods (increases NE and 5HT);can result in hypertensive disaster

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3
Q

Fluoxetine (Prozac); Sertraline (Zoloft); Citalopram (Celexa); Escitalopram (Lexapro)

A

-Selective Serotonin Reuptake Inhibitors (SSRIs)
-Only prevent reuptake 5HT. 7 types of receptors; 5HT2A receptor appears to be responsible for clinical improvement
-Large therapeutic index, chance of being able to commit suicide with pills is very small.
Adverse Effects:
-Weight loss, nausea, diarrhea, anxiety, nervousness, sexual dysfunction, non-sedating

*DO NOT USE ALONE IN BIPOLAR DISORDER, need to include a mood stabilizer

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4
Q

Venlafaxine (Effecor, Effexor XR)

A
  • Atypical (Dual/Mixed Action) antidepressants
  • Selective serotonin and norepinephrine reuptake inhibitor (SNRI)
  • Does not affect adrenergic, histaminergic, or cholinergic receptors
  • Raising the dose causes increased serotonin, norepinephrine, dopamine, respectively.
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5
Q

Desvenlafaxine (Pristiq)

A
  • Active metabolite of venlafaxine

- No evidence it is more effective than venlafaxine, maybe less interactions

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6
Q

Lithium carbonate (Eskalith)

A
  • Treats bipolar disorder
  • Clinical effect in 5-21 days (does nothing in normal subjects)
  • Mechanism not known
  • Competes with sodium for reabsorption, thus sodium deficiency (low sodium diet, diuretics) increases lithium toxicity (body mistakes lithium for sodium and sequesters it)

Adverse effects:

  • fatigue, muscular weakness, slurred speech, ataxia, fine tremor of the hands
  • Blocks ADH, nephrogenic diabetes insipidus
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7
Q

Valproic Acid (Depakote, Depakene)

A
  • Anticonvulsants for bipolar disorder
  • Good for non-rapid cycling bipolar disorder
  • Superior to lithium for rapid cycling bipolar disorder
  • Work better for acute manic episodes than for long-term management of bipolar disorder
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8
Q

Carbamezepine (Tegretol)

A

-Anticonvulsants approved by the FDA for prophylaxis of bipolar disorder

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9
Q

Quetiapine (Seroquel)

A
  • Atypical antipsychotic
  • Good for mood stabilizers in bipolar disorder
  • Blocks 5-HT2A subtype
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10
Q

Lurasidone (Latuda)

A
  • Atypical antipsychotic
  • Approved to treat BIPOLAR DEPRESSION in 2013
  • D2 and 5HT2A receptor antagonism seems to be involved, mechanism not known.
  • Doesn’t cause light switch to go in bipolar disorder like the SSRIs
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