Anti-Depressants And Mood Stabilizing Agents

Front 1

how long does major depressive syndroem last?
peak age of onset?
mortality rate?

Back 1

more than 2 weeks
25 yo
15%

Front 2

which type of depression is most common

Back 2

reactive depression (associated with adverse life events, drugs/alcohol, mental d/o)

Front 3

definition of rapid cycling bipolar d/o

Back 3

4+ mood swings or episodes in 12 month pd

Front 4

peak age of bipolar d/o

Back 4

19 yo

Front 5

pathogenesis of major depression

Back 5

norE, 5HT (or both) deficiency

Front 6

examples of TCAs

Back 6

imipramine
amitriptyline
desipramine

Front 7

MOA of TCA

Back 7

blcks norE and/or 5HT reuptake w/i hours
stimulates histamine, muscarinic, and a-receptors outside CNS

Front 8

which TCA has the least amt of side effects

Back 8

desipramine

Front 9

what in combo with TCA --> acute HTN and cardiac arrhythmias

Back 9

sympatothomimetics

Front 10

which drug is absolutely contraindicated with TCA

Back 10

MAOIs (inhibits TCA metabolism)
--> tremors, hyperthermia, convulsions, coma, cardiac toxicity ad death
(5HT syndrome)

Front 11

what drugs can enhance metabolism of TCA? inhibits?

Back 11

p450 inducers (some anti-convulsants)
p450 inhibitors (SSRIs)

Front 12

Effects of TCA Od

Back 12

coma
shock
metabolic acidosis
respiratory depression
agitation
delirium, seizures

Front 13

Which drugs are second generation heterocyclics

Back 13

buproprion
maprotiline
amoxapine

Front 14

which drug is 1st line to treat depressive phase of bipolar

Back 14

buproprion

Front 15

d

Back 15

d

Front 16

MOA buproprion

Back 16

weak blocker of norE and 5HT reuptake
blocks DA reuptake --> psychosis

Front 17

Adverse effects of buproprion

Back 17

CNS stimulation
incresaed risk of seizures
can worsen panic and OCD

Front 18

contraindications of buproprion

Back 18

MAOIs
h/o bulimia
seizure d.o
caution if pregnant

Front 19

uses of maprotiline

Back 19

depression w/ anxiety or sleep probs

Front 20

MOA maprotiline

Back 20

potenet norE uptake inhibition

Front 21

adverse effects of maprotiline

Back 21

seizures
psychosis and hallucinations
sedative and anit-muscarinic actions
orthostatic hypotension

Front 22

contraindication of maprotriline

Back 22

MAOIs

Front 23

use of amoxapine

Back 23

dperession in psychotic pts (metabolite of anytpsych med loxapine)

Front 24

MOA amoxapine

Back 24

reduces reuptake of norE and 5HT
blocks DA receptors, alleviating psychosis

Front 25

adveerse effects of amoxapine

Back 25

seation
antimuscarinic effects
orthostatic hypotension

Front 26

contraindications of amoxapine

Back 26

MAOIs
nursing mothers/pregnancy

Front 27

which drugs are 3rd generation heterocyclics?

Back 27

mirtazapine
venlafaxine

Front 28

indications for 3rd generation heterocyclics

Back 28

major depressive syndrome
severe reactive depression

Front 29

uses of mirtazapine

Back 29

depression assoc with anxiety/sleep disturbances

Front 30

MOA mirtazapine

Back 30

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

Front 31

adverse effects of mirtazapine

Back 31

H1 antagonist (sedation, weight gain)
a-1 antagonist (orthostatic hypotension)
muscarinic antagonist (few muscarinic effects)

Front 32

uses of venlafaxine

Back 32

GAD
OCD

Front 33

MOA venlafaxine

Back 33

inhibits 5Ht, norE and DA reuptake

Front 34

adverse effects of venlafaxine

Back 34

sexual side effects
nausea
anxiety
nervousness
insomnia
hypertension, agitiation
tremors
sweating

Front 35

contraindications of venlafaxine

Back 35

MAOI

Front 36

which heterocyclic is not contraindicated with MAOIs?

Back 36

mirtazapine

Front 37

which drug class is a first lne chice for depressive phase of bipolar d/o

Back 37

SSRIs
buproprion

Front 38

MOA of SSRIs

Back 38

inhibits 5HTH reuptake
weak effects on norE and DA reuptak e

Front 39

examples of SSRIs

Back 39

fluoxetine
sertralin e
paroxetine

Front 40

which SSRI has the longest t1/2

Back 40

fluoxetine (7-9 days)

Front 41

SSRI drug interactions

Back 41

inhibit p450 enzymes
MAOI contraindicated!!! --> 5HT syndrome

Front 42

MAOI examples

Back 42

phenelzine
tranylcypromine

Front 43

MOA of MAOIs

Back 43

inhibits MAO-A (degrades norE, 5HT, tyramine) and MAO-B (degrades DA)
MAO-A inhibition likely more impt

Front 44

adverse effects of MAOIs

Back 44

CNS stimulation
weight gain
dizziness
angina
bronchospasm
drowsiness
elevated liver enzyme levels

Front 45

how long does phenelzine last?

Back 45

2-3 weeks, it's an irreversible inactivator... must wait for MAO to be regenerated to terminate phenlzine activity

Front 46

what does MAOI + tyramine do

Back 46

hypertensive crisis
MAO normally metabolizes tyramine, but it can't so tyramine displaces norE --> vasocontstriction

Front 47

W/d from anti-depressants

Back 47

can lead to "discontinuation syndrome"
--> fatigue, nasuea, insomnia, anxiety, blurred vision, halluciniations, etc

Front 48

which drugs tend to have w/d sx
which doesn't cause probs

Back 48

those with short t1/2
fluoxetine doesn't usually cause probs

Front 49

indications for lithium

Back 49

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

Front 50

MOA lithium

Back 50

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

Front 51

adverse effects of lithium

Back 51

polydipsia
polyuria
AVOID dehydration
weight gain
thinning of hair
teratogenic
TOXICITY CAN OCCUR AT THERAPEUTIC DOSE... VERY NARROW THERAPEUTIC INDEX

Front 52

interaction of lithium and Na

Back 52

competes with Na for renal uptake (na retention increases lithium clearance and na depletion increases li retetion