Segars: antidepressants and Mood stabilizers

Question 1

General Antidepressants MOA?

Answer 1

• serotonergic or noradrenergic nt system effects

- primarily, block 5HT and NE re uptake by presynaptic transporters (SERT, NET, or both)

Question 2

What are the MAOI’s

Answer 2

• monamine oxidase inhibitors
• Isocarboxazid
• Phenelzine
• Selegine
• Tranylcypromine

Question 3

What are the 3 amine TCA?

Answer 3

• amitriptyline
• clomipramine
• doxepin
• imipramine

Question 4

secondary amine TCAs

Answer 4

• amoxapine
• desipramine
• nortiptyline

Question 5

SSRI

Answer 5

• serotonin-selective reuptake inhibitors
• Citalopram
• Escitalopram
• Fluoxetine

Question 6

What is the one NDRI?

Answer 6

• Buprpion

- Noradrenergic dopamine reuptake inhibitor

Question 7

What are the SSRI’s?

Answer 7

• Cittalopram
• excitalopram
• fluoxetine
• paroxetine
• sertraline
• vilazodone
• cortioxetine

Question 8

SSRI MOA

Answer 8

-inhibits reuptake of serotonin…. like the name says

Question 9

Side effects of SSRI’s

Answer 9

• CNS
• Sexual df
• weight gain
• Acute withdrawal rxns: flu like sx (all antidepressants have this)

Question 10

Serious effects of SSRIs?

Answer 10

• serotonin syndrome:
• sweating
• hyperreflexia
• myoclonus
• shivering
• Suicidality!!!!!!!
• highest risk in children/adolescents/young adults

Question 11

drug drug interactions of SSRI’s (CYP450)

Answer 11

• most is fluoxetine (borad and strong inhibitor of CYP450)

- Least is citalopram and sertraline (mild inhibitors)

Question 12

SNRI’s

Answer 12

-selectively inhibit the pre synpatic reuptake of serotonin (via SERT) and norepinephrin (via NET)

Question 13

difference between the 3 and 2 TCA’s?

Answer 13

• 3 inhibits both NE/5HT relatively equally

- 2 gets NE> 5HT

Question 14

What other receptors are involved with TCA’s

Answer 14

• H1
• Muscarinic
• alpha 1 adrenergic

Question 15

What are the 3 key TCA system side effects?

Answer 15

• CV: tachy, ortho hypotension, dysrhythmias
• Anticholinergic: dry mouth, urinary retention, blurred vision
• CNS (histamine): sedation and whatnot

Question 16

Toxic ingestion of TCA’s

Answer 16

• three C’s
• Coma
• Cardiotoxicity
• convulsions

Question 17

SARA

Answer 17

• selectively block post synaptic alpha 1 receptors on NE neurons
• Trazodone
• Nefazodone

Question 18

What does Mirtazapine do?

Answer 18

-selectively blocks pre synaptic alpha 2 receptors

Question 19

Which SARA has weight gain as a side efect?

Answer 19

-Mirtazapine

Question 20

NDRI’s

Answer 20

• bupropion

- selectively inhibits pre synaptic reuptake of NE and dopamine (via DAT)

Question 21

side effects of NDRI’s

Answer 21

-seizures

Question 22

MAOI’s

Answer 22

-inhibit MAO increases levels of monoamines in neuronal vesicles and increase amount so fNE, 5HT, and DA released

Question 23

MAOI’s names

Answer 23

-Isocarboxazid
=Phenelzine
-Selegiline
-Tranylcypromine

Question 24

What do we do if there is drug interactions with 5HT/NE affecting drugs?

Answer 24

• 2 week wash out perior
• risk of serotonin syndrome
• risk of htn crisis

Question 25

What is the major concern with MAOI's?

Answer 25

-hypertensive crisis

Question 26

What are some tyramine containg foods that will gibve us a htn crisis?

Answer 26

- cheeses - fava beans - fermented or pickled meats - processed pickled, or cured meats - tap beer - yeast - over ripe fruits - soy/fish/shrimp sauces

Question 27

What are the 5 R's for general antidepressant efficacy?

Answer 27

- response - remission - recovery: 2-6 months - relapse: return of sx after remission - recurrence: return of sx after recovery

Question 28

What is a thing that we have to keep in mind about all antidepressants?

Answer 28

- withdrawal syndrome | - do slow titration downward

Question 29

What are the 2 things we can use for Mood disorders

Answer 29

- Anti-seizure agents: Carbamazepine, Lamotrigine, divalproate/valproic acid - lithium**

Question 30

Lithium

Answer 30

-inhibits Ca dependent and depolarization provoked release of NE and DA

Question 31

What is the lithium side effects?

Answer 31

- Polyuria (polydipsia | - clinical picture of Nepthrogenic diabetes insipidus

Question 32

What is lithium?

Answer 32

- a monovalent ion - competes with Na for kidney reabsorption - resistance to ADH

Question 33

What are the drug interactions with lithium?

Answer 33

- diuretics, especially thiazides - ACEI's: lisinopril - NSAIDs: through alteration of renal perfusion

Question 34

Is lithium a narrow therapeutic agent?

Answer 34

-yes

Question 35

What is the broad CYP450 inhibitor that we have to remember?

Answer 35

-Carbamazepine!

Question 36

Which class of drugs are bad generally because they have a lot of anticholinergic effects?

Answer 36

- TCA antidepressants - Amitriptyliine - Amoxapine - Clomipramine - Desipramine - Doxepin - Imipramine - Nortiptylline - this class had a lot of + signs in that chart

Question 37

Which drug class along with TCA's gave us drowsiness

Answer 37

- Serotonin modulators - Trazodone - Nefazodone - but not Vilazodone

Question 38

Which drug class along with TCA's gave us orthostatic hypotension?

Answer 38

- MOAI's - Isocarboxazid - Phenelzine - Selegilline - Tranylcypromine - (trazodone will also do this)

Question 39

What other side effect was relatively unique to TCA's besides anticholinergic effects

Answer 39

-QTc prolongation

Question 40

Which class would give us insomnia/agitation?

Answer 40

- SSRI's - Citalopram - Escitalopram - Fluoxetine - Paroxetine - Sertraline

Question 41

Which drug along with the TCA's will give us weight gain?

Answer 41

-Mirtazapine

Question 42

Which 2 drug classes along with TCA's give us Sexual dysfunction?

Answer 42

- SSRI's | - MOAI's.... but not Selegilline, that had like no + signs by it :)

Question 43

What are the signs and sx of hypertensive crisis?

Answer 43

- Severe headache - nausea/comiting - sweating/severe anxiety - nosebleeds - tachycardia - chest pain - changes in vision - shortness of breath - confusion

Question 44

Which 2 SARA's block the post synaptic alpha 1 receptors?

Answer 44

- Trazodone | - Nefazodone

Question 45

Which SARA will block the pre synaptic alpha2 receptors?

Answer 45

-Mirtazapine