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34 Cards in this Set
- Front
- Back
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Signs and symptoms of Depressions
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no go
no eat no sex no sleep no live no joy |
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3 major types of depression
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bipolar affective disorder
reactive depression (no rx. needed) major depressive disorder |
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Biogenic amine theory
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deficiency NE, dopamine, 5HT
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Classification of antidepressants
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TCAs
MAO-I SSRIs heterocyclics |
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Imipramine and Amitriptyaline
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TCA
MOA: acts by inhibiting nonselective reuptake of NE and 5HT |
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Half life TCA
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8-36 hrs.
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Active metabolites of imipramine and amitriptyline
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desipramine and nortriptyline
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Pharmacokinetics TCA
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well absorbed orally
high volume of distribution once daily dosage possible |
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TCA toxicity
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sedation
M-block alpha1 block--> hypotension, orthostatic wt. gain lowers seizure threshold arrhythmias OD--> 3C's C/I: DO NOT GIVE TO THE ELDERLY B/C OF ALPHA 1 BLOCK hypertensive crisis w/ MAO-I serotonin syndrome w/ SSRIs and MAO-Is |
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2nd gen. Heterocyclics
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amoxapine, bupropion, maprotiline
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3rd gen. heterocyclics
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mirtazapine, nefazodone, venlafaxine
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MOA heterocyclics
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act by higher degree of specificity to inhibition of NE or 5HT
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Mirtazapine
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specifically inhibits presynaptic alpha2 --> increases release of NT
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ADR Bupropion
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increased risk of seizures--> C/I seizures
(Used in the management of nicotine dependence) |
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ADR Mirtazapine
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sedation and weight gain
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ADR amoxapine
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D2 blocking effect --> akathesia, pseudoparkinsonism and hyperprolactinemia, EPS
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Amoxapine and Maprotiline OD
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seizures and cardiotoxicity
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Fluoxetine, paroxetine, sertraline
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SSRI
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SSRI
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MOA: act by selectively inhibiting serotonin
- little or no effect on NE - less side effects - CYP450 enzyme inhibitor |
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SSRI ADR
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nausea, headache, anxiety, agitation
sexual dysfunction OD: seizures CYP45o inhibitors--> increases action of TCA and warfarin Serotoinin syndrome with MAO-I |
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ADR fluoxetine
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D2 blocking effects
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serotonin syndrome
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hyperthermia, hyperreflexia, tachycardia
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Phenelzine, tranylcypromine, isocarboxazid
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MAO-I
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ADR MAO-I
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- Cheese rxn. --> hypertensive crisis
- lower BP (desensitizes alpha and beta) - OD: shock, hyperthermia - MAO-I + indirect acting sympathomimetic --> CNS stimulation, agitation, convulsions |
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Commonly used since they have less ADR
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SSRIs and heterocyclics
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Used in patients w/ psychomotor retardation, sleep disturbances, loss of appetite, and wt. loss
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TCA
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Useful in patients with severe anxiety, phobic features
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MAO-I
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Decreases appetite and so may be useful in overweight patients
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SSRIs
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Rx. bipolar disorder, chronic pain states, acute panic attacks, phobic disorders
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TCAs
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Rx. OCD
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clomipramine or SSRIs
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Rx. GAD
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SSRI
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SSRIs uses
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major depression
OCD bulimia anxiety disorders PMDD |
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Mechanism of lithium
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decreases cAMP
prevents recycling of inositol (decrease PIP2) |
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Other drugs used in bipolar disorder
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valproic acid
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