Pharm2 6 Neuro pt4 Flashcards Preview

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Flashcards in Pharm2 6 Neuro pt4 Deck (33)
1

Antidepressants
Usually falls into one of three categories:

Monoamine oxidase inhibitors (MAOIs)
Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs)

2

What is monoamine oxidase? (it's inhibited by MAOIs)

an enzyme that terminates the actions of many neurotransmitters including dopamine, norepinephrine, epinephrine, serotonin

3

Were once widely used for depression, now useful only when other, newer, safer drugs fail
Have a significant side-effect profile

Monoamine Oxidase Inhibitors (MAOIs)

4

Monoamine Oxidase Inhibitors (MAOIs) easily interact with __ precipitating __

Easily interact with tyramine containing foods precipitating hypertensive crisis

5

Prototypical MAOI:

Phenelzine sulfate (Nardil®)

6

Phenelzine sulfate (Nardil®)
Indications
Mechanism of action

Indications: Major depression unresponsive to other pharmacotherapies
Mechanism of action: irreversibly inhibits MAO, intensifying NE at the synaptic cleft

7

Phenelzine sulfate (Nardil®)
Adverse Effects
Contraindications

Adverse Effects: Hypertension, tacharrythmias, delerium, mania, anxiety, convulsions, constipation, dry mouth, orthostatic hypotension, insomnia, anorexia, weight loss
Contraindications: Allergy, suicidal ideations, concurrent use of opiods, TCAs or SSRIs

8

Tricyclic Antidepressants (TCAs)
MoA
What's the deal with these?

Inhibit the re-uptake of neurotransmitters norepinephrine and serotonin into pre-synaptic nerve terminals
Although a better cardiovascular risk profile than MAOIs, still have significant side effects and risks
Replaced largely by SSRIs

9

Prototypical Tricyclic Anti-depressant:

Imipramine (Tofranil®)

10

Imipramine (Tofranil®)
Indications
Mechanism of action

Indications: Major depression, OCD
Mechanism of action: Inhibit the re-uptake of neurotransmitters norepinephrine and serotonin into pre-synaptic nerve terminals

11

Imipramine (Tofranil®)
Adverse Effects
Contraindications

Adverse Effects: urinary retention, glaucoma, cardiovascular disease, epilepsy, suicidal ideations, psychosis, diabetes, hyperthyroidism, renal or hepatic dysfunction, potentiates many drugs, esp. ETOH and CNS depressants
Contraindications: Within 14 days of MAOIs, acute s/p AMI

12

TCAs are used less often today than in the past because of newer, better drugs but are still commonly used to treat...

depression in those unresponsive to newer, safer drugs

13

What's the problem with TCAs?

TCA overdoses are very difficult to treat and almost always fatal
Be watchful of any patient who appears suicidal while taking TCAs

14

Prototypical Selective Serotonin Reuptake Inhibitors:

Fluoxetine (Prozac®)

15

Fluoxetine (Prozac®)
Indications
Mechanism of action

Indications: Mild to moderate depression, OCD, Bulimia Nervosa, Premenstrual Dysphoria, Post-Traumatic Stress Disorder
Mechanism of action: Selectively inhibits the re-uptake of serotonin in the pre-synaptic nerve terminals

16

Fluoxetine (Prozac®)
Adverse Effects
Contraindications

Adverse Effects: nausea, insomnia, somnolence, mania/hypomania, anorexia, weight loss, decreased libido, anorgasmia, rash, increased CNS stimulation, serotonin syndrome
Contraindications: Allergy, MAOIs within 14 days, bipolar disorder

17

Bipolar Disorder (Manic-Depression)
The main treatment remains

Lithium, with or without adjunctive therapy (esp. other mood stabilizers such as Tegretol, Depakote)

18

What's the problem with Lithium, dude?

Lithium has an extremely narrow therapeutic range and is easily displaced by common OTC medications

19

Prototypical Mood Stabilizer:

Lithium (Eskalith®)

20

Lithium (Eskalith®)
Indications
Mechanism of action

Indications: Bi-polar disorder, mania with depressive symptoms
Mechanism of action: Unknown, thought to alter NE, dopamine, serotonin reducing their activity ultimately resulting in mood stabilization after ~ 2-3 weeks

21

Lithium (Eskalith®)
Adverse Effects
Contraindications

Adverse Effects: Polyuria, polydipsia, drowsiness, tremor, nausea, vomiting, diarrhea, seizures, arrhythmias, hypotension, metalic taste
Contraindications: Allergy, suicidal ideations, potentiated toxicity with diuretics, ACE-I, NSAIDs, and many others; multiple drug-drug interactions

22

Any patient on lithium requires what?

Requires periodic check of serum levels

23

___ easily interacts with Tyramine containing foods.

and what foods is this found in?

Monoamine Oxidase Inhibitors (MAOIs)
certain meats, cheeses, wines

24

Patient ate a tyramine containing food (some kind of cheese & wine) and their BP shot to 260/140 and is at risk of stroke.

What happened?

MAOI interaction with tyramine containing food

25

What psych drug causes very dry mouth (mouth clicks as they talk to you) & trouble peeing?

Nardil

26

with tca's and suicide, Within 30 minutes of taking 5 of these tablets, there’s nothing that can be done to reverse it. They go into:

cardiac arrhythmia that is untreatable.

27

What side effect affects Prozac's dosing? how?

Nausea, so you titrate upwards. get over it after a few days

28

___'s side fx include both weight gain and anorxia. which is more common?

Prozac

gain

29

Tendency to sleep more, get fat, and not want to have sex
Decreased libido & can’t have an orgasm despite how long. what psych drug?

Prozac

30

Describe Serotonin Syndrome

very rare! Can happen in any drug that hits the serotonin receptor. Tendency to get mental status changes, bp goes up and down, ataxia, and if you withdraw the serotonin inhibitor it goes away.

31

Name 4 drugs that can cause Serotonin syndrome
(b/c they hit serotonin receptor)

Proac, antimigraine drugs (Imitrex, Sumatriptan), Dextromethorfan

32

Danger about Lithium

Lithium is loosely protein bound, so it can easily become toxic.

33

What psych med can leave a really bad taste in your mouth?

Lithium