Anti-Depressants/Mania Flashcards Preview

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Flashcards in Anti-Depressants/Mania Deck (10):
1

Desipramine (Norpramin), Imipramine (Tofranil)

-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!

2

Phenelzine (Nardil)

-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

3

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

-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

4

Venlafaxine (Effecor, Effexor XR)

-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.

5

Desvenlafaxine (Pristiq)

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

6

Lithium carbonate (Eskalith)

-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

7

Valproic Acid (Depakote, Depakene)

-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

8

Carbamezepine (Tegretol)

-Anticonvulsants approved by the FDA for prophylaxis of bipolar disorder

9

Quetiapine (Seroquel)

-Atypical antipsychotic
-Good for mood stabilizers in bipolar disorder
-Blocks 5-HT2A subtype

10

Lurasidone (Latuda)

-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