Affective Disorders & Cns Stimulants

Front 1

Tricyclic Antidepressants

Back 1

1. Imipramine
2. Amitriphyline

Front 2

Selective Serotonin Reuptake Inhibitors (SSRIs)

Back 2

1. Fluoxetine
2. Fluvoxamine
3. Sertraline
4. Paroxetine
5. Citalopram
6. Escitalopram

Front 3

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Back 3

1. Venlafaxine
2. Desvenlafaxine
3. Duloxetine

Front 4

Miscellaneous Second Generation Antidepressants

Back 4

1. Trazadone
2. Nefazodone
3. Buproprion
4. Mirtazepine

Front 5

Selective Norepinephrine Reuptake Inhibitor

Back 5

Atomoxetine

Front 6

MAO Inhibitors

Back 6

1. Phenelzine
2. Tranylcypromine
3. Selegiline

Front 7

Mood Stabilizers

Back 7

1. Lithium carbonate
2. Valproic Acid Analogs
3. Carbamazepine
4. Clonazepam

Front 8

Depression

Back 8

one of the most common psychiatric problems that is characterized by feelings of severe sadness and despair

Front 9

Manic Depressive Disorders (Bipolar)

Back 9

characterized by cyclic swings in mood with periods of depression interspersed with periods of mania

Front 10

Medications used to treat Depression

Back 10

1. SSRIs and other 2nd generation - 1st choice
2. TCAs and MAOIs - 2nd or 3rd line
3. Antianxiety drugs
4. Antipsychotics

Front 11

Medications used to treat Manic Depression Disorder

Back 11

1. Lithium - 1st choice - mood fluctuations
2. Antipsychotics - severe phases of mania
3. Antidepressants - severely depressed

Front 12

Prototype TCA

Back 12

Imipramine

Front 13

CNS effects of Antidepressants

Back 13

1. Sedation - early in therapy, tolerance
2. Antidepressant - develops slowly over 2-4 weeks
3.can be used to treat other psychiatric problems (OCD, panic attacks, GAD, social phobias)
4. CNS stimulation - tremor, restlessness, insomnia, irritability
5. decreased seizure threshold

Front 14

Mechanism of Action of TCAs

Back 14

inhibit synaptic reuptake of both NE and a little bit of 5HT

Front 15

Mechanism of Action of SSRIs

Back 15

selectively inhibit the reuptake of 5HT

Front 16

Mechanism of Action of Bupropion

Back 16

selectively inhibits DA reuptake

Front 17

Mechanism of Action of Venlafaxine

Back 17

inhibits both NE and 5HT reuptake

Front 18

Mechanism of Action of Trazadone and Nefazadone

Back 18

inhibit the reuptake of 5HT and also blocks 5HT2 receptors

Front 19

Anticholinergic side effects of Antidepressants

Back 19

*dry mouth, constipation, urine retention, loss of visual accommodation*
1. more severe than with antipsychotics
2. amitriptyline - worse, SSRI's - the least

Front 20

Cardiovascular Side Effects

Back 20

1. postural hypotension
2. tachycardia
3. arrhythmias

Front 21

Toxic Reactions and side effects of Antidepressants

Back 21

1. anticholinergic
2. CNS - sedation, tremor, agitation, anxiety, irritability

Front 22

Acute poisoning of Antidepressants

Back 22

*Life-Threatening Emergency*
1. CNS agitation - grand mal seizures - coma
2. Extreme hypotension, tachycardia, arrythmias
TREATMENT: Sodium Bicarbonate - reduces cardiotoxic effects of TCAs

Front 23

Imipramine

Back 23

*prototype TCA*
1. can also be used to treat enuresis and urinary incontinence

Front 24

Amitriptyline

Back 24

*TCA*
1. more sedation and anticholinergic activity

Front 25

Fluoxetine

Back 25

*Prototype SSRI*
1. treats OCD, GAD, PMDD
2. much less sedation, anticholinergic, and cardiovascular effects than TCAs
3. Main S/E: headache, anxiety, tremor, agitation, nausea
4. converted to many active metabolites

Front 26

Sertraline

Back 26

*SSRI*
1. treats OCD, GAD, PMDD
2. MAIN S/E: headache, anxiety, tremor, agitation, nausea
3. converted to many active metabolites
4. less potential for drug interactions than fluoxetine

Front 27

Paroxetine

Back 27

*SSRI*
1. treat oCD, GAD, PMDD
2. MAIN S/E: headache, anxiety, tremor, agitation, nausea
3. quickly metabolized - no active metabolites
4. more weight gain

Front 28

Citalopram & Escitalopram

Back 28

*Newest SSRI*
1. very similar to Sertraline

Front 29

Fluvoxamine

Back 29

*SSRI*
1. treats depression and OCD

Front 30

Bupropion

Back 30

*Blocks reuptake of DA*
1. mild stimulant activity ("psychic energizer")
2. most likely to produce seizures
3. used to treat nicotine, cocaine, amphetamine dependence

Front 31

Venlafaxine & Desvenlafaxine

Back 31

*SNRI*
1. treats depression and GAD
2. inhibits reuptake of 5HT, NE, DA
3. rapid onset of action
4. fewer cardiovascular S/E than TCAs, does cause HTN & tachycardia
5. MAIN S/E: nausea, nervousness, anxiety, sweating
6. can be used in treatment of ADHD

Front 32

Duloxetine

Back 32

*SNRI*
1. used for neuropathic pain

Front 33

Trazadone and Nefazadone

Back 33

*2nd generation - inhibits reuptake 5HT and blocks 5HT receptors*
1. lower incidence of anticholinergic and cardiovascular S/E than TCAs
2. can cause priapism and sexual dysfunction
3. very sedating - used in night time medication

Front 34

Mechanism of Action of Mirtazepine

Back 34

blocks presynaptic alpha 2 receptors - enhances synaptic release of NE and 5HT and blocks some 5HT receptors

Front 35

Side effects of Mirtazepine

Back 35

mild anticholinergic, hypotension, tachycardia

Front 36

Atomoxetine

Back 36

*SNRI*
1. treats ADHD in children and adults
2. S/E: suppress appetite, decreased weight gain, increased blood pressure, tachycardia, sexual dysfunction

Front 37

Mechanism of Action of MAO Inhibitors

Back 37

inhibit the activity of monoamine oxidase and alter the metabolism of various neurotransmitters
1. Increases levels of NE, 5HT, DA

Front 38

CNS effects of MAO-Inhibitors

Back 38

1. little effect initially
2. see antidepressant action in several weeks
3. normalize sleep patterns
4. CNS stimulation - tremors, insomnia, hallucinations

Front 39

Side effects and Toxicity of MAO-Inhibitors

Back 39

1. orthostatic hypotension - therapeutic dose
2. HTN - overdose
3. GI effects (nausea, constipation)
4. headache, dizziness, vertigo
5. CNS stimulation
6. liver damage

Front 40

interactions with foods containing tyramine

Back 40

single great problem with use of MAO-inhibitors that can cause potentially lethal interactions

Front 41

Uses of MAO Inhibitors

Back 41

1. antidepressants - 3rd line
2. treat bullimia, OCD, PTSD
3. narcolepsy

Front 42

Mechanism of action of Lithium

Back 42

alter the metabolism of phospholipids

Front 43

Effect of Lithium on the CNS

Back 43

controls mood swings

Front 44

Symptoms of Acute Lithium Intoxication

Back 44

1. GI - n/v/d
2. Neuromuscular - fatigue, weakness, tremor
3. Neurosensory - blurred vision, tinnitis
4. CNS - slurred speech, dizziness, confusion
5. Cardiovascular - arrhythmias, hypotension
*Appears Drunk*

Front 45

Treatment of Lithium Intoxication

Back 45

1. remove drug
2. support symptomatically
3. induce diuresis
4. hemodialysis

Front 46

Other drugs used for Mania

Back 46

1. Carbamazapene - anti-epileptic
2. Valproic Acid - anti-epileptic
3. Clonazepam

Front 47

Medications used for moderate-severe endogenous depression

Back 47

1. SSRIs - 1st choice
2. TCAs
3. MAO Inhibitors

Front 48

Medications for mild acute depression with anxiety

Back 48

antianxiety drugs - alprazolam

Front 49

Medications for Bipolar Manic-Depressive Disorder

Back 49

1. lithium
2. antiphyshotic drugs
3. antidepressants
4. valproic acid analogs
5. carbamazepine

Front 50

Psychomotor Stimulants

Back 50

1. Amphetamine
2. d-amphetamine
3. Lisdexamfetamine (Vyvanse)
4. methamphetamine
5. methylphenidate (Ritalin)
6. Cathinone (Khat, Kat, Cat)
7. Ephedrine
8. Modafanil (Provigil) and Armodafanil (Nuvigil)

Front 51

Prodrug that limits abuse potential used for ADHD

Back 51

lisdexamfetamine (Vyvanse)

Front 52

known as "speed," "crank," or "ice" - produces very intense effects in the CNS and is widely abused

Back 52

methamphetamine

Front 53

shrub indigenous to Eastern Africa - chewed and has become a drug of abuse in the US known as "bath salts"

Back 53

cathinone

Front 54

treats narcolepsy and shift work disorders, not an amphetamine but amphetamine like

Back 54

Modafanil (Provigil) and Armodafanil (Nuvigil)

Front 55

CNS effects of psychomotor stimulants (amphetamine and methamphetamine)

Back 55

1. stimulation (increased arousal and wakefulness)
2. euphoria
3. effects on intellectual and motor performance
4. rebound effects (crashing)
5. tolerance and dependence
6. suppression of appetite

Front 56

Peripheral effects of psychomotor stimulants

Back 56

*Primarily sympathomimetic*
1. autonomic (HTN, tachycardia, arrhythmias, mydriasis)
2. metabolic (decreased food intake, malnutrition)

Front 57

Toxicity of psychomotor stimulants

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1. sympathomimetics - cardiovascular (HTN, tachycardia, arrhythmias, and sudden death)
2. CNS - excessive stimulation, hostility, aggression, psychosis, hallucinations
3. dental problems and lung damage

Front 58

Mechanism of Action of Psychomotor Stimulants

Back 58

*enhanced release and inhibition of uptake of NE and DA*

Front 59

Uses of Amphetamines

Back 59

1. ADHD
2. narcolepsy
3. Obesity and weight reduction
4. stimulants
5. abuse

Front 60

shrub indigenous to mountains of peru and columbia - ABUSED

Back 60

Cocaine

Front 61

Effects of Cocaine

Back 61

1. local anesthetic w/ vasoconstriction
2. CNS effects (stimulation, increased arousal, euphoria, increased confidence, tolerance and dependence)
3. HTN, tachycardia, arrhythmias
4. teratogenic - low birth weight, mental retardation

Front 62

a powerful reinforcer on the reward centers in the brain

Back 62

Cocaine

Front 63

Caffeine and related methylxanthines

Back 63

1. caffeine
2. theophylline
3. aminophylline

Front 64

methylxanthines used to treat asthma

Back 64

1. theophylline
2. aminophylline

Front 65

CNS effects of caffeine and methylxanthines

Back 65

1. cortical stimulation
2. increased mental alertness
3. respiratory stimulation
4. tolerance and dependence

Front 66

Peripheral effects of caffeine and methylxanthines

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1. cardiac stimulation (increased rate and contractility)
2. relaxation of bronchioles
3. stimulation of gastric secretion

Front 67

Methylxanthine overdose

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1. excessive CNS stimulation which can lead to life threatening seizures
2. excessive cardiac stimulation and eventual cardiovascular collapse

Front 68

Treatment for methylxanthine overdose

Back 68

*mainly symptomatic*
--anticonvulsants and antiarrhythmics

Front 69

Uses of Caffeine, theophylline, aminophylline

Back 69

1. CNS stimulants
2. asthma
3. combo with other drugs (headaches)
4. diuretics (OTC preps)
5. respiratory stimulants in preterm infants
6. beverages

Front 70

Spinal Cord Stimulants

Back 70

1. Strychnine
2. Tetanus Toxin

Front 71

Strychnine

Back 71

***potent convulsant used as a rat poison***
antagonist at glycine receptors in the spinal cord and other areas of the CNS
*removes post synaptic inhibitory influences and leads to severe toxic seizures

Front 72

Treatment after strychnine is taken

Back 72

symptomatic support plus the use of diazepam to control seizures

Front 73

Tetanus Toxin

Back 73

***released by Clostridium tetani during infection***
acts by inhibiting the release of glycine from Renshaw cells in the spinal cord.....produces generalized tonic convulsions

Front 74

Treatment after Tetanus Toxin

Back 74

symptomatic support, diazepam for seizures and appropriate antimicrobial therapy