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10 Cards in this Set
- Front
- Back
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Amine Hypothesis of Depression
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deficiency of amines (NE and/or 5-HT) responsible for depression
converse true for mania appears to be the result of the down regulation of post synaptic receptors (don't ask questions b/c there are no answers) |
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Amine Systems
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Noradrenergic - locus ceruleus to caudate, amygdala, thalamus, hypothalamus, limbic cortex
Serotonergic - raphe nuclei to limbic system and cortex |
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SSRIs
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less anticholinergic, antihistaminergic, and antiadrenergic effects
fewer AE uses - depression, OCD, panic disorder, PTSD, eating disorder, GAD, premenstrual syndrome AE - nervous, irritable, insomnia, sexual dysfunction, n/v/d, CYP450 SSRI+warfarin, phenytoi, metoprolol, triazolam, midazolam, nifedipine, erythromycin --> toxicity SSRI + MAOi, TCA, Li, Carbamazepine --> serotonin syndrome |
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Fluoxetine
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SSRI
long half life |
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Sertraline
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SSRI
reaches steady state quickly (1 wk) less drug washout time |
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Paroxetine
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SSRI w/ anticholinergic action
more sedating, more constipating |
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Tricyclic Antidepressants
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resemble phenothiazines
GOLD STANDARD Imipramine, Desipramine, Amitriptyline, Nortriptyline uses - depression, enuresis of childhood, pain rarely used b/c of AE burden AE - sedation, anticholinergic, ortho HOTN, ECG changes, weight gain, jaundic, sexual poisoning Tx: cardiac monitor, gastric lavage, bicarb, lidocaine or phenytoin TCA + EtOh --> increase sedation TCA + MAOi --> atropine like poisoning TCA + anti-HTN --> reversal of anti-HTN action Amitryptyline + morphine --> potentiates morphine |
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Serotonin and NE Reuptake Inhibitors
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effectiveness of TCA w/ SSRI AE profile
Duloxetine - used for DM neuropathy Venlafaxine - prodrug CYP2D6 excrete CYP3A4, withdrawal syndrome, dose dependent HTN |
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Monoamine Oxidase Inhibitors
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Phenelzine - weight gain, ortho HOTN, hepatotox, anxiolytic, slow onset, sex dysfunction
Tranylcypromine - related to amphetamines, fast onset, sex dysfunction bind irreversibly and non selectively caution w/ Tyramine containing foods --> HTN crisis caution w/ Meperidine --> convulsions, CV fail uses - atypical depression, dysthymia, phobic anxiety, migraine, neurodermatitis |
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Norepinephrine and Dopamine reuptake inhibitor
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Buproprion - blocks active reuptake of NE and DA at cell membrane
AE - agitation, insomnia, headache, nausea, blurred vision, seizure uses - depression, smoking cessation, ADHD |
