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52 Cards in this Set

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  • Back
how long does major depressive syndroem last?
peak age of onset?
mortality rate?
more than 2 weeks
25 yo
15%
which type of depression is most common
reactive depression (associated with adverse life events, drugs/alcohol, mental d/o)
definition of rapid cycling bipolar d/o
4+ mood swings or episodes in 12 month pd
peak age of bipolar d/o
19 yo
pathogenesis of major depression
norE, 5HT (or both) deficiency
examples of TCAs
imipramine
amitriptyline
desipramine
MOA of TCA
blcks norE and/or 5HT reuptake w/i hours
stimulates histamine, muscarinic, and a-receptors outside CNS
which TCA has the least amt of side effects
desipramine
what in combo with TCA --> acute HTN and cardiac arrhythmias
sympatothomimetics
which drug is absolutely contraindicated with TCA
MAOIs (inhibits TCA metabolism)
--> tremors, hyperthermia, convulsions, coma, cardiac toxicity ad death
(5HT syndrome)
what drugs can enhance metabolism of TCA? inhibits?
p450 inducers (some anti-convulsants)
p450 inhibitors (SSRIs)
Effects of TCA Od
coma
shock
metabolic acidosis
respiratory depression
agitation
delirium, seizures
Which drugs are second generation heterocyclics
buproprion
maprotiline
amoxapine
which drug is 1st line to treat depressive phase of bipolar
buproprion
d
d
MOA buproprion
weak blocker of norE and 5HT reuptake
blocks DA reuptake --> psychosis
Adverse effects of buproprion
CNS stimulation
incresaed risk of seizures
can worsen panic and OCD
contraindications of buproprion
MAOIs
h/o bulimia
seizure d.o
caution if pregnant
uses of maprotiline
depression w/ anxiety or sleep probs
MOA maprotiline
potenet norE uptake inhibition
adverse effects of maprotiline
seizures
psychosis and hallucinations
sedative and anit-muscarinic actions
orthostatic hypotension
contraindication of maprotriline
MAOIs
use of amoxapine
dperession in psychotic pts (metabolite of anytpsych med loxapine)
MOA amoxapine
reduces reuptake of norE and 5HT
blocks DA receptors, alleviating psychosis
adveerse effects of amoxapine
seation
antimuscarinic effects
orthostatic hypotension
contraindications of amoxapine
MAOIs
nursing mothers/pregnancy
which drugs are 3rd generation heterocyclics?
mirtazapine
venlafaxine
indications for 3rd generation heterocyclics
major depressive syndrome
severe reactive depression
uses of mirtazapine
depression assoc with anxiety/sleep disturbances
MOA mirtazapine
antagonist at presynaptic 5HT2 and 5HT3 receptors
prevents serotonin activating autofeedback loop, which would otherwise reduce levels of extracellular 5HT
potenet H1 antagonist
moderate muscarinic antagonist
adverse effects of mirtazapine
H1 antagonist (sedation, weight gain)
a-1 antagonist (orthostatic hypotension)
muscarinic antagonist (few muscarinic effects)
uses of venlafaxine
GAD
OCD
MOA venlafaxine
inhibits 5Ht, norE and DA reuptake
adverse effects of venlafaxine
sexual side effects
nausea
anxiety
nervousness
insomnia
hypertension, agitiation
tremors
sweating
contraindications of venlafaxine
MAOI
which heterocyclic is not contraindicated with MAOIs?
mirtazapine
which drug class is a first lne chice for depressive phase of bipolar d/o
SSRIs
buproprion
MOA of SSRIs
inhibits 5HTH reuptake
weak effects on norE and DA reuptak e
examples of SSRIs
fluoxetine
sertralin e
paroxetine
which SSRI has the longest t1/2
fluoxetine (7-9 days)
SSRI drug interactions
inhibit p450 enzymes
MAOI contraindicated!!! --> 5HT syndrome
MAOI examples
phenelzine
tranylcypromine
MOA of MAOIs
inhibits MAO-A (degrades norE, 5HT, tyramine) and MAO-B (degrades DA)
MAO-A inhibition likely more impt
adverse effects of MAOIs
CNS stimulation
weight gain
dizziness
angina
bronchospasm
drowsiness
elevated liver enzyme levels
how long does phenelzine last?
2-3 weeks, it's an irreversible inactivator... must wait for MAO to be regenerated to terminate phenlzine activity
what does MAOI + tyramine do
hypertensive crisis
MAO normally metabolizes tyramine, but it can't so tyramine displaces norE --> vasocontstriction
W/d from anti-depressants
can lead to "discontinuation syndrome"
--> fatigue, nasuea, insomnia, anxiety, blurred vision, halluciniations, etc
which drugs tend to have w/d sx
which doesn't cause probs
those with short t1/2
fluoxetine doesn't usually cause probs
indications for lithium
manic phase of bipolar
for severe mania, use with fast-acting antipsychotic drugs or potent benzos
can be used adjuncctively for psychoses, schizoaffective and refractory cases of major depression
MOA lithium
selective depression in overactive circuits involved in mania (alters Na transport necessary for generating actioin potentials in nerve cells)
modulates NT activity
inhibits normal recycline of inositol substrates in neuronal membranes
adverse effects of lithium
polydipsia
polyuria
AVOID dehydration
weight gain
thinning of hair
teratogenic
TOXICITY CAN OCCUR AT THERAPEUTIC DOSE... VERY NARROW THERAPEUTIC INDEX
interaction of lithium and Na
competes with Na for renal uptake (na retention increases lithium clearance and na depletion increases li retetion