Antidepressants And Mood Stabilizers Ii

Front 1

MAOI's

Back 1

1. use for refractory depression
2. inactivated MAO increases NE and serotonin in synapse
3. worry about reaction w/other releasers like tyramine in wine, cheese, shellfish, aged food, raisins
4. isocarboxazid, phenelzine, tranylcypromine

Front 2

antidepressant adverse effects 1

Back 2

1. sedation: largest initial problem
2. CV effects: ortho hypotension, antimuscarinic at SA
3. seizures: lower seizure threshold
4. sexual dysfunction: lead non-compliance
5. blood abnormalities: agranulocytosis and BM depression
6. serotonin syndrome: similar malignant hyperthermia

Front 3

antidepressant adverse effects 2

Back 3

1. abnormal bleedin: increase bleeding due binding plasma proteins
2. manic epidsodes
3. suicidality
4. drug interactions: never give other CNS depressants like alcohol, antimuscarinics, or MAO inhibitors, and sympathomimetics like tyramine can be problematic

Front 4

mood stabilizers

Back 4

1. lithium
2. lamotrigine: prophylactice tx long term bipolar D/O with minial risk of mania
3. valproic acid: FDA approved mania, and off label tx bipolar D/O replacing lithium
4. cabamazepine: refractory bipolar D/O,
olanzapine and aripiproazole antipsychotics given conjugation with mood stabilizers to increase compliance

Front 5

Lithium

Back 5

1. excreted 95% in urine, doesnt bind plasma proteins
2. excreted in breast milk
3. ineffective in 30% patients
4. inhibits nerve metabolism decreasing protein kinases
5. AE related to lithium blocking Na in GI, cardio, polyuria, NDI, thyroid dysfunction, increased PMN

Front 6

Lithium drug interactions

Back 6

1. osmotic and acetazolamide (CA inhibit) increase Li excretion
2. loop and thiazide decrease Li excretion
3. NSAIDs decrease clearance and increase reabsorption