Antidepressants II Flashcards
patients who present with depressive symptoms should be screened for what and why?
screened for bipolar disorder because given antidepressants to those with bipolar can precipitate mania
standard treatment for bipolar disorder
Lithium
other treatment for bipolar disorder
CRAVZ LOQ
Carbamazepine Risperidone Aripiprazole Valproate Zisprasidone
Lamotrigine (antiepileptic)
Olanzapine
Quetiapine
all atypical antipsychotics with exception of carbamazepine and valproate
what drugs are usually used as alternatives to lithium
Carbamazepine and Valproate
mechanism of lithium
inhibits inositol polyphosphatase and inositol monophosphatase –> inhibits synthesis of inositol –> needed for synthesis of PIP2 –>low PIP2 inhibits central adrenergic, muscaranic, and serotonergic neurotransmission
since lithium in uncompetitive how does it exert its action
it only affects neurons with active receptors
AE of lithium
LMNOP
Lithium side effects Movement (tremor) Nephrogenic Diabetes Insipidus hypOthyroidism Pregnancy problems
used for treatment of lithium induced tremors
beta blockers propanolol and atenolol
if lithium cannot be discontinued, what is used to treat nephrogenic diabetes
Amiloride –> inhibits ENAC in collecting tubules –> minimized accumulation of lithium
Thiazides and NSAIDs
contraindications of lithium
pregnancy (congenital cardiac defects)
nursing mothers
other bipolar medication that should be avoided during pregnancy
Valproate and Carbamazepine
effects of using thiazides and NSAIDs to treat nephrogenic diabetes induced by lithium
they treat polyuria but both increase lithium serum concentration
other drugs that can cause lithium retention
ACEIs and ARBs
