antidepressants and mood stabilizers

Question 1

Depression

Answer 1

chemical imbalance between 3 neurotransmitters

• norepinephrine
• serotonin
• dopamine

Question 2

Antidepressants

Answer 2

• orally administered
• 90-95%bound to plasma proteins
• metabolized by the liver with metabolites excreted in urine
• long half lives
• relatively small therapeutic index

Question 3

Classes of antidepressant drugs

Answer 3

• tricyclics
• Selective Serotoni Reuptake Inhibitors (SSRI’s)
• Sellective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI’s)
• Atypical
• Monoamine Oxidase Inhibitors (MAOI’s)

Question 4

Tricyclics

Answer 4

Attempt to remedy depression by inactivating the amine pump on the presynaptic nere terminal and limiting the reuptake of both NE and serotonin. May also have effects at muscarinic, histamine , and alpha receptors.

Question 5

Tertiary Amine Tricyclics

Answer 5

-amitryptyline-can be given IM

Question 6

Tertiary Amine Tricyclics

Answer 6

-clomipramine - given for OCD, not very selective,

can cause seizures

Question 7

Doxepin (sinequan)

Answer 7

• tertiary amine tricyclics
• increased sedation
• no CV side effects

Question 8

Imipramine (Tofranil)

Answer 8

• Tertiary amine tricyclic
• can be given IM
• long actin pamoate formula is available

Question 9

Trimipramine (Surmontil)

Answer 9

-Tertiary Amine Tricyclic

Question 10

Secondary Amine Tricyclics

Answer 10

• RX for sleepy depressive
• have affinity for serotonin and added affinity for the NE transporter
• add back the sympathetic component

Question 11

Amoxapine (Asendin)

Answer 11

-Secondary Amine Tricyclic
_dibenzodiazipe that is a metabolite of the antipsychotic loxapine
-It has a dopaminergic and adrenergic mechanism

Question 12

Desipramine (norpram)

Answer 12

• Secondary Amine Tricyclics
• metabolite of imipramine

-

Question 13

maprotiline (ludiomil)

Answer 13

_Secondary Amine Tricyclic

• new
• increased ptotential for seizures

Question 14

nortryptyline (pamelor)

Answer 14

• Secondary Amine Tricyclic
• metaolite of amitryptyline
• elderly patients

Question 15

protryptryptyline (vivactil)

Answer 15

• Secondary Amine Tricyclic
• lacks sedative properties
• RX for sleepy depressives

Question 16

Selective Serotonin Reuptake Inhibitors (SSRI’s)

Answer 16

• often 1st choice for monopolar depression
• most effective in the treatment for premenstrual dysphoric disorder (PMDD)
• safer side effect profile
• work on the serotonin side

Question 17

citalopram (celexa)

Answer 17

-SSRI

-

Question 18

escitalopram (lexapro)

Answer 18

• SSRI

- adolescents approved

Question 19

fluoxetine (prozac)

Answer 19

• SSRI

- 72 hr half life

Question 20

fluvoxamine (luvox)

Answer 20

-SSRI

Question 21

Paroxetine (paxil)

Answer 21

• SSRI
• anticholinergic side effects
• social phobia

Question 22

setraline (zoloft)

Answer 22

-SSRI

36 hr half life

Question 23

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI’s)

Answer 23

-fewer antimuscarinic and antihistaminic effects than the tricyclics and have more of an adrenergic effect compared to the SSRIs

Question 24

duloxetine (cymbalta)

Answer 24

• SNRI
• 1:10 affinidy for serotonin (5-HT) and NE transporters
• First approval drug for fibromyalgia

Question 25

milnacipran (ixel)

Answer 25

- SNRI - 1:1 affinity for 5 HT and NE transporters - second approved drug for fibromyalgia

Question 26

venlafazine (effexor)

Answer 26

- SNRI - withdrawal and rebound effects - 1:30 affinity for the 5 HT and NE transporters

Question 27

desvenlafaxine (pritiq)

Answer 27

- SNRI | - isomer of venlafaxine

Question 28

Atypical

Answer 28

do not fit in any catagory

Question 29

bupropion (wellbutrin/zyban)

Answer 29

- Atypical - no sexual side effects - no serotonin - block reuptake of dopamins, NE - 3 fold increase in risk of seizures

Question 30

nefazodone (serzone)

Answer 30

-BLACK BOX -liver failure (life threatening) -serotonergic mechanisms -

Question 31

mirtazapine (remeron)

Answer 31

- Atypical - sedation common adverse effect - blocks histamine receptors - block 5 HT2A, alpha 1 and alpha 2 centrall receptors

Question 32

reboxetine (edronax)

Answer 32

- Atypical | - inhibits NE

Question 33

trazadone (desyrel)

Answer 33

- Atypical - sedative hypnotic for those with difficulty sleeping - drug of choice for sleep - priapism

Question 34

vilazodone (viibryd)

Answer 34

- Atypical - new "dual action" - blocks sertonin reuptake transporter and acts as a partial agonist at the 5HT1Areceptor - low incidence of sexual side effects

Question 35

Monoamine Oxidase Inhibitors (MAOI's)

Answer 35

- refractory depression | - inactivates the enzyme (MAO) that metabolizes NE and serotonin

Question 36

MAOI's

Answer 36

- isocarboxazid (marplan) - phenelzine (nardil) - tranylcypromine (Parnate)

Question 37

antidepressant side effects

Answer 37

- sedation | - CV- orthostatic hypotension, tacycardia,