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41 Cards in this Set
- Front
- Back
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What is the first line treatment for depression?
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Selective Serotonin Reuptake Inhibitor
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What are the side effects of SSRIs?
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nausea, vomiting, headache, sexual dysfunction
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Fluoxetine
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SSRI
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Mechanism of SSRI?
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Inhibits serotonin reuptake
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Mechanism of tricyclic antidepressants?
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inhibit NE and/or 5HT reuptake
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Subcategories of TCAS's. Uses?
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Seconary amines: effective for inhibition of NE reuptake
Tertiary Amines more effective for serotonergic reuptake |
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Side effects of TCA's.
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antimuscarinic effects (dry mouth, constipation, visual effects, sedation, drowsiness)
a1 blockade results in POSTURAL HYPOTENSION (switches to mania in bipolar pts) |
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Mechanism of monoamine oxidase inhibitors?
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Blocks MAO which decreases degradation of NE, serotonin, and DA to prolong their action
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When would you prescribe an MAOI?
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When tricyclics and/or SSRIs are ineffective
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What is serotonin syndrome?
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combining several serotonin enhancing drugs causes euphoria, drowsiness, sustained REM, overreaction of reflexes, restlesness, etc.
happy drunk state |
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Side effects of MAOIs?
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hypertensive crisis (especially if you consume foods with tyramine; wine and cheese effect)
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What are third generation antidepressants?
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drugs that attempt to combine effects of serotonin/NE TRANSPORTER (reuptake) inhibition in addition to antagonizing some serotonergic receptors
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What is the proposed mechanism of ECT?
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downregulation of beta receptors in CNS
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When is ECT used?
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Refractory, life-threatening depression
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Paroxetine
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SSRI
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Sertraline
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SSRI
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Citalopram
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SSRI
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Fluvoxamine
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SSRI
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Venlafaxine
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5HT/NE Reuptake Inhibitor
Antagonist of 5HT, NE presynaptic receptors |
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Duloxetine
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5HT/NE Reuptake Inhibitor
Antagonist of 5HT, NE presynaptic receptors |
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Mirtazapine
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5HT/NE Reuptake Inhibitor
Antagonist of 5HT, NE presynaptic receptors |
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Nefazodone
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SSRI + 5HT2 postsynaptic blockade
Possibly DA agonist |
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Trazodone
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SSRI + 5HT2 postsynaptic blockade
Possibly DA agonist |
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Bupropion
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SSRI + 5HT2 postsynaptic blockade
Possibly DA agonist |
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Amitriptyline
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Tricyclic - tertiary amine!
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Desipramine
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Tricyclic - Secondary Amine!
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Lithium: mechanism, use, side effects
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Second messenger system (adnylate cyclase, phophatidylinositol)--perhaps inhibit PI creation/turnover
Uses: first-line for acute mania; long-term prophilactic for bipolar disorder (slow; takes 7-14 days) Side effects: renal inflammation, nausea, vomiting, abdominal pain, diarrhea, tremor, coma, DEATH (lithium toxicity) |
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Carbamazepine: mechanism, use, side effects
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blocks Na+ channels opened by glutamate, slows rate of neuronal recovery from inactivated state
Use: anticonvulsant (antiepilectic) but rarely used as first line tx for BIPOLAR disorder Side effect: sedation, agranulocytosis |
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Valproate: mechanism, use, side effects
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Mech: similar to carbamazepine (blocks Na+-channel opened by glutamate)
Side effects: sedation, hepatotoxicity, neural tube defects (spina bifida, anencephaly) in pregnancy Uses: anticonvulsants for epilepsy, bipolar disorder |
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Gabapentin: use
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Mech: Unk
Use: anticonvulsant, bipolar disorder |
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Mutliple Myeloma
What is it? Characterized by? - - - - - |
A malignant plasma cell dyscrasia
Characterized by: Monoclonal protein (Bence Jones Proteins) in serum, urine or both Abnormalities of bone Anemia Hypercalcemia Renal failure |
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Topiramate: use
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anticonvulsant, bipolar disoder (anticonvulsants act as mood stabilizers)
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Oxcarbazapine: use
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Anticonvulsant, Bipolar disorder
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What are the benefits of antipsychotics? Uses?
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Antipsyychotics have rapid effects and can be used to treat mania (acute and prophylactic)
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Haloperidol: use, side effects
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anti-psychotic: treats acute mania, bipolar disorder
Side effects: extrapyramidal side effects, tardive dyskinesia, neuroleptic malignant syndrome after long-term use |
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Olanzapine: use, side effects
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Atypical antipsychotic: first line treatment for bipolar disorder
Side effects: anti-muscarinic effects (Sedation, dry mouth) |
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List and describe two extrapyramidal symptoms.
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Akinesia (inability to initiate movement)
Akathisia (inability to remain motionless) |
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What is tardive dyskinesia?
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tardive (slow onset) dyskinesia (involuntary, repetitive body movements)
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Lorazepam: use
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Sedative, acute mania
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Clonazepam: use
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sedative, acute mania (may be used for maintenance)
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When should antidepressants be used to treat bipolar disorder? Risks involved?
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Used when mood stabilizers (anticonvulsants, antipsychotics, sedatives) are ineffective
Risk: antidepressants may induce mania in bipolar patient |
