What mechanisms mediate de cardiovascular side effects of cyclic antidepressants?
- blocking Alfa 1 receptor and block 5HT re-uptake
What is the treatment for sexual dysfunction by cyclic antidepressant and Serototin syndrome by SSRI? How does it work?
- Serototin antagonist (also anticholinergic, antihistamine)
Some cautions with cyclic antidepressants are
Seizure, alcohol, drive, first trimester pregnant, respiratory illness, manic
“First rest for your man and don’t drink” and seizure
Most common reason to stop SSRI
Anorgasmia and delayed orgasm (15-20%)
Why MAOIs when combine with Tyramine containing food causes hypertensive crisis?
- Tyramine is not metabolized (is metabolized by MAO) - ⬆️⬆️
- it’s a catecholamine releasing agent - ⬆️ NE, EPI, DOPA via sympathetic.
Treatment for hypertensive crisis by MAOIs + tyramine
- phentolamine (Alfa block)
- chlorpromazine (antipsychotic with hypotensive effects)
Highly indication of electro convulsive therapy (ECT)
- highly suicidal patients
- depressed pregnant patients
How do the cyclic antidepressants work?
- block re-uptake: 5HT, NE
- block Alfa 1 receptor, muscarinic receptor
Which antidepressant is approved for smoking cessation, has increase risk of seizure and suppress the appetite?
- Before initiate lithium what functions you must be sure are normal?
- Why some side effects are polyuria and polydipsia?
- thyroid, causes hypothyroidism
- kidney, is nephrotoxic (long term use too)
- Diabetes insipidus
For what alterations are valproate and carbamazepine recommended?
Acute mania, rapid cycling bipolar disorder, impulse control
Hematologic side effects of valproate and carbamazepine
Agranulocytosis - both
Mild leukopenia and aplastic anemia - carbamazepine
Effect of alcohol and oral contraceptive in benzodiazepines
- Alcohol: potentiate the effect (rise sensibility of the GABA-Cl receptor), and benzo lowers tolerance to alcohol
- oral contraceptives: ⬇️ metabolism
Effects of overdose and ABRUPT withdrawal of benzo
- overdose: apnea and respiratory depression
- abrupt withdrawal: seizure (no abrupt withdrawal: insomnia, anxiety and agitation)
Symptoms of serotonin syndrome, how is it produce?
- general restlessness, sweating, insomnia, nausea, diarrhea, cramps, delirium; seizures, high fever arrhythmia (life threat)
- ⬆️⬆️ Serotonin. Normally; central nervous system ▶️ serotonin regulate attention, behavior and body temperature
Other sites (primarily intestines) ▶️ serotonin regulate digestive process, blood flow and breathing.l
Most common causes of serotonin syndrome
- high doses of SSRI
- SSRI + MAOI combo
- MAOI + sinthetic narcotic combo
Which antipsychotic produces agranulocytosis and seizures as side effects?
Which antipsychotic have the lowest risk of movement side effects and is used for schizophrenia and bipolar too?
Gold standard treatment for schizophrenia
Mention some MAOI’s
- Rasagiline (Azilect)
- Selegiline (Eldepryl, Zelapar, Deprenyl, topical patch Emsam)
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Moclobemide (Aurorix, Manerix)
- Pirlindole (Pirazidol)
- Toloxatone (Humoryl)