Antidepressants - Antimanic agents [4] Flashcards Preview

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Flashcards in Antidepressants - Antimanic agents [4] Deck (20):
1

Buproprion blocks what

DA reuptake
NE reuptake

(it is a NDRI)
bad for comorbid anxiety


not first line tx for anxiety disorders -SSRI

2

Most dangerous antidepressants to use in schizo?

f

fluoxetine
SSRI

3

Monoamine theory of depression

Depression is associated with decreased NE/5HT levels
(antidepressant drugs share property to enhance NE-5HT-DA availability)
- effects on amines immediate, but mood doesnt elevate for 2-3 weeks

- shifted focus to NT effects on receptors and downstream sig molecules

4

Neurodegenerative hypothesis

major depression associated with neuronal loss (neural apoptosis) in PREFRONTAL CORTEX and HIPPOCAMPUS
- antidepressants act by inhibiting-reversing loss by stimulating neurogenesis

5

SSRI

Fluoxetine
paroxetine
escitralopram
- best drugs for depression + most anxiety

6

SNRI

Venlafaxine
- good in chronic pain

7

Trazodone

Mixed serotonin reuptake blocker/receptor antagonist
- will help you sleep better if depressed

8

Amitriptyline

TCA - NET/SERT reuptake inhibitor
- like typical low potency antipsychotics bc they also block a1, H1, muscarinic r
- 3rd line bc sedative action unlike SNRI, SSRIs, NDRIs

9

SSRI Acute side effects

Acute effects (goes away with time)
- Nausea-diarrhea (increased serotonin effects)
- activation-insomnia
- restlessness (akathisia)

(giddy up drug)
- make sure you rule out mania

10

SSRI Chronic side effects

Delayed onset
- weight gain
- sexual dysfunction
- cognitive blunting
- withdrawl upon discontinuation

11

SNRI side effects

HTN
Anxiety

(venlafaxine) - more NE - more vasoconstriction

12

NDRIs side effects

tremor
insomnia
anxiety
seizure at high dose

(bupropion) - mild stimulant action

13

TCADs side effects

1. sedation
2. antimuscarinic effects
3. cardiovascular (sudden death in overdose - EK abnormalities)
4. orthostatic hypotension
5. Neurologic (seizure in overdose)

(Amitriptyline - NET/SERT reuptake inhibitor)

14

MAOIs side effects

Postural Hypotension (blocks a1)
Seizure, shock, hyperthermia in overdose (bc you increase in DA, 5HT, NE)

(Phenylzine)

15

concommitant use of SSRI and MAOIs can result in __________

serotonin syndrome

16

MAOIs DDI

hypertensive crisis with drugs or foods high in tyramine (decongestants, beer, wine, cheese)

17

Antimanic agent

Lithium carbonate
- slow onset
- use dependence (greatest effects on cells with highest level of activity)
- interferes with PIP recycling Gq protein

18

Lithium interferes with Gq proteins, but it can also lead to interference with Gs and Gi (adenylyl cyclas), which can lead to which side effects?

In thyroid: HYPOthyroidism
In kidney: Polyuria - polydipsia

19

Adverse effects of lithium
- which DDIs should you watch out for?

very narrow therapeutic index
- minor → moderate → severe toxicities

severe: seizures, stupor, coma

Diuretics and NSAIDS can increase lithium levels

20

Lithium dosage may need to be decreased in pts taking thiazide diuretics why?

bc it can increase Lithium levels leading to
adverse effects (fine tremor, GI upset, muscle weakness --> confusion, sedation, lethargy --> seizure, stupor, coma