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Flashcards in Antidepressants and Mood Stabilizers Deck (30)
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1

Serotonin-Selective Reuptake Inhibitor MOA - ___ inhibit the ___‐synaptic reuptake of serotonin (via ___)

Selectively inhibit the pre‐synaptic reuptake of serotonin (via SERT)
o results in enhanced, prolonged serotonergic neurotransmission to post‐synaptic receptors

2

As a class, why do SSRI's have fewer side effects than TCA's?

As a class, much less impact on
-histamine receptors (CNS)
-muscarinic receptors (anticholingergic)
-adrenergic receptors (CV)

3

Minor/infrequent side effects of SSRI's (five areas).

What other class subset has this?

o Sexual dysfunction
o GI (N/V/dyspepsia)
o CNS (sedation or insomnia/agitation)
o Weight gain
o QT prolongation

Non-TCA SNRI's have similar side effects.

4

**What drug in the SSRI class has highest risk of drug-drug interaction?

**Fluoxetine (strong CYP450 inhibitor)

5

What two drugs in the SSRI class has least risk of drug-drug interaction?

Citalopram and sertraline (mild CYP450 inhibitor)

6

Sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors - What state is this and what causes it?

Serotonin Syndrome.
Increased risk of this when given in combo with other serotonin-affecting (i.e. SSRI's) agents.

7

What drug class includes TCA's?

SNRI's

8

Difference in MOA between tertiary and secondary amine TCA's.

Tertiary - inhibit both NE/5‐HT relatively equally.
Secondary - inhibit NE more than 5‐HT.

9

What three receptors do TCA-based SNRI's impact?

alpha adrenergic - CV
muscarinic - anticholinergic
Histamine - CNS

10

Symptoms indicating a toxic TCA overdose?

3 C's (Tri C): Coma, Cardiotoxicity (Conduction abnormalities - CoD), Convulsions

11

What is the "Quinidine-like" effect that results from toxic TCA overdose?

Class 1A Antiarrhythmic:
-Slows Conduction - In Ventricular cells: Slows phase 0 depolarization & conduction velocity
- Na channel blockade

12

What Serotonin-Adrenergic Receptor Antagonists (SARA's) has sleep assistance?

trazodone

13

What Serotonin-Adrenergic Receptor Antagonists (SARA's) selectively block pre‐synaptic 5‐HT2A and block α1 post‐synaptic adrenergic receptors?

Trazodone and nefazodone

14

What Serotonin-Adrenergic Receptor Antagonists (SARA's) selectively blocks pre‐synaptic α2 adrenergic
receptors & on serotonergic neurons?

mirtazapine

15

Common SE of Serotonin-Adrenergic Receptor Antagonists (SARA's)

o Constipation
o CNS (sedation) - H1 and/or alpha1
o Weight gain
o Dry mouth

16

A depressed smoker who needs meds for both depression and smoking cessation.

Bupropion, which is a Noradrenergic-Dopamine Reuptake Inhibitors (NDRI) - inhibit the pre‐synaptic reuptake of serotonin norepinephrine (via NET) & dopamine (via DAT)

17

MOA of Bupropion?

(An NDRI) Selectively inhibit the pre‐synaptic reuptake of
serotonin norepinephrine (via NET) & dopamine
(via DAT)

18

Unique side effect of Noradrenergic-Dopamine Reuptake Inhibitors

agitation/insomnia - stimulating property

19

What three amine neurotransmitters do do MAOI's increase levels of?

NE, 5-HT, DA (they inhibit both MAO A and B)

20

What is the only B-selective MAOI is NOT irreversible?

Selegiline (B-selective, non-selective at high doses)

21

Cheese and wine :)

MAOI hypertensive crisis

22

What is the biggest limiting factor of MAOI's?

What MAOI would not have this effect?

Hypertensive crisis - because MAOI's inhibit MAO-A, which is necessary for Tyramine metabolism.

Selegiline

23

What drug can reduce risk of suicide in bipolar patients?

Lithium

24

Three classic drug-drug interaction with lithium.

Any drug that increases Na excretion **(NSAIDs, ACE inhibitor lisinopril, diuretic thiazides)** will increase reabsorption of lithium.

25

***What drug causes nephrogenic diabetes insipidus?

***Lithium (see polyuria/polydipsia).

Due to the renal impact Na/K/lithium.

26

***What antiseizure/bipolar medication is a major CYP450 inducer?

***carbamazepine (esp drugs metab by CYP3A4)
used for actue and maintenance treatment

27

Which mood stabilizer is used for acute bipolar with or w/o psychotic features?

divalproex

28

***What anti-seizure/bipolar medication is a major CYP450 inhibitor?

lamotrigine (CYP2C9)

29

When taking SSRI's, TCA's, SNRI's, sympathomimetics, antihypertensives, or any 5-HT/NE affecting drugs, what is contraindicated in tx of depression/anxiety?

MAOI's

30

alpha1 blockage causes ___ symtpoms

postural hypotension